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Simmonds WM, Awuku Y, Barrett C, Brand M, Davidson K, Epstein D, Fredericks E, Gabriel S, Grobler S, Gounden C, Katsidzira L, Louw VJ, Naidoo V, Noel C, Ogutu E, Ramonate N, Seabi N, Setshedi M, Van Zyl J, Watermeyer G, Kassianides C. Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa. S Afr Med J 2024; 114:e711. [PMID: 38525666 DOI: 10.7196/samj.2024.v114i1b.711] [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] [Received: 01/30/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Over 30% of the world's population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID anaemia involves referral to a gastroenterologist. The current drive towards patient blood management in sub-Saharan Africa (SSA)prescribes that we regulate not only the use of blood transfusion but also the management of patients in whom the cause of iron loss or inadequate iron absorption is sought. Recommendations have been developed to: (i) aid clinicians in the evaluation of suspected gastrointestinal iron loss and iron malabsorption, and often a combination of these; (ii) improve clinical outcomes for patients with gastrointestinal causes of ID; (iii) provide current, evidence-based, context-specific recommendations for use in the management of ID; and (iv) conserve resources by ensuring rational utilisation of blood and blood products. METHOD Development of the guidance document was facilitated by the Gastroenterology Foundation of Sub-Saharan Africa and the South African Gastroenterology Society. The consensus recommendations are based on a rigorous process involving 21 experts in gastroenterology and haematology in SSA. Following discussion of the scope and purpose of the guidance document among the experts, an initial review of the literature and existing guidelines was undertaken. Thereafter, draft recommendation statements were produced to fulfil the outlined purpose of the guidance document. These were reviewed in a round-table discussion and were subjected to two rounds of anonymised consensus voting by the full committee in an electronic Delphi exercise during 2022 using the online platform, Research Electronic Data Capture. Recommendations were modified by considering feedback from the previous round, and those reaching a consensus of over 80% were incorporated into the final document. Finally, 44 statements in the document were read and approved by all members of the working group. CONCLUSION The recommendations incorporate six areas, namely: general recommendations and practice, Helicobacter pylori, coeliac disease, suspected small bowel bleeding, inflammatory bowel disease, and preoperative care. Implementation of the recommendations is aimed at various levels from individual practitioners to healthcare institutions, departments and regional, district, provincial and national platforms. It is intended that the recommendations spur the development of centre-specific guidelines and that they are integrated with the relevant patient blood management protocols. Integration of the recommendations is intended to promote optimal evaluation and management of patients with ID, regardless of the presence of anaemia.
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Affiliation(s)
- W M Simmonds
- Gastroenterology Division, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - Y Awuku
- Department of Medicine, University of Health and Allied Sciences, Ho, Ghana.
| | - C Barrett
- School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - M Brand
- Department of General Surgery, School of Medicine, University of Pretoria, South Africa.
| | - K Davidson
- Private practice, IBD nurse specialist, Cape Town, South Africa.
| | - D Epstein
- Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - E Fredericks
- Department of Medicine, Stellenbosch University, South Africa.
| | - S Gabriel
- Gastroenterology Unit, Tygerberg Hospital and Stellenbosch University, South Africa.
| | - S Grobler
- niversitas Netcare Private Hospital, Bloemfontein, South Africa.
| | - C Gounden
- Department of Gastroenterology, School of Clinical Medicine, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
| | - L Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
| | - V J Louw
- Division of Clinical Haematology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - V Naidoo
- Department of Gastroenterology, School of Clinical Medicine, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
| | - C Noel
- Division of Gastrointestinal Surgery, Department of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - E Ogutu
- Department of Internal Medicine, University of Nairobi and Kenyatta National Hospital, Kenya.
| | - N Ramonate
- Gastroenterology Division, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - N Seabi
- Gastroenterology Division, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
| | - M Setshedi
- Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - J Van Zyl
- Department of Internal Medicine, Faculty of Health Sciences, University of the Free State and Netcare Universitas Private Hospital, Bloemfontein, South Africa.
| | - G Watermeyer
- Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - C Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Morningside Mediclinic, Johannesburg, South Africa.
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Stelzle D, Makasi C, Welte TM, Ruether C, Schmidt V, Gabriel S, Bottieau E, Fleury A, Ngowi BJ, Winkler AS. Report of three patients with extensive neurocysticercosis in rural southern Tanzania: neurological, serological and neuroradiological findings. J Med Case Rep 2023; 17:311. [PMID: 37408061 DOI: 10.1186/s13256-023-03974-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/05/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Neurocysticercosis (NCC) is common in eastern Africa, but disease presentation varies considerably. Most patients have single or few NCC-typical lesions in their brain but some present with a large number of lesions. We present three patients with positive antibody-based serology for Taenia solium cysticercosis screened at the Vwawa district hospital, Mbozi district, southern Tanzania, in whom extensive NCC was confirmed by neuroimaging. CASE PRESENTATIONS Patient 1 was a 55-year-old female from the tribe Malila smallholder farmer who has had four generalized tonic-clonic epileptic seizures over a period of 11 years and one episode of transient left hemiparesis one year before seizure onset. The patient also reported monthly to weekly episodes of severe, progressive, unilateral headache. The computed tomography (CT) scan of the brain showed 25 NCC lesions of which 15 were in the vesicular stage. Patient 2 was a 30-year-old male from tribe Nyha mechanic who reported monthly episodes of moderate to severe, progressive, bilateral headache, but no epileptic seizures. The CT scan showed 63 NCC lesions of which 50 were in the vesicular stage. Patient 3 was a 54-year-old female from the tribe Malila smallholder farmer who suffered from frequent generalized tonic-clonic epileptic seizures with potential signs of focal seizure onset. She also reported weekly to daily episodes of severe, progressive, unilateral headache. The CT scan showed 29 NCC lesions of which 28 were in the vesicular stage. CONCLUSIONS Clinical presentation of NCC with multiple brain lesions varies considerably ranging from few epileptic seizures and severe headache to severe epilepsy with frequent epileptic seizures. Individuals with neurological signs/symptoms that may be due to NCC, based for example on epidemiological criteria or serological evidence of cysticercosis, are recommended to undergo neuroimaging before anthelminthic treatment is considered.
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Affiliation(s)
- D Stelzle
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.
| | - C Makasi
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - T M Welte
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - C Ruether
- Department of Neuroradiology, RoMed Clinic Rosenheim, Rosenheim, Germany
| | - V Schmidt
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - S Gabriel
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - E Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - A Fleury
- Departamento de Medicina Genómica y Toxicología ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México/Instituto Nacional de Neurología y Neurocirugía, Ciudad de Mexico, Mexico
| | - B J Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
- University of Dar Es Salaam, Mbeya College of Health and Allies Sciences, Mbeya, Tanzania
| | - A S Winkler
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Mahmoudi M, McClintock R, Ruzangi J, Were J, O'Connell S, Gabriel S. A UK retrospective analysis of recurrent cardiovascular events following acute myocardial infarction in patients with multivessel disease and additional risk factors. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with multivessel disease (MVD) are at increased risk of recurrent cardiovascular (CV) events in the early period after acute myocardial infarction (AMI) compared to patients without MVD, possibly due to increased atherosclerotic burden. Moreover, many have additional risk factors such as older age, peripheral artery disease (PAD), prior AMI or diabetes that could further increase risk of recurrent events. Real-world evidence regarding the impact of additional CV risk factors on outcomes in patients with MVD remains sparse.
Purpose
To assess clinical outcomes in the early period after AMI in a UK cohort of patients with MVD and additional risk factors.
Methods
A retrospective analysis (January 1, 2008–December 31, 2018, inclusive) was conducted using the Clinical Practice Research Datalink database linked to Hospital Episode Statistics and Office of National Statistics databases to identify patients with a confirmed diagnosis of MVD within the study period and at least one non-fatal myocardial infarction (MI) diagnosis code on or after their first recorded MVD diagnosis. The effect of diabetes on clinical outcomes was assessed by comparing patients diagnosed with diabetes on or prior to their index AMI with those with no concurrent diabetes diagnosis (MVD+DM and MVD-DM cohorts, respectively). Clinical outcomes were also assessed in AMI patients without diabetes but with at least two additional risk factors including: age >65 years, PAD diagnosis or prior MI diagnosis (MVD2RF+ cohort), and those with a single or none of the aforementioned risk factors (MVD2RF- cohort). Major adverse CV events (MACE) was defined as a composite of non-fatal AMI, non-fatal stroke or CV death.
Results
Of the 78,128 patients with MVD identified, 19,768 and 52,197 were eligible for inclusion in the MVD+DM and MVD-DM cohorts respectively. Occurrence of MACE was similar between the MVD+DM and MVD-DM cohorts at both 90 days (15% vs. 14%) and 1 year (19% vs. 17%) post-AMI; however, all-cause and CV mortality were significantly higher in the MVD+DM cohort over the study period (p<0.001). In the subset of patients without diabetes, 7,531 and 44,666 patients met the criteria for the MVD2RF+ and MVD2RF- cohorts, respectively. A substantially higher proportion of patients in the MVD2RF+ cohort experienced a MACE within 90 days or 1 year post-MI compared with the MVD2RF- cohort (90 days: 45% vs. 9%; 1 year: 56% vs. 11%), with non-fatal MI accounting for the majority of recurrent events. Kaplan-Meier survival analysis revealed that both all-cause and CV mortality were significantly higher in the MVD2RF+ than the MVD2RF- cohort (p<0.001).
Conclusions
Having multiple risk factors including older age, PAD and a history of AMI substantially increases the risk of recurrent events in patients with MVD, particularly in the early period after AMI. Strategies to reduce the systemic atherosclerotic burden and risk of recurrent events in these patients are needed.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): CSL Behring
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Affiliation(s)
- M Mahmoudi
- University Hospital Southampton NHS Foundation Trust , Southampton , United Kingdom
| | | | - J Ruzangi
- Health Iq Ltd. , London , United Kingdom
| | - J Were
- Health Iq Ltd. , London , United Kingdom
| | | | - S Gabriel
- CSL Behring , King of Prussia , United States of America
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Daza JF, Cuthbertson BH, Myles PS, Shulman MA, Wijeysundera DN, Wijeysundera DN, Pearse RM, Myles PS, Abbott TEF, Shulman MA, Torres E, Ambosta A, Melo M, Mamdani M, Thorpe KE, Wallace S, Farrington C, Croal BL, Granton JT, Oh P, Thompson B, Hillis G, Beattie WS, Wijeysundera HC, Ellis M, Borg B, Kerridge RK, Douglas J, Brannan J, Pretto J, Godsall MG, Beauchamp N, Allen S, Kennedy A, Wright E, Malherbe J, Ismail H, Riedel B, Melville A, Sivakumar H, Murmane A, Kenchington K, Kirabiyik Y, Gurunathan U, Stonell C, Brunello K, Steele K, Tronstad O, Masel P, Dent A, Smith E, Bodger A, Abolfathi M, Sivalingam P, Hall A, Painter TW, Macklin S, Elliott A, Carrera AM, Terblanche NCS, Pitt S, Samuels J, Wilde C, Leslie K, MacCormick A, Bramley D, Southcott AM, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, McCartney CJL, Choi S, Somascanthan P, Flores K, Karkouti K, Clarke HA, Jerath A, McCluskey SA, Wasowicz M, Day L, Pazmino-Canizares J, Belliard R, Lee L, Dobson K, Stanbrook M, Hagen K, Campbell D, Short T, Van Der Westhuizen J, Higgie K, Lindsay H, Jang R, Wong C, McAllister D, Ali M, Kumar J, Waymouth E, Kim C, Dimech J, Lorimer M, Tai J, Miller R, Sara R, Collingwood A, Olliff S, Gabriel S, Houston H, Dalley P, Hurford S, Hunt A, Andrews L, Navarra L, Jason-Smith A, Thompson H, McMillan N, Back G. Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery. Br J Surg 2022; 109:968-976. [PMID: 35929065 DOI: 10.1093/bjs/znac263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort. METHODS Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups. RESULTS The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status. CONCLUSION The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.
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Affiliation(s)
- Julian F Daza
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brian H Cuthbertson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Mark A Shulman
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
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Chleboun P, Gabriel S, Grosskinsky S. Poisson-Dirichlet asymptotics in condensing particle systems. ELECTRON J PROBAB 2022. [DOI: 10.1214/22-ejp882] [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: 12/05/2022]
Affiliation(s)
- Paul Chleboun
- Department of Statistics, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Simon Gabriel
- Mathematics Institute, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Stefan Grosskinsky
- Lehrstuhl für Stochastik und ihre Anwendungen Universität Augsburg, D-86135 Augsburg, Germany
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Gabriel S, Herepath M, Zhang X, Were JJ, Ruzangi J, O'Connell SP. Clinical burden of MACE in patients with multivessel disease during the early period following acute myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite numerous interventions that have improved outcomes in acute myocardial infarction (AMI) patients, the first 90 days after AMI remains a high-risk period for recurrent events. Due to higher disease burden and suboptimal outcomes, it is crucial to characterize the clinical burden upon patients with multivessel disease (MVD) and various comorbidities.
Purpose
To describe the post-AMI clinical burden of major adverse cardiovascular events (MACE) in patients with MVD at 30, 90, and 365 days.
Methods
This was a retrospective cohort study (1st January, 2008 to 31st December, 2018) using data from a longitudinal, representative UK population health dataset comprising primary care data from the Clinical Practice Research Datalink (CPRD). This was linked to data from the Hospital Episode Statistics (HES) and Office of National Statistics (ONS) databases to identify patients with a confirmed diagnosis code of MVD. A MACE was defined as any one of non-fatal MI, non-fatal stroke, or cardiovascular death. The prevalence of MACE among post-AMI patients with MVD and the effect of concurrent risk factors was quantified.
Results
403,631 patients with MVD were identified (21.69% of the total study population), nearly one-fifth of whom (n=78,128; 19.35%) experienced an AMI after their first recorded diagnosis of MVD (MVD+). The mean and median age of MVD+ patients was 66 years, and the majority (72.9%) were male. Almost half (48.9%) had a Charlson co-morbidity score of at least 1, and 99.8% had an index of multiple deprivation recorded, distributed evenly across the quintiles. At least one of the composite MACE occurred in 9,533 (12.2%), 11,694 (14.9%), and 15,188 (19.4%) MVD+ patients within 30, 90, and 365 days, respectively. In MVD+ patients with 2 or more additional risk factors (peripheral artery disease [PAD], age >65, prior AMI; w/out comorbid diabetes; n=7,531), the proportion of MACE within 90 days was substantially higher (42.7%). Non-fatal MI was the most common MACE episode in MVD+ patients, occurring in 7,696, (9.8%), 8,924 (11.4%), and 10,673 (13.7%) MVD+ patients at 30, 90, and 365 days, respectively. Within 90 days of AMI, 39.1% of MVD+ patients with 2 or more risk factors experienced non-fatal MI.
Conclusions
MVD patients have a considerable clinically relevant burden of MACE following AMI. The majority of 1-year recurrent events occurred within 90 days of MACE, with 90-day risk almost 3-fold higher in patients with two additional risk factors. For patients with MVD and other risk factors, opportunities remain for treatments that may reduce the risk of recurrent events in the early period following AMI.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): CSL Behring
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Affiliation(s)
- S Gabriel
- CSL Behring, King of Prussia, United States of America
| | - M Herepath
- Optimal Access Life Science Consulting Limited, Swansea, United Kingdom
| | - X Zhang
- CSL Behring, King of Prussia, United States of America
| | - J J Were
- Health Iq Ltd., London, United Kingdom
| | - J Ruzangi
- Health Iq Ltd., London, United Kingdom
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Gabriel S, Herepath M, Zhang X, Were JJ, Ruzangi J, O'Connell SP. Hospital readmissions and economic burden associated with multivessel disease in the early period following acute myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is emerging evidence that particularly high rates of major adverse cardiovascular events (MACE) occur in the 90-day period after acute myocardial infarction (AMI). Post-AMI MACE are associated with additional resource utilization and economic burden for healthcare systems, with multivessel disease (MVD) conferring a 3- to 4-fold increase in risk of recurrent MACE in the first year post AMI vs. single vessel disease. Thus, characterizing the prevalence and outcomes of patients with MVD and various comorbidities is crucial to predict and mitigate clinical risk and associated costs.
Purpose
To describe post-AMI readmissions and economic burden in MVD patients at 30, 90, and 365 days.
Methods
This was a retrospective cohort study (1st January, 2008 to 31st December, 2018). Patients with MVD were identified by a confirmed diagnosis code from a longitudinal, representative UK population health dataset comprising primary care data from the Clinical Practice Research Datalink (CPRD), which was linked to secondary care data from the Hospital Episode Statistics (HES) and Office of National Statistics (ONS) databases. Patients who experienced at least one AMI after their first recorded MVD diagnosis were defined as MVD+. A MACE was defined as any one of non-fatal MI, non-fatal stroke, or cardiovascular death. Readmissions were defined as non-elective admissions with a MACE outcome diagnosis occurring up to 28 days from a previous admission with the same treatment speciality.
Results
The study population included 78,128 MVD+ patients (4.2% of the total patient population). In the MVD+ cohort, 3,753 (4.8%) patients were readmitted with at least one MACE event or other non-elective admission within the cardiovascular specialty: 2,394 (63.8%), 2,562 (68.3%), and 2,830 (75.4%) readmissions occurred within 30, 90, and 365 days, respectively. The mean length of hospital stay per patient, per readmission for MACE within 30, 90, and 365 days was 7.22, 7.46, and 7.74 days, respectively. The mean cost per MACE admission within 90 days of index AMI was £3,926.52. Non-fatal MI was the most common reason for readmission at all timepoints. Percutaneous transluminal balloon angioplasty and saphenous vein graft procedures (coronary artery bypass graft, CABG) were among the most common cardiac procedures in MVD+ patients, at 70,276 (22.7%) and 15,418 (5.0%), respectively.
Conclusions
In patients with MVD who suffer an AMI, there is high resource utilization and cost, particularly in the first 90-days post AMI; therefore, the 90-day post-AMI period represents significant economic costs to healthcare systems.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): CSL Behring
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Affiliation(s)
- S Gabriel
- CSL Behring, King of Prussia, United States of America
| | - M Herepath
- Optimal Access Life Science Consulting Limited, Swansea, United Kingdom
| | - X Zhang
- CSL Behring, King of Prussia, United States of America
| | - J J Were
- Health Iq Ltd., London, United Kingdom
| | - J Ruzangi
- Health Iq Ltd., London, United Kingdom
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Gabriel S, Liberman JN, Alexander JE, Allen KB. Adherence to guideline-recommended care following acute myocardial infarction: impact on clinical outcomes at 90 days and 1 year. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guideline-recommended care is effective for secondary prevention following acute myocardial infarction (AMI); however, most pharmacotherapies take time to become efficacious and not all patients comply with treatment. It is well established that the risk of recurrent cardiovascular (CV) events is high following an AMI; however, the clinical burden of recurrent CV events among guideline-treated patients, specifically in the 90-day period post-AMI, has been relatively unexplored.
Purpose
To evaluate adherence to guideline-recommended care and determine how it impacts clinical outcomes at 90 days and 1 year post-discharge in a U.S. population.
Methods
A retrospective analysis was conducted using the IBM Health Marketscan Commercial Claims and Encounters database (July 1, 2013–June 1, 2016). In U.S. individuals with a primary diagnosis of AMI, adherence to evidence-based care was assessed in terms of claims for guideline-recommended interventions: completed physician follow-up visit within 30 days of discharge, participation in cardiac rehabilitation, and adherent (PDC ≥0.8) to beta-blocker, antiplatelet, statin, and ACE inhibitor/ARB drug classes in the year following discharge. Rates of rehospitalisation (all-cause and cardiac) and recurrent AMI events within 90 days and 1 year post-AMI were evaluated.
Results
Of the 21,977 patients included in the analysis, the majority (80.9%) visited a physician within 30 days of discharge, but few (15.4%) entered cardiac rehabilitation or were adherent to all guideline-recommended drug classes (17.1%). Even in patients fully compliant with guideline-recommended care (3.1% of the total population), event rates were high in the first year post-MI (recurrent AMI: 1.6%; cardiac rehospitalisation: 8.9%; all-cause hospitalisation 13.3%) with a large proportion of the events occurring in the first 90 days: 75%, 58.4%, and 51.1% respectively. Adherence to all drug classes significantly reduced the risk of all-cause and cardiac rehospitalisation but did not reduce the risk of recurrent AMI events (OR=1.03 [95% CI 0.73–1.46] at 90 days and OR=0.80 [95% CI 0.60–1.07] at 1 year) when compared to patients not receiving guideline-recommended pharmacotherapy.
Conclusions
Even among patients receiving guideline-recommended treatment following discharge, the risk of recurrent events remained high at both 90 days and 1 year in patients following an AMI. Novel approaches to reducing the risk of early recurrent AMI, in particular, are needed.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): CSL Behring
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Affiliation(s)
- S Gabriel
- CSL Behring, King of Prussia, United States of America
| | - J N Liberman
- Health Analytics, LLC, Columbia, United States of America
| | - J E Alexander
- Healthcare Compliance Management, LLC, Fort Worth, United States of America
| | - K B Allen
- St. Luke's Mid America Heart Institute, Kansas City, United States of America
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9
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Schwartzman G, Lei D, Ahmed A, Chavda R, Gabriel S, Silverberg JI. Longitudinal course and phenotypes of health-related quality of life in adults with atopic dermatitis. Clin Exp Dermatol 2021; 47:359-372. [PMID: 34623642 DOI: 10.1111/ced.14948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/27/2021] [Accepted: 09/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The real-world course of health-related quality of life (HRQoL) in atopic dermatitis (AD) is not well established. AIM To examine predictors, longitudinal course and phenotypes of HRQoL in adult patients with AD. METHODS This was a prospective dermatology-practice based study of 955 patients with AD (age 18-97 years). Patients were assessed at baseline and approximately 6, 12, 18 and 24 months. HRQoL was assessed using the 10-item short-form Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health (PGH). AD severity and impact was assessed by patient-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Eczema Area and Severity Index (EASI), Objective SCORing Atopic Dermatitis (O-SCORAD), Investigator's Global Assessment (IGA), Numerical Rating Scale (NRS) average and worst itch, PROMIS sleep-related impairment (SRI), and nine-item Patient Health Questionnaire (PHQ)-9. Repeated-measures regression models were constructed to examine itch over time. RESULTS In multivariable linear regression models controlling for age, race/ethnicity, history of asthma, hay fever and food allergy, baseline PGH-physical (PGH-P4) T scores were inversely associated with patient-reported global AD severity, POEM, EASI, objective SCORAD, IGA, NRS average and worst itch, PROMIS SRI and PHQ-9, with stepwise decreases of physical health with worsening severity. PGH-mental health (PGH-M4) T scores were associated with all aforementioned severity measures aside from POEM. In multivariable repeated measures linear regression models, decreased PGH-P4 and PGH-M4 T scores and mapped five-dimension EuroQoL over time were associated with self-reported global AD severity, NRS worst and mean itch, POEM, PROMIS sleep disturbance and SRI, EASI, objective SCORAD, IGA and PHQ-9. Latent class analysis identified six classes of HRQoL, which were associated with measures of AD severity, nonwhite race, Hispanic ethnicity and having only public health insurance, but not age or sex. CONCLUSION Patients with AD have a heterogeneous longitudinal course and distinct patterns of HRQoL. Many patients had fluctuating HRQoL over time. Most patients with moderate to severe disease at baseline had persistent HRQoL impairment over time.
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Affiliation(s)
- G Schwartzman
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - D Lei
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - A Ahmed
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - R Chavda
- Galderma SA Rx Strategy and Innovation Group, La Tour-de-Peliz, Switzerland
| | - S Gabriel
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - J I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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10
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Puelles J, Fofana F, Rodriguez D, Silverberg JI, Wollenberg A, Dias Barbosa C, Vernon M, Chavda R, Gabriel S, Piketty C. Psychometric validation and responder definition of the sleep disturbance numerical rating scale in moderate-to-severe atopic dermatitis. Br J Dermatol 2021; 186:285-294. [PMID: 34608623 PMCID: PMC9299666 DOI: 10.1111/bjd.20783] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/27/2022]
Abstract
Background Sleep disturbance (SD) is an important part of the burden of atopic dermatitis (AD), but patient‐reported outcomes that are easy to understand and interpret in the target population have been lacking. A daily, single‐item, self‐reported SD 11‐point numerical rating scale (NRS) was recently developed to assess SD for patients with moderate‐to‐severe AD, but its psychometric properties have not yet been described. Objectives To assess the psychometric properties of the SD NRS in patients with moderate‐to‐severe AD. Methods The psychometric properties of the SD NRS were assessed using data from a phase IIb clinical trial in 218 adults with moderate‐to‐severe AD. Results Test–retest reliability of the SD NRS was substantial to almost perfect (interclass correlation 0·66–1·00) in participants who had stable SD or stable pruritus scores over 1 week. Baseline correlations were moderate to large (r > 0·30) between SD NRS and pruritus or sleep loss scores, but were small (r = −0·11 to 0·17) between SD NRS and EQ‐5D‐3L index and visual analogue scores, Hospital Anxiety and Depression Scale, Scoring Atopic Dermatitis, and Investigator’s Global Assessment. The SD NRS could discriminate groups of participants in the expected direction according to different quality‐of‐life scores but not according to different clinician‐reported disease severity scores. SD NRS scores significantly decreased as sleep loss, itch and quality‐of‐life scores improved. Analysis of meaningful change suggested a 2–5‐point improvement as the initial range of responder definition in the SD NRS score. Conclusions The SD NRS is a reliable, valid and responsive measure of SD in adults with moderate‐to‐severe AD. Whatis already known about this topic? Sleep disturbance (SD) is a dynamic, multidimensional concept resulting in daytime fatigue and subsequent changes in physical and mental health that vary from day to day. SD is an important part of the burden of atopic dermatitis, but ways of effectively and reliably measuring it from the patient perspective have been lacking. A self‐reported, daily, 11‐point SD numerical rating scale (NRS) was recently developed for assessing SD in patients with moderate‐to‐severe atopic dermatitis, and its content validity was previously established.
Whatdoes this study add? The study showed that the SD NRS is reliable, valid and responsive and can measure day‐to‐day fluctuations in SD related to atopic dermatitis. The study also established an initial responder definition (i.e. meaningful interpatient change) for the SD NRS score.
Whatare the clinical implications of this work? The SD NRS is a brief, simple, easy‐to‐interpret and validated patient‐reported global measure for the daily assessment of SD related to atopic dermatitis. The SD NRS can be used in clinical trials and clinical practice to assess changes in sleep quality in patients with atopic dermatitis.
Plain language summary available online
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Affiliation(s)
- J Puelles
- Galderma, La Tour-de-Peilz, Switzerland
| | - F Fofana
- Evidera, Bennekom Born, the Netherlands
| | | | - J I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - A Wollenberg
- Department of Dermatology and Allergology, Ludwig-Maximilians-Universität, Munich, Germany
| | | | | | - R Chavda
- Galderma, La Tour-de-Peilz, Switzerland
| | - S Gabriel
- Galderma, La Tour-de-Peilz, Switzerland
| | - C Piketty
- Galderma, La Tour-de-Peilz, Switzerland
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11
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Aggarwal P, Choi J, Sutaria N, Roh YS, Wongvibulsin S, Williams KA, Huang AH, Boozalis E, Le T, Chavda R, Gabriel S, Kwatra SG. Clinical characteristics and disease burden in prurigo nodularis. Clin Exp Dermatol 2021; 46:1277-1284. [PMID: 33969517 DOI: 10.1111/ced.14722] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/17/2021] [Accepted: 05/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by intense pruritus, but information on patient experience and impact on quality of life (QoL) remains understudied. AIM To characterize disease characteristics and QoL in a global sample of patients with PN. METHODS An anonymous survey was distributed via patient support groups for PN. RESULTS In total, 231 members responded to the survey. The majority of respondents reported itch localized both to nodules and to intervening skin (67.0%). Associated symptoms included prickling, pain, stinging and burning. The extensor lower legs (69% right, 67.3% left) and flexor forearms (66.1% right, 62% left) were the most common sites of itch. Participants reported frequent healthcare utilization, with 36.3% visiting a doctor ≥ 10 times in the past year. Physician-diagnosed anxiety (45.4%), depression (16.4%) and the atopic triad (18.7%) were commonly reported. Patients with PN had mean scores of 16.4, 11.6 and 16.8 on the Dermatology Life Quality Index, Pittsburgh Sleep Quality Index and 5-Dimensions Itch, respectively. CONCLUSIONS Severe pruritus with accompanying pain, stinging and burning is characteristic of PN, with the majority of patients experiencing itch in both nodular and interlesional skin. Patients further report decreased QoL scores and impaired sleep. Patient experiences should guide future management of PN.
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Affiliation(s)
- P Aggarwal
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Y S Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Wongvibulsin
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A H Huang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Boozalis
- Division of Dermatology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - T Le
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Chavda
- Galderma SA, Lausanne, Switzerland
| | | | - S G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Sutaria N, Choi J, Roh YS, Alphonse MP, Adawi W, Lai J, Pollock JR, Fontecilla Biles N, Gabriel S, Chavda R, Kwatra SG. Association of prurigo nodularis and infectious disease hospitalizations: a national cross-sectional study. Clin Exp Dermatol 2021; 46:1236-1242. [PMID: 33763852 DOI: 10.1111/ced.14652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/07/2021] [Accepted: 03/16/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Prurigo nodularis (PN) is associated with a variety of systemic comorbidities, including infectious diseases such as HIV and viral hepatitis. There are limited data on other infectious disease comorbidities in patients with PN. AIM To characterize infectious disease hospitalizations among patients with PN and the associated cost burden. METHODS We searched the 2016-2017 National Inpatient Sample, a cross-sectional sample of 20% of all US hospitalizations, for infectious disease hospitalizations among patients with PN. Associations of PN with infections and related costs were determined using multivariable logistic and linear regression, adjusting for age, race, sex and insurance type. RESULTS PN was associated with any infection overall (OR = 2.98, 95% CI 2.49-3.56), and with HIV, cutaneous, hepatobiliary, central nervous system, bacterial, viral and fungal/parasitic infections and for sepsis. Patients with PN had a higher mean cost of care (US$11 667 vs. US$8893, P < 0.001) and length of stay (5.5 vs. 4.2 days, P < 0.001) for any infection overall and for 7 of 13 other infections. Adjusting for age, race, sex and insurance coverage, PN was associated with higher cost (+30%, 95% CI +17 to +44%) and higher length of stay (+30%, 95% CI +18 to +44%) for any infection overall, and for several specific infections. These associations remained with alternate regression models adjusting for severity of illness. CONCLUSION There is a high infectious disease burden among patients with PN, corresponding to higher healthcare utilization and spending. Clinicians must be aware of these associations when treating these patients with immunomodulatory drugs.
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Affiliation(s)
- N Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Y S Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M P Alphonse
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W Adawi
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - J Lai
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J R Pollock
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Dermatology, Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - N Fontecilla Biles
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Gabriel
- Galderma SA, Prescription GBU, Lausanne, Switzerland
| | - R Chavda
- Galderma SA, Prescription GBU, Lausanne, Switzerland
| | - S G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Escoda T, Benyamine A, Belenotti P, Masson E, Chemouni D, Vaccaro J, Gabriel S, Swiader L, Weiller P, Rossi P, Granel B. Atteinte osseuse axiale de la sarcoïdose. Rev Med Interne 2020; 41:846-851. [DOI: 10.1016/j.revmed.2020.07.008] [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: 01/30/2020] [Revised: 06/28/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
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14
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Silverberg JI, Lei D, Yousaf M, Janmohamed SR, Vakharia PP, Chopra R, Chavda R, Gabriel S, Patel KR, Singam V, Kantor R, Hsu DY. What are the best endpoints for Eczema Area and Severity Index and Scoring Atopic Dermatitis in clinical practice? A prospective observational study. Br J Dermatol 2020; 184:888-895. [PMID: 32959390 DOI: 10.1111/bjd.19457] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multiple strategies have been used to evaluate the minimal important change (MIC) of the Eczema Area and Severity Index (EASI) and Scoring Atopic Dermatitis (SCORAD). The meaningfulness of these MICs is not well established across all severities of atopic dermatitis (AD). OBJECTIVES To determine the MIC of percentage and absolute improvement of EASI and SCORAD scores in adults and children with AD. METHODS We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 826). An anchor-based approach was used to determine thresholds for the percentage and absolute MICs of EASI, SCORAD and objective SCORAD (O-SCORAD) at follow-up from baseline. RESULTS One-grade improvements of Physician's Global Assessment (PGA) and validated Investigator Global Assessment scale for AD (vIGA-AD) were associated with 50%, 35% and 35% decreases of EASI, SCORAD and O-SCORAD, respectively. The thresholds for percentage MIC of EASI (Kruskal-Wallis test, P = 0·61), SCORAD (P = 0·07) and O-SCORAD (P = 0·09) were similar across baseline AD severities. One-grade improvements of PGA and vIGA-AD were associated with 14·0- and 14·9-point decreases of EASI, 19·9- and 14·9-point decreases of SCORAD, and 15·5- and 17·4-point decreases of O-SCORAD. The thresholds for the absolute MIC of EASI (P < 0·001), SCORAD (P < 0·001) and O-SCORAD (P < 0·001) significantly differed by baseline AD severity. Percentage and absolute MICs for EASI and SCORAD were associated with improvements of AD symptoms and quality of life. CONCLUSIONS EASI 50, SCORAD 35 and O-SCORAD 35 were meaningful percentage MICs regardless of baseline AD severity. The absolute MICs for EASI, SCORAD and O-SCORAD varied by baseline AD severity.
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Affiliation(s)
- J I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, Jette, 1090, Belgium
| | - D Lei
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, Jette, 1090, Belgium
| | - M Yousaf
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, Jette, 1090, Belgium
| | - S R Janmohamed
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, Jette, 1090, Belgium
| | - P P Vakharia
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Chopra
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - R Chavda
- Galderma SA, Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - S Gabriel
- Galderma SA, Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - K R Patel
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - V Singam
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - R Kantor
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - D Y Hsu
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, Jette, 1090, Belgium
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15
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Silverberg JI, Lei D, Yousaf M, Janmohamed SR, Vakharia PP, Chopra R, Chavda R, Gabriel S, Patel KR, Singam V, Kantor R, Hsu DY. Measurement properties of the product of investigator's global assessment and body surface area in children and adults with atopic dermatitis. J Eur Acad Dermatol Venereol 2020; 35:180-187. [PMID: 32745300 DOI: 10.1111/jdv.16846] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/13/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multiple clinician-reported outcome measures exist for atopic dermatitis (AD) severity. However, there is no gold standard for use in clinical practice. OBJECTIVES To determine the measurement properties of the product of validated Investigator's Global Assessment for AD (vIGA) and body surface area (BSA) overall or divided into six categories (cBSA: 0%/0.1, <10%/10, <30%/30, <50%/50, <70%/70 and <90%/90-100%) and compare with other clinician-reported and patient-reported outcomes in adults and children with AD. METHODS We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 653). RESULTS vIGA*BSA and vIGA*cBSA had good convergent validity with BSA (Spearman's ρ = 0.97 and 0.93), eczema area and severity index (ρ = 0.94 and 0.92), and objective SCORAD (ρ = 0.88 and 0.89); and weak-to-good convergent validity with Numeric Rating Scale average itch (ρ = 0.22 and 0.22) and worst itch (ρ = 0.27 and 0.28), Patient-Oriented Eczema Measure (ρ = 0.44 and 0.43), Dermatology Life Quality Index (ρ = 0.48 and 0.49), ItchyQOL (ρ = 0.45 and 0.46), PROMIS Sleep Disturbance (ρ = 0.46 and 0.37) and sleep-related impairment (ρ = 0.31 and 0.31) in adults and/or children; very good discriminant validity for physician-reported global AD severity; good responsiveness to change of severity of AD and itch; and good reliability (intraclass correlation coefficient [95% confidence interval]: 0.72 [0.60-0.81] and 0.74 [0.62-0.82]) with no floor or ceiling effects. Thresholds for interpretability bands and clinically important difference were established. CONCLUSIONS vIGA*BSA and vIGA*cBSA scores showed good convergent and discriminant validity, reliability, responsiveness and interpretability in adults and children with AD, and were feasible for use in clinical practice. vIGA*BSA and vIGA*cBSA had slightly lower convergent validity than EASI or objective SCORAD, but might be more efficient to collect and score.
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Affiliation(s)
- J I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - D Lei
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Yousaf
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S R Janmohamed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - P P Vakharia
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Chopra
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - R Chavda
- Galderma SA, Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - S Gabriel
- Galderma SA, Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - K R Patel
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - V Singam
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - R Kantor
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - D Y Hsu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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16
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Silverberg JI, Lei D, Yousaf M, Janmohamed SR, Vakharia PP, Chopra R, Chavda R, Gabriel S, Patel KR, Singam V, Kantor R, Hsu DY. Measurement properties of the Rajka-Langeland severity score in children and adults with atopic dermatitis. Br J Dermatol 2020; 184:87-95. [PMID: 32348552 DOI: 10.1111/bjd.19159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multiple atopic dermatitis (AD) severity scales exist, with no gold standard for use in clinical practice. OBJECTIVES To determine the measurement properties of the Rajka-Langeland score and compare it with other clinician-reported outcomes in adults and children with AD. METHODS We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 427). RESULTS Rajka-Langeland had good concurrent validity with the Eczema Area and Severity Index (Spearman rho = 0·63), SCORing AD (SCORAD) (rho = 0·61), objective-SCORAD (rho = 0·52) and body surface area (rho = 0·51); good convergent validity with the numeric rating scale average-itch (rho = 0·60) and worst-itch (rho = 0·59), Patient-Oriented Eczema Measure (rho = 0·57), Dermatology Life Quality Index (rho = 0·53), Patient-Reported Outcomes Measurement Information System Itch Questionnaire (rho = 0·35-0·55) in adults and/or children; fair discriminant validity for patient- and physician-reported global AD severity; good responsiveness to change of severity of AD and itch; good reliability; internal consistency; with no floor or ceiling effects. Interpretability bands (3, clear/almost clear; 4-5, mild; 6-7, moderate; 8-9, severe) and minimal clinically important difference (1 point) were established. CONCLUSIONS The Rajka-Langeland score showed good construct validity, reliability, internal consistency and responsiveness in adults and children with AD.
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Affiliation(s)
- J I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-425, 2150 Pennsylvania Avenue, Washington, DC, 20037, USA.,Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - D Lei
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - M Yousaf
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - S R Janmohamed
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - P P Vakharia
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Chopra
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - R Chavda
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - S Gabriel
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - K R Patel
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - V Singam
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - R Kantor
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Derek Y Hsu
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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17
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Silverberg J, Lei D, Yousaf M, Janmohamed S, Vakharia P, Chopra R, Chavda R, Gabriel S, Patel K, Singam V, Kantor R, Hsu D, Cella D. 534 Association of itch triggers with atopic dermatitis severity, persistence, flares and seasonality in adults. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.543] [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]
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18
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Lei D, Yousaf M, Janmohamed S, Vakharia P, Chopra R, Chavda R, Gabriel S, Sacotte R, Patel K, Singam V, Immaneni S, Kantor R, Hsu D, Cella D, Silverberg J. 549 Measurement properties of four different patient-reported outcomes to assess sleep disturbance in adults with atopic dermatitis. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Otero-Lobato M, Esslinger S, Gabriel S, Clark M, Sheridan P, Geldhof A. SAT0117 TRIMESTER EXPOSURE AND PREGNANCY OUTCOMES IN WOMEN EXPOSED TO GOLIMUMAB – RESULTS FROM THE COMPANY PHARMACOVIGILANCE DATABASE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2796] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatologic disorders and inflammatory bowel disease can affect women of childbearing potential. Golimumab (GLM) is approved for several rheumatologic indications and ulcerative colitis (UC).Objectives:To characterize pregnancy outcomes in patients treated with GLM, data obtained from maternal exposure to GLM are presented.Methods:This dataset includes individual patient cases reported to the manufacturer through 06 April 2019. Cases included in the analysis were medically confirmed cases of maternal exposures to GLM during pregnancy or within 3 months prior to conception, and a reported pregnancy outcome. Both prospectively reported (ie, pregnancy outcome not known when first reported) and retrospectively reported cases (ie, pregnancy outcome known when first reported) were included. Cases originated from various sources, including spontaneous reporting, clinical studies, and registries.Results:Two hundred eight pregnancy cases (131 rheumatologic indications; 43 UC; and 34 other) with 211 reported birth outcomes were identified. Of these 208 pregnancy cases, 119 were prospective and 89 were retrospective. Average maternal age was 31.9 years. Of the 119 prospectively reported pregnancy cases, 89 (74.8%) resulted in live births, 19 (16.0%) resulted in spontaneous abortion (of these, 42.1% (8/19) received GLM in combination with methotrexate [MTX]), 10 (8.4%) resulted in induced/elective abortion, and 1 (0.8%) resulted in ectopic pregnancy. Overall, 9 congenital anomalies were reported (2 prospective and 7 retrospective cases).For 183 of the 208 pregnancy cases with reported outcomes, the trimester of exposure to GLM was known. Among the 110 prospectively reported cases, 82 (74.5%) were exposed during trimester 0 or 1. Of these, 19 had concomitant exposure to MTX, with the following birth outcomes: 8 live births, 8 spontaneous abortions, 3 elective/induced abortions. Eighteen of the prospectively reported cases (16.4%) were exposed to GLM through trimesters 1-3 and all resulted in live births (none with congenital anomalies; 1 infant with exposure to GLM and MTX was born preterm).Conclusion:The rates of congenital malformations and spontaneous abortions were consistent with published background rates for the general population. Persistent exposure throughout pregnancy was rare. Limitations of this analysis include the lack of a direct comparison group, the variable amount of data available in the reports, and the possible bias towards reporting more negative outcomes in retrospective cases.Disclosure of Interests:Marijo Otero-Lobato Shareholder of: Johnson & Johnson, Employee of: Johnson & Johnson, Suzan Esslinger Shareholder of: Johnson & Johnson, Consultant of: Johnson & Johnson, Novartis, Eli Lilly and Sandoz, Employee of: Johnson & Johnson, Susan Gabriel Shareholder of: Johnson & Johnson, Employee of: Johnson & Johnson, Merck, GSK, Michael Clark Shareholder of: Johnson & Johnson, Employee of: Johnson & Johnson, Pamela Sheridan Shareholder of: Johnson & Johnson, Roche Pharmaceuticals, Employee of: Johnson & Johnson, Roche, Novartis, Bayer, Anja Geldhof Shareholder of: Johnson & Johnson, Employee of: Johnson & Johnson
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Ogami T, Naka Y, Sanchez J, Ning Y, Kurlansky P, Witer L, Kaku Y, Topkara V, Yuzefpolskaya M, Colombo P, Gabriel S, Uriel N, Takayama H, Takeda K. Incidence and Cause of Persistent Low Flow Alarm after HeartMate 3 Left Ventricular Assist Device Insertion. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zilhão J, Angelucci DE, Igreja MA, Arnold LJ, Badal E, Callapez P, Cardoso JL, d'Errico F, Daura J, Demuro M, Deschamps M, Dupont C, Gabriel S, Hoffmann DL, Legoinha P, Matias H, Monge Soares AM, Nabais M, Portela P, Queffelec A, Rodrigues F, Souto P. Last Interglacial Iberian Neandertals as fisher-hunter-gatherers. Science 2020; 367:367/6485/eaaz7943. [PMID: 32217702 DOI: 10.1126/science.aaz7943] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/11/2020] [Indexed: 11/02/2022]
Abstract
Marine food-reliant subsistence systems such as those in the African Middle Stone Age (MSA) were not thought to exist in Europe until the much later Mesolithic. Whether this apparent lag reflects taphonomic biases or behavioral distinctions between archaic and modern humans remains much debated. Figueira Brava cave, in the Arrábida range (Portugal), provides an exceptionally well preserved record of Neandertal coastal resource exploitation on a comparable scale to the MSA and dated to ~86 to 106 thousand years ago. The breadth of the subsistence base-pine nuts, marine invertebrates, fish, marine birds and mammals, tortoises, waterfowl, and hoofed game-exceeds that of regional early Holocene sites. Fisher-hunter-gatherer economies are not the preserve of anatomically modern people; by the Last Interglacial, they were in place across the Old World in the appropriate settings.
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Affiliation(s)
- J Zilhão
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Passeig Lluís Companys 23, 08010 Barcelona, Spain. .,Universitat de Barcelona, Departament d'Història i Arqueologia, Facultat de Geografia i Història, c/Montalegre 6, 08001 Barcelona, Spain.,Centro de Arqueologia da Universidade de Lisboa (UNIARQ), Faculdade de Letras de Lisboa, Universidade de Lisboa, Alameda da Universidade, 1600-214 Lisboa, Portugal
| | - D E Angelucci
- Università degli Studi di Trento, Dipartimento di Lettere e Filosofia, via Tommaso Gar 14, 38122 Trento, Italy
| | - M Araújo Igreja
- Centro de Arqueologia da Universidade de Lisboa (UNIARQ), Faculdade de Letras de Lisboa, Universidade de Lisboa, Alameda da Universidade, 1600-214 Lisboa, Portugal.,Laboratório de Arqueociências (LARC), Direcção Geral do Património Cultural, Calçada do Mirante à Ajuda 10A, 1300-418 Lisboa, Portugal.,Environmental Archaeology Group, Research Center in Biodiversity and Genetic Resources (ENVARCH, CIBIO/InBIO), University of Oporto, Rua Padre Armando Quintas 7, 4485-661 Vairão, Portugal
| | - L J Arnold
- Environment Institute and Institute for Photonics and Advanced Sensing (IPAS), Department of Earth Sciences, School of Physical Sciences, University of Adelaide, North Terrace Campus, Adelaide, South Australia 5005, Australia
| | - E Badal
- Universitat de València, Departament de Prehistòria, Arqueologia i Història Antiga, Av. Blasco Ibañez 28, 46010 València, Spain
| | - P Callapez
- Departamento de Ciências da Terra (CITEUC), Faculdade de Ciências e Tecnologia, Universidade de Coimbra, Rua Sílvio Lima, 3030-790 Coimbra, Portugal
| | - J L Cardoso
- Centro de Arqueologia da Universidade de Lisboa (UNIARQ), Faculdade de Letras de Lisboa, Universidade de Lisboa, Alameda da Universidade, 1600-214 Lisboa, Portugal.,Universidade Aberta, Rua da Escola Politécnica 147, 1269-001 Lisboa, Portugal
| | - F d'Errico
- CNRS (UMR 5199-PACEA), Université de Bordeaux, Bât. B18, Allée Geoffroy Saint Hilaire, CS 50023, 33615 Pessac Cedex, France.,SFF Centre for Early Sapiens Behaviour (SapienCE), Sydnesplassen 12/13, 4 Etage, Postboks 7805, 5020 University of Bergen, Bergen, Norway
| | - J Daura
- Universitat de Barcelona, Departament d'Història i Arqueologia, Facultat de Geografia i Història, c/Montalegre 6, 08001 Barcelona, Spain.,Centro de Arqueologia da Universidade de Lisboa (UNIARQ), Faculdade de Letras de Lisboa, Universidade de Lisboa, Alameda da Universidade, 1600-214 Lisboa, Portugal
| | - M Demuro
- Environment Institute and Institute for Photonics and Advanced Sensing (IPAS), Department of Earth Sciences, School of Physical Sciences, University of Adelaide, North Terrace Campus, Adelaide, South Australia 5005, Australia
| | - M Deschamps
- Centro de Arqueologia da Universidade de Lisboa (UNIARQ), Faculdade de Letras de Lisboa, Universidade de Lisboa, Alameda da Universidade, 1600-214 Lisboa, Portugal.,Centre National de la Recherche Scientifique, UMR 5608-TRACES, Université Toulouse Jean Jaurès, Maison de la Recherche, 5 allées Antonio Machado, 31058 Toulouse cedex 9, France
| | - C Dupont
- Centre National de la Recherche Scientifique, UMR 6566-CReAAH, Laboratoire Archéosciences, Bât. 24-25, Université de Rennes 1-Campus de Beaulieu, 35042 Rennes Cedex, France
| | - S Gabriel
- Centro de Arqueologia da Universidade de Lisboa (UNIARQ), Faculdade de Letras de Lisboa, Universidade de Lisboa, Alameda da Universidade, 1600-214 Lisboa, Portugal.,Laboratório de Arqueociências (LARC), Direcção Geral do Património Cultural, Calçada do Mirante à Ajuda 10A, 1300-418 Lisboa, Portugal.,Environmental Archaeology Group, Research Center in Biodiversity and Genetic Resources (ENVARCH, CIBIO/InBIO), University of Oporto, Rua Padre Armando Quintas 7, 4485-661 Vairão, Portugal
| | - D L Hoffmann
- Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany.,Geoscience Center, Isotope Geology Division, University of Göttingen, Goldschmidtstrasse 3, 37077 Göttingen, Germany
| | - P Legoinha
- Geobiotec, Departamento de Ciências da Terra, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
| | - H Matias
- Centro de Arqueologia da Universidade de Lisboa (UNIARQ), Faculdade de Letras de Lisboa, Universidade de Lisboa, Alameda da Universidade, 1600-214 Lisboa, Portugal
| | - A M Monge Soares
- Centro de Ciências e Tecnologias Nucleares (C2TN), Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10, 2695-066 Bobadela, Portugal
| | - M Nabais
- Centro de Arqueologia da Universidade de Lisboa (UNIARQ), Faculdade de Letras de Lisboa, Universidade de Lisboa, Alameda da Universidade, 1600-214 Lisboa, Portugal.,Institute of Archaeology, University College London, 31-34 Gordon Square, London WC1H 0PY, UK
| | - P Portela
- Centro de Ciências e Tecnologias Nucleares (C2TN), Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10, 2695-066 Bobadela, Portugal
| | - A Queffelec
- CNRS (UMR 5199-PACEA), Université de Bordeaux, Bât. B18, Allée Geoffroy Saint Hilaire, CS 50023, 33615 Pessac Cedex, France
| | - F Rodrigues
- Centro de Arqueologia da Universidade de Lisboa (UNIARQ), Faculdade de Letras de Lisboa, Universidade de Lisboa, Alameda da Universidade, 1600-214 Lisboa, Portugal
| | - P Souto
- Sociedade Torrejana de Espeleologia e Arqueologia, Quinta da Lezíria, 2350-510, Torres Novas, Portugal
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Chauliac N, Brochard N, Payet C, Margue Y, Bordin P, Depraz P, Dumont A, Kroupa E, Pacaut-Troncin M, Polo P, Straub S, Boissin J, Burtin C, Montoya G, Rivière A, Didier C, Fournel C, Durand C, Barrellon M, Amigues O, Brosson A, Mahé E, Haxaire O, Bonnot C, Defaux M, Rougier D, Gaultier A, Gutierrez A, Pozo M, Lefèvre V, Nier A, Bolzan S, Liautaud M, Barbosa S, Garcia S, Anfreville A, Mazille S, Durantet C, Morlon M, Gaboriau C, Halbert C, Cholvy M, Milinkovich P, Martin L, Maury-Abello L, Toulier B, Kerleguer V, Gabriel S, Duclos A, Terra JL. How does gatekeeper training improve suicide prevention for elderly people in nursing homes? A controlled study in 24 centres. Eur Psychiatry 2020; 37:56-62. [DOI: 10.1016/j.eurpsy.2016.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/02/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022] Open
Abstract
AbstractBackgroundThe death rate due to suicide in elderly people is particularly high. As part of suicide selective prevention measures for at-risk populations, the WHO recommends training “gatekeepers”.MethodsIn order to assess the impact of gatekeeper training for members of staff, we carried out a controlled quasi-experimental study over the course of one year, comparing 12 nursing homes where at least 30% of the staff had undergone gatekeeper training with 12 nursing homes without trained staff. We collected data about the residents considered to be suicidal, their management further to being identified, as well as measures taken at nursing home level to prevent suicide.ResultsThe two nursing home groups did not present significantly different characteristics. In the nursing homes with trained staff, the staff were deemed to be better prepared to approach suicidal individuals. The detection of suicidal residents relied more on the whole staff and less on the psychologist alone when compared to nursing homes without trained staff. A significantly larger number of measures were taken to manage suicidal residents in the trained nursing homes. Suicidal residents were more frequently referred to the psychologist. Trained nursing homes put in place significantly more suicide prevention measures at an institutional level.ConclusionsHaving trained gatekeepers has an impact not only for the trained individuals but also for the whole institution where they work, both in terms of managing suicidal residents and routine suicide prevention measures.
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Shulman M, Cuthbertson B, Wijeysundera D, Pearse R, Thompson B, Torres E, Ambosta A, Wallace S, Farrington C, Myles P, Wallace S, Thompson B, Ellis M, Borg B, Kerridge R, Douglas J, Brannan J, Pretto J, Godsall M, Beauchamp N, Allen S, Kennedy A, Wright E, Malherbe J, Ismail H, Riedel B, Melville A, Sivakumar H, Murmane A, Kenchington K, Gurunathan U, Stonell C, Brunello K, Steele K, Tronstad O, Masel P, Dent A, Smith E, Bodger A, Abolfathi M, Sivalingam P, Hall A, Painter T, Macklin S, Elliott A, Carrera A, Terblanche N, Pitt S, Samuels J, Wilde C, MacCormick A, Leslie K, Bramley D, Southcott A, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, McCartney C, Choi S, Somascanthan P, Flores K, Beattie W, Karkouti K, Clarke H, Jerath A, McCluskey S, Wasowicz M, Granton J, Day L, Pazmino-Canizares J, Hagen K, Campbell D, Short T, Van Der Westhuizen J, Higgie K, Lindsay H, Jang R, Wong C, Mcallister D, Ali M, Kumar J, Waymouth E, Kim C, Dimech J, Lorimer M, Tai J, Miller R, Sara R, Collingwood A, Olliff S, Gabriel S, Houston H, Dalley P, Hurford S, Hunt A, Andrews L, Navarra L, Jason-Smith A, Thompson H, McMillan N, Back G, Melo M, Mamdani M, Hillis G, Wijeysundera H. Using the 6-minute walk test to predict disability-free survival after major surgery. Br J Anaesth 2019; 122:111-119. [DOI: 10.1016/j.bja.2018.08.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/13/2018] [Accepted: 08/29/2018] [Indexed: 11/16/2022] Open
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Akdeniz M, Gabriel S, Lichterfeld-Kottner A, Blume-Peytavi U, Kottner J. 健康成人中的 TEWL 参考值. Br J Dermatol 2018. [DOI: 10.1111/bjd.17229] [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: 11/27/2022]
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Akdeniz M, Gabriel S, Lichterfeld-Kottner A, Blume-Peytavi U, Kottner J. Transepidermal water loss in healthy adults: a systematic review and meta-analysis update. Br J Dermatol 2018; 179:1049-1055. [DOI: 10.1111/bjd.17025] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Affiliation(s)
- M. Akdeniz
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - S. Gabriel
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - A. Lichterfeld-Kottner
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - U. Blume-Peytavi
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
| | - J. Kottner
- Charité-Universitätsmedizin Berlin; Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany
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Balp MM, Khalil S, Tian H, Gabriel S, Vietri J, Zuberbier T. Burden of chronic urticaria relative to psoriasis in five European countries. J Eur Acad Dermatol Venereol 2017; 32:282-290. [PMID: 28898460 PMCID: PMC6084337 DOI: 10.1111/jdv.14584] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 04/26/2017] [Accepted: 09/05/2017] [Indexed: 01/22/2023]
Abstract
Background Quantification of burden of chronic spontaneous urticaria (CSU) vs. psoriasis (PsO) is limited. Objective To evaluate the burden associated with CSU vs. PsO of all severities (overall PsO), mild and moderate/severe PsO. Methods This retrospective cross‐sectional analysis compared data from adult patients with chronic urticaria (CU), used as a proxy for CSU, and PsO from the National Health and Wellness Survey in France, Germany, Italy, Spain and the United Kingdom. Outcomes included mental and physical component summary scores (MCS and PCS) calculated from the Short Form (SF)‐36v2 or SF‐12v2, SF‐6D health utility scores, self‐reported psychological complaints (anxiety, depression and sleep difficulties), work productivity and activity impairment, and self‐reported healthcare resource utilization. Bivariate and multivariate analyses for each outcome and comparative groups were conducted. Results This analysis included 769 CU and 7857 PsO (26.9% moderate/severe) patients. Following adjustment for covariates, CU patients showed a greater health‐related quality of life (HRQoL) impairment vs. overall PsO (MCS: −2.4, PCS: −1.6, SF‐6D: −0.03; all P < 0.001). CU patients showed a higher risk of anxiety, depression and sleep difficulties [odds ratio (OR): 1.63, 1.34 and 1.56, respectively; all P < 0.01] and greater healthcare resource use vs. overall PsO. The overall activity impairment was significantly greater in CU patients than in overall PsO patients (P = 0.001), while the impact on work was not significantly different. The results vs. moderate/severe PsO group showed no significant differences on all outcomes. Conclusion Burden of illness in CU is higher than PsO of all severities but similar to that observed in moderate/severe PsO. Both diseases have a similar negative impact on work productivity.
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Affiliation(s)
- M M Balp
- Novartis Pharma AG, Basel, Switzerland
| | - S Khalil
- Novartis Pharma AG, Basel, Switzerland
| | - H Tian
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Gabriel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - T Zuberbier
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Moreddu E, Baumstarck-Barrau K, Gabriel S, Fakhry N, Sebag F, Mundler O, Chossegros C, Taïeb D. Incidence of salivary side effects after radioiodine treatment using a new specifically-designed questionnaire. Br J Oral Maxillofac Surg 2017; 55:609-612. [DOI: 10.1016/j.bjoms.2017.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/28/2017] [Indexed: 11/16/2022]
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Szende A, Bussey B, Szabo E, Klastersky J, Tomey O, Mueller U, Gabriel S, Tang B. Budgetary impact of lipegfilgrastim to the Mexican healthcare system. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maurer M, Sofen H, Ortiz B, Kianifard F, Gabriel S, Bernstein JA. Positive impact of omalizumab on angioedema and quality of life in patients with refractory chronic idiopathic/spontaneous urticaria: analyses according to the presence or absence of angioedema. J Eur Acad Dermatol Venereol 2017; 31:1056-1063. [PMID: 27911016 PMCID: PMC6084322 DOI: 10.1111/jdv.14075] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/22/2016] [Indexed: 11/30/2022]
Abstract
Background Approximately 50% of patients with chronic idiopathic/spontaneous urticaria (CIU/CSU) report hives and angioedema; some experience hives/angioedema only. Objective Assess omalizumab's effect on angioedema and quality of life (QoL) in subgroups with refractory CIU/CSU: those with and without angioedema. Methods Patients received omalizumab (75, 150 or 300 mg) or placebo every 4 weeks for 12/24 weeks. Angioedema and QoL were assessed [Urticaria Patient Daily Diary and Dermatology Quality of Life Index (DLQI)]. Subgroups were based on the presence/absence of baseline angioedema 7 days prior to randomization. Results Patients with baseline angioedema randomized to omalizumab 300 mg had a greater reduction in mean weekly incidence of angioedema and mean number of days/week with angioedema vs. placebo at 12 and 24 weeks. A 3.3‐ to 4.5‐point greater mean reduction in DLQI score was achieved with omalizumab 300 mg treatment vs. placebo, above the minimal clinically important difference threshold. Results with lower doses vs. placebo were variable. Conclusion Compared with placebo, omalizumab 300 mg treatment over 12–24 weeks resulted in marked reduction in incidence and number of days/week with angioedema accompanied by clinically relevant improvement in QoL.
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Affiliation(s)
- M Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité at the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - H Sofen
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - B Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - F Kianifard
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Gabriel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - J A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Bergamasco A, Dinet J, Berthon A, Gabriel S, Nayroles G, Moride Y. Prevalence of gastroenteropancreatic and lung neuroendocrine tumours in the European Union. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.09] [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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Rickard CM, Edwards M, Spooner AJ, Mihala G, Marsh N, Best J, Wendt T, Rapchuk I, Gabriel S, Thomson B, Corley A, Fraser JF. A 4-arm randomized controlled pilot trial of innovative solutions for jugular central venous access device securement in 221 cardiac surgical patients. J Crit Care 2016; 36:35-42. [PMID: 27546745 DOI: 10.1016/j.jcrc.2016.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/16/2016] [Accepted: 06/06/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To improve jugular central venous access device (CVAD) securement, prevent CVAD failure (composite: dislodgement, occlusion, breakage, local or bloodstream infection), and assess subsequent trial feasibility. MATERIALS AND METHODS Study design was a 4-arm, parallel, randomized, controlled, nonblinded, pilot trial. Patients received CVAD securement with (i) suture+bordered polyurethane (suture + BPU; control), (ii) suture+absorbent dressing (suture + AD), (iii) sutureless securement device+simple polyurethane (SSD+SPU), or (iv) tissue adhesive+simple polyurethane (TA+SPU). Midtrial, due to safety, the TA+SPU intervention was replaced with a suture + TA+SPU group. RESULTS A total of 221 patients were randomized with 2 postrandomization exclusions. Central venous access device failure was as follows: suture + BPU controls, 2 (4%) of 55 (0.52/1000 hours); suture + AD, 1 (2%) of 56 (0.26/1000 hours, P=.560); SSD+SPU, 4 (7%) of 55 (1.04/1000 hours, P=.417); TA+SPU, 4 (17%) of 23 (2.53/1000 hours, P=.049); and suture + TA+SPU, 0 (0%) of 30 (P=.263; intention-to-treat, log-rank tests). Central venous access device failure was predicted (P<.05) by baseline poor/fair skin integrity (hazard ratio, 9.8; 95% confidence interval, 1.2-79.9) or impaired mental state at CVAD removal (hazard ratio, 14.2; 95% confidence interval, 3.0-68.4). CONCLUSIONS Jugular CVAD securement is challenging in postcardiac surgical patients who are coagulopathic and mobilized early. TA+SPU was ineffective for CVAD securement and is not recommended. Suture + TA+SPU appeared promising, with zero CVAD failure observed. Future trials should resolve uncertainty about the comparative effect of suture + TA+SPU, suture + AD, and SSD+SPU vs suture + BPU.
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Affiliation(s)
- C M Rickard
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia.
| | - M Edwards
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - A J Spooner
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - G Mihala
- Centre for Applied Health Economics, Menzies Health Institute Queensland, School of Medicine, Griffith University, Meadowbrook, 4131, Queensland, Australia.
| | - N Marsh
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, 4006, Queensland, Australia.
| | - J Best
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - T Wendt
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - I Rapchuk
- Department of Anaesthesia, The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - S Gabriel
- Cardiac Surgery Research Unit, The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - B Thomson
- Department of Cardiac Surgery, The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - A Corley
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - J F Fraser
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
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Kasar S, Kim J, Improgo R, Tiao G, Polak P, Haradhvala N, Lawrence MS, Kiezun A, Fernandes SM, Bahl S, Sougnez C, Gabriel S, Lander ES, Kim HT, Getz G, Brown JR. Whole-genome sequencing reveals activation-induced cytidine deaminase signatures during indolent chronic lymphocytic leukaemia evolution. Nat Commun 2015; 6:8866. [PMID: 26638776 PMCID: PMC4686820 DOI: 10.1038/ncomms9866] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/08/2015] [Indexed: 12/17/2022] Open
Abstract
Patients with chromosome 13q deletion or normal cytogenetics represent the majority of chronic lymphocytic leukaemia (CLL) cases, yet have relatively few driver mutations. To better understand their genomic landscape, here we perform whole-genome sequencing on a cohort of patients enriched with these cytogenetic characteristics. Mutations in known CLL drivers are seen in only 33% of this cohort, and associated with normal cytogenetics and unmutated IGHV. The most commonly mutated gene in our cohort, IGLL5, shows a mutational pattern suggestive of activation-induced cytidine deaminase (AID) activity. Unsupervised analysis of mutational signatures demonstrates the activities of canonical AID (c-AID), leading to clustered mutations near active transcriptional start sites; non-canonical AID (nc-AID), leading to genome-wide non-clustered mutations, and an ageing signature responsible for most mutations. Using mutation clonality to infer time of onset, we find that while ageing and c-AID activities are ongoing, nc-AID-associated mutations likely occur earlier in tumour evolution. The oncogenic events driving indolent chronic lymphocytic leukaemia are relatively unknown. Here, the authors perform whole genome sequencing on 30 such tumours and identify recurrent mutations in IGLL5 and two activation induced cytidine deaminase signatures that are operative at different stages of CLL evolution.
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Affiliation(s)
- S Kasar
- Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
| | - J Kim
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
| | - R Improgo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
| | - G Tiao
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
| | - P Polak
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
| | - N Haradhvala
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
| | - M S Lawrence
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
| | - A Kiezun
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
| | - S M Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
| | - S Bahl
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
| | - C Sougnez
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
| | - S Gabriel
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
| | - E S Lander
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
| | - H T Kim
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - G Getz
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA.,Department of Pathology and Cancer Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.,Department of Pathology, Harvard Medical School, Boston, Massachusetts 02215, USA
| | - J R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
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Srinivasan S, Kroeker RM, Gabriel S, Plotnik A, Godinez SR, Hu P, Halnon N, Finn JP, Ennis DB. Free-breathing variable flip angle balanced SSFP cardiac cine imaging with reduced SAR at 3T. Magn Reson Med 2015; 76:1210-6. [PMID: 26509846 DOI: 10.1002/mrm.26011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 11/08/2022]
Abstract
PURPOSE To develop a free-breathing variable flip angle (VFA) balanced steady-state free precession (bSSFP) cardiac cine imaging technique with reduced specific absorption rate (SAR) at 3 Tesla. METHODS Free-breathing VFA (FB-VFA) images in the short-axis and four-chamber views were acquired using an optimal VFA scheme, then compared with conventional breath-hold constant flip angle (BH-CFA) acquisitions. Two cardiac MRI experts used a 5-point scale to score images from healthy subjects (N = 10). The left ventricular ejection fraction, end diastolic volume (LVEDV), end systolic volume, stroke volume (LVSV), and end diastolic myocardial mass (LVEDM) were determined by manual contour analysis for BH-CFA and FB-VFA. A pilot evaluation of FB-VFA was performed in one patient with Duchenne muscular dystrophy. RESULTS FB-VFA SAR was 25% lower than BH-CFA with similar blood-myocardium contrast. The qualitative FB-VFA score was lower than the BH-CFA for the short-axis (3.1 ± 0.5 versus 4.3 ± 0.8; P < 0.05) and the four-chamber view (3.4 ± 0.4 versus 4.6 ± 0.6; P < 0.05). The LVEDV and the LVSV were 5% and 12% larger (P < 0.05) for FB-VFA compared with BH-CFA. There was no difference in LVEDM. CONCLUSION FB-VFA bSSFP cardiac cine imaging decreased the SAR at 3T with image quality sufficient to perform cardiac functional analysis. Magn Reson Med 76:1210-1216, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Subashini Srinivasan
- Department of Radiological Sciences, University of California, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | | | - Simon Gabriel
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Adam Plotnik
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Sergio R Godinez
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Peng Hu
- Department of Radiological Sciences, University of California, Los Angeles, California, USA.,Biomedical Physics Interdepartmental Program, University of California, Los Angeles, California, USA
| | - Nancy Halnon
- Department of Pediatrics, University of California, Los Angeles, California, USA
| | - J Paul Finn
- Department of Radiological Sciences, University of California, Los Angeles, California, USA.,Biomedical Physics Interdepartmental Program, University of California, Los Angeles, California, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, University of California, Los Angeles, California, USA. .,Department of Bioengineering, University of California, Los Angeles, California, USA. .,Biomedical Physics Interdepartmental Program, University of California, Los Angeles, California, USA.
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Han F, Rapacchi S, Khan S, Ayad I, Salusky I, Gabriel S, Plotnik A, Finn JP, Hu P. Four-dimensional, multiphase, steady-state imaging with contrast enhancement (MUSIC) in the heart: a feasibility study in children. Magn Reson Med 2015; 74:1042-9. [PMID: 25302932 DOI: 10.1002/mrm.25491] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/09/2014] [Accepted: 09/21/2014] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop a technique for high resolution, four-dimensional (4D), multiphase, steady-state imaging with contrast enhancement (MUSIC) in children with complex congenital heart disease. METHODS Eight pediatric patients underwent cardiovascular MRI with controlled mechanical ventilation after ferumoxytol administration. Breath-held contrast-enhanced MRA (CE-MRA) was performed during the first-pass and delayed phases of ferumoxytol, followed by a respiratory gated, 4D MUSIC acquisition during the steady state distribution phase of ferumoxytol. The subjective image quality and image sharpness were evaluated. Assessment of ventricular volumes based on 4D MUSIC was compared with those based on multislice 2D cardiac cine MRI. RESULTS The 4D MUSIC technique provided cardiac-phase-resolved (65-95 ms temporal resolution) and higher spatial resolution (0.6-0.9 mm isotropic) images than previously achievable using first-pass CE-MRA or 2D cardiac cine. When compared with Ferumoxytol-based first-pass CE-MRA, the 4D MUSIC provided sharper images and better definition of the coronary arteries, aortic root, myocardium, and pulmonary trunk (P < 0.05 for all). The ventricular volume measurements were in good agreement between 4D MUSIC and 2D cine (concordance correlation coefficient >0.95). CONCLUSION The 4D MUSIC technique may represent a new paradigm in MR evaluation of cardiovascular anatomy and function in children with complex congenital heart disease.
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Affiliation(s)
- Fei Han
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Stanislas Rapacchi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Sarah Khan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ihab Ayad
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Isidro Salusky
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Simon Gabriel
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Adam Plotnik
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - J Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, California, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, California, USA
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Gabriel S, Sullivan E, Roughley A, Palmer J, Herrera V. AB0809 Unmet Needs Still Remain in the Biologic Therapy Options for Psoriatic Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
The quadricuspid aortic valve is a very rare congenital defect that may be an isolated entity or associated with a multitude of cardiovascular abnormalities. Isolated cases usually manifest late in life with the complication of aortic regurgitation, which can be delayed by early valve replacement. We present a case of quadricuspid aortic valve associated with truncus arteriosus, ventricular septal defect, and interrupted aortic arch.
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Affiliation(s)
- Arie Franco
- Department of radiology, University of California, Los Angeles, USA
| | - Simon Gabriel
- Department of radiology, University of California, Los Angeles, USA
| | - Stefan G Ruehm
- Department of radiology, University of California, Los Angeles, USA
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Kim H, Zheng S, Amini S, Virk S, Mikkelsen T, Brat D, Sougnez C, Muller F, Hu J, Sloan A, Cohen M, Van Meir E, Scarpace L, Lander E, Gabriel S, Getz G, Meyerson M, Chin L, Barnholtz-Sloan J, Verhaak R. GE-17 * ALTERATION OF THE p53 PATHWAY AND ANCESTRAL PROGENITORS ARE ASSOCIATED WITH TUMOR RECURRENCE IN GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou256.17] [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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Chuang CC, Dinet J, Bhurke S, Chen SY, Gabriel S. What are the Health Care Resource Utilization and Medical Cost of Untreated Patients with Neuroendocrine Tumors in the United States? Value Health 2014; 17:A656-A657. [PMID: 27202376 DOI: 10.1016/j.jval.2014.08.2398] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - J Dinet
- IPSEN Pharma, Boulogne-Billancourt, France
| | | | | | - S Gabriel
- IPSEN Pharma, Boulogne Billancourt, France
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40
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Marteau F, Gimonet G, Gabriel S, Dinet J, Flinois A, LE Cleac'h JY. Epidemiology of Patients with Metastatic Castrate Resistant Prostate Cancer in Europe and Australia. Value Health 2014; 17:A619. [PMID: 27202173 DOI: 10.1016/j.jval.2014.08.2188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- F Marteau
- IPSEN Pharma, Boulogne-Billancourt, France
| | - G Gimonet
- IPSEN Pharma, Boulogne-Billancourt, France
| | - S Gabriel
- IPSEN Pharma, Boulogne Billancourt, France
| | - J Dinet
- IPSEN Pharma, Boulogne-Billancourt, France
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Mouw K, Van Allen E, O’Connor K, Wagle N, Kim P, Al-Ahmadie H, Zhu C, Ostravnaya I, Iyer G, Signoretti S, Reuter V, Getz G, Kantoff P, Bochner B, Choueiri T, Bajorin D, Gabriel S, D’Andrea A, Garraway L, Rosenberg J. Somatic ERCC2 Mutations Confer Cisplatin Sensitivity in Muscle-Invasive Urothelial Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.481] [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]
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42
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Rapacchi S, Natsuaki Y, Plotnik A, Gabriel S, Laub G, Finn JP, Hu P. Reducing view-sharing using compressed sensing in time-resolved contrast-enhanced magnetic resonance angiography. Magn Reson Med 2014; 74:474-81. [PMID: 25157749 DOI: 10.1002/mrm.25414] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/23/2014] [Accepted: 07/25/2014] [Indexed: 11/11/2022]
Abstract
PURPOSE To study temporal and spatial blurring artifacts from k-space view-sharing in time-resolved MR angiography (MRA) and to propose a technique for reducing these artifacts. METHODS We acquired k-space data sets using a three-dimensional time-resolved MRA view-sharing sequence and retrospectively reformatted them into two reconstruction frameworks: full view-sharing via time-resolved imaging with stochastic trajectories (TWIST) and minimal k-space view-sharing and compressed sensing (CS-TWIST). The two imaging series differed in temporal footprint but not in temporal frame rate. The artifacts from view-sharing were compared qualitatively and quantitatively in nine patients in addition to a phantom experiment. RESULTS CS-TWIST was able to reduce the imaging temporal footprint by two- to three-fold compared with TWIST, and the overall subjective image quality of CS-TWIST was higher than that for TWIST (P < 0.05). View sharing caused a delay in the visualization of small blood vessels, and the mean transit time of the carotid artery calculated based on TWIST reconstruction was 0.6 s longer than that for CS-TWIST (P < 0.01). In thoracic MRA, the shorter temporal footprint decreased the sensitivity to physiological motion blurring, and vessel sharpness was improved by 8.8% ± 6.0% using CS-TWIST (P < 0.05). CONCLUSION In time-resolved MRA, the longer temporal footprint due to view-sharing causes spatial and temporal artifacts. CS-TWIST is a promising method for reducing these artifacts.
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Affiliation(s)
- Stanislas Rapacchi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Adam Plotnik
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Simon Gabriel
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Gerhard Laub
- Siemens Healthcare, Los Angeles, California, USA
| | - J Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Gabriel S, Eckel LJ, DeLone DR, Krecke KN, Luetmer PH, McCollough CH, Fletcher JG, Yu L. Pilot study of radiation dose reduction for pediatric head CT in evaluation of ventricular size. AJNR Am J Neuroradiol 2014; 35:2237-42. [PMID: 25082822 DOI: 10.3174/ajnr.a4056] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE CT is a ubiquitous, efficient, and cost-effective method to evaluate pediatric ventricular size, particularly in patients with CSF shunt diversion who often need emergent imaging. We therefore sought to determine the minimum dose output or CT dose index required to produce clinically acceptable examinations. MATERIALS AND METHODS Using a validated noise insertion method and CT projection data from 22 patients, standard pediatric head CT images were reconstructed with weighted filtered back-projection and sinogram-affirmed iterative reconstruction corresponding to routine, 25%, and 10% dose. Reconstructed images were then evaluated by 3 neuroradiologists (blinded to dose and reconstruction method) for ventricular size, diagnostic confidence, image quality, evidence of hemorrhage, and shunt tip location, and compared with the reference standard. RESULTS There was no significant difference in the ventricular size ranking, and the sensitivity for moderate to severe hydrocephalus was 100%. There was no significant difference between the full-dose level and the ventricular size rankings at the 25% or the 10% dose level for either reconstruction kernel (P > .979). Diagnostic confidence was maintained across doses and kernel. Hemorrhage was more difficult to identify as image quality degraded as dose decreased but was still seen in a majority of cases. Shunts were identified by all readers across all doses and reconstruction methods. CONCLUSIONS CT images having dose reductions of 90% relative to routine head CT examinations provide acceptable image quality to address the specific clinical task of evaluating ventricular size.
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Affiliation(s)
- S Gabriel
- From the Department of Radiology (S.G.), University of California Los Angeles, Los Angeles, California
| | - L J Eckel
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota.
| | - D R DeLone
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - K N Krecke
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - P H Luetmer
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - C H McCollough
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - J G Fletcher
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - L Yu
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
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Verhaak RGW, Kim H, Zheng S, Amini SS, Virk SM, Mikkelsen T, Brat DJ, Grimsby J, Sougnez C, Muller F, Hu J, Sloan AE, Cohen ML, Van Meir EG, Scarpace L, Laird PW, Weinstein JN, Lander E, Gabriel S, Getz G, Meyerson M, Chin L, Barnholtz-Sloan JS. THE P53 PATHWAY AND ANCESTRAL PROGENITORS ARE ASSOCIATED WITH TUMOR RECURRENCE IN GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou206.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Abstract
On the basis of the perimeter model for 4N-electron [n]annulenes, algebraic expressions for the B values of perturbed four-membered rings (n = 4) with four ;r electrons (N = 1) have been derived. The results are used to interpret the MCD spectrum of l,3-di-fm-butyl-2,4-diethyI-1,3,2,4-diazadiboretidine.
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Affiliation(s)
- J. Fleischhauer
- Lehr- und Forschungsgebiet Theoretische Chemie der RWTH Aachen, Prof. Pirletstr. 1, D-52076 Aachen
| | - P. Laura
- Institut für Anorganische Chemie der RWTH Aachen, Prof. Pirletstr. 1, D-52076 Aachen
| | - P. Paetzold
- Institut für Anorganische Chemie der RWTH Aachen, Prof. Pirletstr. 1, D-52076 Aachen
| | - S. Gabriel
- Lehr- und Forschungsgebiet Theoretische Chemie der RWTH Aachen, Prof. Pirletstr. 1, D-52076 Aachen
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Bittencourt N, Ocarino J, Sorrentino F, Jales F, Gabriel S, Mendonça L, Fonseca S. NORMATIVE DATA FOR MUSCLE FLEXIBILITY IN MALE SOCCER PLAYERS. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brown M, Sheppeard V, Gabriel S, Thomas J. Description of the Western Sydney and Nepean Blue Mountains local health districts' influenza prevention programme. Intern Med J 2014; 43:760-6. [PMID: 23656638 DOI: 10.1111/imj.12175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 04/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Influenza is a major cause of morbidity and mortality. In 2011, influenza vaccination was provided free for people at greatest risk of severe disease: people aged 65 years and over, Aboriginal Australians 15 years and older, pregnant women, and individuals aged 6 months and over who suffered chronic medical conditions. AIMS To evaluate the Western Sydney and Nepean Blue Mountains Local Health District Influenza Prevention Program and to identify some of the enablers and barriers to vaccination in the hospital outpatient setting. METHODS Western Sydney and Nepean Blue Mountains local health districts' influenza prevention programme provided influenza vaccine in hospital outpatient settings between 21 March 2011 and 30 June 2011. Accredited nurse immunisers vaccinated 2824 individuals and recorded their primary reason for vaccination. Nurse immunisers were interviewed to identify barriers and enablers to influenza immunisation uptake. RESULTS Two thousand, eight hundred and twenty-four doses of influenza vaccine were administered to people at high risk of influenza in four hospitals in the region: two tertiary facilities and two district hospitals. The primary indication for vaccination was chronic disease in 50% and pregnancy in 37%. Estimated direct cost of the programme was $19 per dose. CONCLUSIONS A hospital-based influenza vaccination programme can be an effective way to improve influenza vaccination rates among specific population groups at high risk of severe disease with influenza, particularly pregnant women and those younger than 65 years with a chronic medical condition.
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Affiliation(s)
- M Brown
- Public Health Unit, Nepean Blue Mountains and Western Sydney, and Community Paediatrics Department, Liverpool Hospital, Sydney, New South Wales, Australia.
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Villanueva C, Ranawaka Y, Pearse B, Gabriel S, McGree J, Wall D, Tesar P. Impact of Preoperative Serum Creatinine on Isolated Elective Aortic Valve Replacements. Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2013.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ranawaka Y, Villanueva C, Pearse B, Gabriel S, McGree J, Nair L, Thompson H, Wall D, Tesar P. The Influence of Preoperative Anaemia on Postoperative Outcomes in First Time Elective Isolated Aortic Valve Replacement Surgery in the Prince Charles Hospital: A Ten-Year Review. Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2013.10.034] [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]
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Merzak F, Berkovic P, Verhoeven K, Gabriel S, Van de Voorde L, Dirix P, Moretti L, Scalliet P, Van Houtte P. Radiothérapie après chirurgie conservatrice du cancer du sein : résultats d’une enquête multicentrique sur la pratique en Belgique. Cancer Radiother 2013. [DOI: 10.1016/j.canrad.2013.07.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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