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Dong W, Thorne T, Da Silva Z, Dauk M, Marchand L, Rothberg D, Higgins T, Haller J. Patient-Reported Outcome Measurement Information Systems Physical Function and Pain Interference Scores Are Correlated With Tibial Shaft Fracture Nonunion Following Intramedullary Nailing. J Orthop Trauma 2024; 38:201-206. [PMID: 38470150 DOI: 10.1097/bot.0000000000002799] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/05/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES To assess trends in Patient-Reported Outcome Measurement Information Systems (PROMIS) Physical Function (PF) and Pain Interference (PI) in surgically treated tibial shaft fracture patients progressing to union versus nonunion. METHODS DESIGN Retrospective cohort study. SETTING Level 1 trauma center. PATIENT SELECTION CRITERIA Patients with operatively treated tibial shaft fractures (AO/OTA 42-A, B, C) using an intramedullary nail. OUTCOME MEASURES AND COMPARISONS PROMIS PF and PI were compared between patients progressing to union and patients requiring nonunion repair. RESULTS A total of 234 patients (196 union, 38 nonunion) were included consisting 144 men and 90 women. The mean age of included patients was 40.8 years. A significant difference in mean PROMIS PF between union and nonunion patients was observed at 1-3 months ( P = 0.005), 3-6 months ( P < 0.001), 6-9 months ( P = 0.003), and 6-12 months ( P = 0.018). The odds of developing nonunion for every unit decrease in PROMIS PF was significant at 3-6 months (OR 1.07, P = 0.028) and 6-9 months (OR 1.17, P = 0.015). A significant difference in mean PROMIS PI between union and nonunion patients was observed at 1-3 months ( P = 0.001), 3-6 months ( P = 0.005), and 6-9 months ( P = 0.005). The odds of developing nonunion for every unit increase in PROMIS PI was significant at 1-3 months (OR 1.11, P = 0.005), 3-6 months (OR 1.10, P = 0.011), and 6-9 months (OR 1.23, P = 0.011). CONCLUSIONS Poorly trending PROMIS PF and PI in the clinical setting is a factor that can be used to evaluate progression to nonunion following tibial shaft repair where imaging studies may lag behind. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Willie Dong
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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Smittenaar R, Quaife SL, von Wagner C, Higgins T, Hubbell E, Lee L. Impact of screening participation on modelled mortality benefits of a multi-cancer early detection test by socioeconomic group in England. J Epidemiol Community Health 2024; 78:345-353. [PMID: 38429085 DOI: 10.1136/jech-2023-220834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/10/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Cancer burden is higher and cancer screening participation is lower among individuals living in more socioeconomically deprived areas of England, contributing to worse health outcomes and shorter life expectancy. Owing to higher multi-cancer early detection (MCED) test sensitivity for poor-prognosis cancers and greater cancer burden in groups experiencing greater deprivation, MCED screening programmes may have greater relative benefits in these groups. We modelled potential differential benefits of MCED screening between deprivation groups in England at different levels of screening participation. METHODS We applied the interception multi-cancer screening model to cancer incidence and survival data made available by the National Cancer Registration and Analysis Service in England to estimate reductions in late-stage diagnoses and cancer mortality from an MCED screening programme by deprivation group across 24 cancer types. We assessed the impact of varying the proportion of people who participated in annual screening in each deprivation group on these estimates. RESULTS The modelled benefits of an MCED screening programme were substantial: reductions in late-stage diagnoses were 160 and 274 per 100 000 persons in the least and most deprived groups, respectively. Reductions in cancer mortality were 60 and 99 per 100 000 persons in the least and most deprived groups, respectively. Benefits were greatest in the most deprived group at every participation level and were attenuated with lower screening participation. CONCLUSIONS For the greatest possible population benefit and to decrease health inequalities, an MCED implementation strategy should focus on enhancing equitable, informed participation, enabling equal participation across all socioeconomic deprivation groups. TRIAL REGISTRATION NUMBER NCT05611632.
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Affiliation(s)
| | | | | | - Thomas Higgins
- National Cancer Registration and Analysis Service, Leeds, UK
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Dong W, Sroka O, Campbell M, Thorne T, Siebert M, Rothberg D, Higgins T, Haller J, Marchand L. Recovery Curves for Lisfranc ORIF Using PROMIS Physical Function and Pain Interference. J Orthop Trauma 2024; 38:e175-e181. [PMID: 38381118 DOI: 10.1097/bot.0000000000002787] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To determine the postoperative trajectory and recovery of patients who undergo Lisfranc open reduction and internal fixation using Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI). METHODS DESIGN Retrospective cohort study. SETTING Level 1 trauma center. PATIENT SELECTION CRITERIA Patients who underwent Lisfranc open reduction and internal fixation between January 2002 and December 2022 with documented PROMIS PF and/or PI scores after surgery. OUTCOME MEASURES AND COMPARISONS PROMIS PF and PI were mapped over time up to 1 year after surgery. A subanalysis was performed to compare recovery trajectories between high-energy and low-energy injuries. RESULTS A total of 182 patients were included with average age of 38.7 (SD 15.9) years (59 high-energy and 122 low-energy injuries). PROMIS PF scores at 0, 6, 12, 24, and 48 weeks were 30.2, 31.4, 39.2, 43.9, and 46.7, respectively. There was significant improvement in PROMIS PF between 6 and 12 weeks ( P < 0.001), 12-24 weeks ( P < 0.001), and 24-48 weeks ( P = 0.022). A significant difference in PROMIS PF between high and low-energy injuries was seen at 0 week (28.4 vs. 31.4, P = 0.010). PROMIS PI scores at 0, 6, 12, 24, and 48 weeks were 62.2, 58.5, 56.6, 55.7, and 55.6, respectively. There was significant improvement in PROMIS PI 0-6 weeks ( P = 0.016). A significant difference in PROMIS PI between high-energy and low-energy injuries was seen at 48 weeks with scores of (58.6 vs. 54.2, P = 0.044). CONCLUSIONS After Lisfranc open reduction and internal fixation, patients can expect improvement in PF up to 1 year after surgery, with the biggest improvement in PROMIS PF scores between 6 and 12 weeks and PROMIS PI scores between 0 and 6 weeks after surgery. Regardless the energy type, Lisfranc injuries seem to regain comparable PF by 6-12 months after surgery. However, patients with higher energy Lisfranc injuries should be counseled that these injuries may lead to worse PI at 1 year after surgery as compared with lower energy injuries. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Willie Dong
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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4
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Broughan JM, Martin D, Higgins T, Swan G, Cullum A, Kurinczuk JJ, Draper ES, Luyt K, Wellesley DG, Stevens S, Tedstone A, Rankin J. Prevalence of neural tube defects in England prior to the mandatory fortification of non-wholemeal wheat flour with folic acid: a population-based cohort study. Arch Dis Child 2024; 109:106-112. [PMID: 37875332 PMCID: PMC10850651 DOI: 10.1136/archdischild-2023-325856] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES To determine the baseline trends in the total birth prevalence of neural tube defects (NTDs) in England (2000-2019) to enable the impact of folic acid fortification of non-wholemeal wheat flour to be monitored. DESIGN Population-based, observational study using congenital anomaly (CA) registration data for England curated by the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS). SETTING Regions of England with active registration in the time period. PARTICIPANTS Babies that were liveborn or stillborn and pregnancies that resulted in a termination of pregnancy or a late miscarriage (20-23 weeks' gestation) with an NTD. MAIN OUTCOME MEASURES Total birth prevalence of anencephaly, spina bifida and all NTDs in England. Poisson regression analysis was used to evaluate time trends with regional register as a random effect. The progress of national registration across England was assessed. RESULTS There were 4541 NTD pregnancies out of 3 637 842 births in England; 1982 anencephaly and 2127 spina bifida. NTD prevalence was 12.5 (95% CI 12.1 to 12.9) per 10 000 total births. NTD prevalence per 10 000 total births was significantly higher in 2015-2019 (13.6, 95% CI 12.9 to 14.4) compared with 2010-2014 (12.1, 95% CI 11.7 to 12.5). An increasing trend in NTDs overall was detected (incidence rate ratio (IRR) 1.01, 1.00 to 1.02), although further analysis determined this effect was confined to 2015-2019 (compared against 2000-2004, IRR 1.14, 1.04 to 1.24). The birth prevalence of anencephaly reflected this pattern. The prevalence of spina bifida remained relatively stable over time. CONCLUSIONS Baseline NTD prevalence for England has been established. National and standardised CA registration is in place, facilitating the systematic and consistent monitoring of pre-fortification and post-fortification NTD trends and evaluating the impact of fortification on NTD prevalence.
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Affiliation(s)
| | - Danielle Martin
- National Disease Registration Service (NDRS), NHS England, Redditch, UK
| | - Thomas Higgins
- National Disease Registration Service (NDRS), NHS England, Redditch, UK
| | - Gillian Swan
- Office for Health Improvement and Disparities, United Kingdom Department of Health and Social Care, London, UK
| | - Adrienne Cullum
- Office for Health Improvement and Disparities, United Kingdom Department of Health and Social Care, London, UK
| | | | | | - Karen Luyt
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Sarah Stevens
- National Disease Registration Service (NDRS), NHS England, Redditch, UK
| | - Alison Tedstone
- Office for Health Improvement and Disparities, United Kingdom Department of Health and Social Care, London, UK
| | - Judith Rankin
- National Disease Registration Service (NDRS), NHS England, Redditch, UK
- Institute of Health & Society, Newcastle University, Newcastle, UK
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Deshpande A, Klompas M, Guo N, Imrey PB, Pallotta AM, Higgins T, Haessler S, Zilberberg MD, Lindenauer PK, Rothberg MB. Intravenous to Oral Antibiotic Switch Therapy Among Patients Hospitalized With Community-Acquired Pneumonia. Clin Infect Dis 2023; 77:174-185. [PMID: 37011018 PMCID: PMC10527888 DOI: 10.1093/cid/ciad196] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/09/2023] [Accepted: 03/30/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a leading cause of hospital admissions and antimicrobial use. Clinical practice guidelines recommend switching from intravenous (IV) to oral antibiotics once patients are clinically stable. METHODS We conducted a retrospective cohort study of adults admitted with CAP and initially treated with IV antibiotics at 642 US hospitals from 2010 through 2015. Switching was defined as discontinuation of IV and initiation of oral antibiotics without interrupting therapy. Patients switched by hospital day 3 were considered early switchers. We compared length of stay (LOS), in-hospital 14-day mortality, late deterioration (intensive care unit [ICU] transfer), and hospital costs between early switchers and others, controlling for hospital characteristics, patient demographics, comorbidities, initial treatments, and predicted mortality. RESULTS Of 378 041 CAP patients, 21 784 (6%) were switched early, most frequently to fluoroquinolones. Patients switched early had fewer days on IV antibiotics, shorter duration of inpatient antibiotic treatment, shorter LOS, and lower hospitalization costs, but no significant excesses in 14-day in-hospital mortality or late ICU admission. Patients at a higher mortality risk were less likely to be switched. However, even in hospitals with relatively high switch rates, <15% of very low-risk patients were switched early. CONCLUSIONS Although early switching was not associated with worse outcomes and was associated with shorter LOS and fewer days on antibiotics, it occurred infrequently. Even in hospitals with high switch rates, <15% of very low-risk patients were switched early. Our findings suggest that many more patients could be switched early without compromising outcomes.
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Affiliation(s)
- Abhishek Deshpande
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ning Guo
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter B Imrey
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Thomas Higgins
- Department of Medicine, Division of Pulmonary Critical Care Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Sarah Haessler
- Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | | | - Peter K Lindenauer
- Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
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Myhre L, Featherall J, O’Neill D, Rothberg D, Haller J, Higgins T, Marchand L. Patient-reported Anxiety Scores Are Associated With Lower Physical Function in Patients Experiencing Orthopaedic Trauma. Clin Orthop Relat Res 2023; 481:967-973. [PMID: 36728246 PMCID: PMC10097580 DOI: 10.1097/corr.0000000000002516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The outcomes of orthopaedic trauma are not solely determined by injury severity or surgical treatment. Studies of numerous orthopaedic outcomes have found that psychosocial factors are also important. Symptoms of anxiety have been linked to long-term pain and disability. Although the existence of a relationship between psychosocial factors and functional outcomes is accepted across multiple disciplines, quantification of this association in patients who have experienced orthopaedic trauma has remained limited. Measuring the anxiety experienced by these individuals and the association with long-term functional outcomes remain poorly understood. QUESTIONS/PURPOSES (1) Is there an association between early postoperative anxiety symptoms and late recovery of self-reported physical function in patients with orthopaedic trauma? (2) What was the impact of other factors such as demographic variables and comorbidities on late recovery physical function scores, and how did the magnitude of these factors compare with the association with anxiety score? (3) Did patients who presented as trauma activations differ regarding their anxiety symptoms and late-recovery self-reported physical function? METHODS A total of 1550 patients with lower extremity fractures and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and physical function scores treated between January 1, 2014, and January 1, 2021, at an academic Level I trauma center in North America were assessed. We performed a bivariate regression between the initial PROMIS anxiety and physical function, as well as a multivariate regression including age, gender, BMI, and American Society of Anesthesiologists class to control for potential confounding variables. In a subgroup of 787 patients presenting as trauma activations, we performed a separate regression including Injury Severity Score. RESULTS PROMIS anxiety was associated with decreased late-recovery physical function (β = -2.64 [95% CI -3.006 to -2.205]; p < 0.001). The relationship between PROMIS anxiety and physical function remained after controlling for confounding variables in our overall cohort (β = -2.54 [95% CI -2.93 to -2.15]; p < 0.001) and in the trauma activation cohort (β = -2.71 [95% CI -3.19 to -2.23]; p < 0.001). Age and American Society of Anesthesiologists score were associated with worse PROMIS physical function scores, while being a man was associated with better PROMIS physical function scores (age: β= -1.26 [95% CI -1.50 to -1.02]; American Society of Anesthesiologists class: β=-2.99 [95% CI -3.52 to -2.46]; men: β = 0.95 [95% CI 0.16 to 1.75]). There were no differences in initial anxiety symptoms or late-recovery physical function between patients who presented as trauma activations and those who did not. Injury Severity Scores were independently associated with worse function (β = -1.45 [95% CI -2.11 to -0.79]. CONCLUSION Initial patient self-reported anxiety is negatively associated with patient-reported physical function at the final follow-up interval in a broad cohort of patients with orthopaedic lower extremity injuries undergoing surgery. Identifying patients with high initial PROMIS anxiety scores may allow us to determine which patients will report lower functional scores at the final follow-up. Future investigations could focus on the effect of psychosocial interventions such as cognitive behavioral therapy and mindfulness on functional scores. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Luke Myhre
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Joseph Featherall
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Dillon O’Neill
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - David Rothberg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Justin Haller
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Thomas Higgins
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Lucas Marchand
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Boissonneault A, O Hara N, Pogorzelski D, Marchand L, Higgins T, Gitajn L, Gage MJ, Natoli RM, Sharma I, Pierrie S, O'Toole RV, Sprague S, Slobogean G. The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes. Injury 2023; 54:S0020-1383(23)00197-3. [PMID: 37002119 PMCID: PMC10480339 DOI: 10.1016/j.injury.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/04/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) is a common complication after surgical fixation of acetabular fractures. Numerous strategies have been employed to prevent HO formation, but results are mixed and optimal treatment strategy remains controversial. The purpose of the study was to describe current national heterotopic ossification (HO) prophylaxis patterns among academic trauma centers, determine the association between prophylaxis type and radiographic HO, and identify if heterogeneity in treatment effects exist based on outcome risk strata. METHODS We used data from a subset of participants enrolled in the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. We included only patients with closed AO-type 62 acetabular fractures that were surgically treated via a posterior (Kocher-Langenbeck), combined anterior and posterior, or extensile exposure. PREPARE Clinical Trial Registration Number: NCT03523962 Patient population This cohort study was nested within the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. The PREPARE trial is a multicenter cluster-randomized crossover trial evaluating the effectiveness of two alcohol-based pre-operative antiseptic skin solutions. All PREPARE trial clinical centers that enrolled at least one patient with a closed AO-type 62 acetabular fracture were invited to participate in the nested study. RESULTS 277 patients from 20 level 1 and level 2 trauma centers in the U.S. and Canada were included in this study. 32 patients (12%) received indomethacin prophylaxis, 100 patients (36%) received XRT prophylaxis, and 145 patients (52%) received no prophylaxis. Administration of XRT was associated with a 68% reduction in the adjusted odds of overall HO (OR 0.32, 95% CI, 0.14 - 0.69, p = 0.005). The overall severe HO (Brooker classes III or IV) rate was 8% for the entire cohort; XRT reduced the rate of severe HO in high-risk patients only (p=0.03). CONCLUSION HO prophylaxis patterns after surgical fixation of acetabular fractures have changed dramatically over the last two decades. Most centers included in this study did not administer HO prophylaxis. XRT was associated with a marked reduction in the rate of overall HO and the rate of severe HO in high-risk patients. Randomized trials are needed to fully elucidate the potential benefit of XRT. PREPARE Clinical Trial Registration Number: NCT03523962.
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Affiliation(s)
- Adam Boissonneault
- R Adams Cowley Shock Trauma Center, University of Maryland, MD, 22 S Greene St, Baltimore, MD 21201, USA.
| | - Nathan O Hara
- R Adams Cowley Shock Trauma Center, University of Maryland, MD, 22 S Greene St, Baltimore, MD 21201, USA
| | - David Pogorzelski
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lucas Marchand
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Thomas Higgins
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Leah Gitajn
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Mark J Gage
- Department of Orthopaedic Surgery, Section of Orthopaedic Trauma, Duke University, Durham, North Carolina
| | - Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ishani Sharma
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sarah Pierrie
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, University of Maryland, MD, 22 S Greene St, Baltimore, MD 21201, USA
| | - Sheila Sprague
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Gerard Slobogean
- R Adams Cowley Shock Trauma Center, University of Maryland, MD, 22 S Greene St, Baltimore, MD 21201, USA
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Murphy PB, Kasotakis G, Haut ER, Miller A, Harvey E, Hasenboehler E, Higgins T, Hoegler J, Mir H, Cantrell S, Obremskey WT, Wally M, Attum B, Seymour R, Patel N, Ricci W, Freeman JJ, Haines KL, Yorkgitis BK, Padilla-Jones BB. Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma and the Orthopedic Trauma Association. Trauma Surg Acute Care Open 2023; 8:e001056. [PMID: 36844371 PMCID: PMC9945020 DOI: 10.1136/tsaco-2022-001056] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/09/2023] [Indexed: 02/25/2023] Open
Abstract
Objectives Fracture is a common injury after a traumatic event. The efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) to treat acute pain related to fractures is not well established. Methods Clinically relevant questions were determined regarding NSAID use in the setting of trauma-induced fractures with clearly defined patient populations, interventions, comparisons and appropriately selected outcomes (PICO). These questions centered around efficacy (pain control, reduction in opioid use) and safety (non-union, kidney injury). A systematic review including literature search and meta-analysis was performed, and the quality of evidence was graded per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group reached consensus on the final evidence-based recommendations. Results A total of 19 studies were identified for analysis. Not all outcomes identified as critically important were reported in all studies, and the outcome of pain control was too heterogenous to perform a meta-analysis. Nine studies reported on non-union (three randomized control trials), six of which reported no association with NSAIDs. The overall incidence of non-union in patients receiving NSAIDs compared with patients not receiving NSAIDs was 2.99% and 2.19% (p=0.04), respectively. Of studies reporting on pain control and reduction of opioids, the use of NSAIDs reduced pain and the need for opioids after traumatic fracture. One study reported on the outcome of acute kidney injury and found no association with NSAID use. Conclusions In patients with traumatic fractures, NSAIDs appear to reduce post-trauma pain, reduce the need for opioids and have a small effect on non-union. We conditionally recommend the use of NSAIDs in patients suffering from traumatic fractures as the benefit appears to outweigh the small potential risks.
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Affiliation(s)
- Patrick B Murphy
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - George Kasotakis
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elliott R Haut
- Department of Surgery, Johns Hopkins Univ, Baltimore, Maryland, USA
| | - Anna Miller
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Edward Harvey
- Department of Surgery, McGill University, Montreal, Québec, Canada
| | - Eric Hasenboehler
- Holy Spirit Hospital Penn State Health, Camp Hill, Pennsylvania, USA
| | - Thomas Higgins
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - Joseph Hoegler
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hassan Mir
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Sarah Cantrell
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - William T Obremskey
- The Vanderbilt Orthopaedic Institute Center for Health Policy, Nashville, Tennessee, USA
| | - Meghan Wally
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Basem Attum
- Institute Center for Health Policy, Nashville, Tennessee, USA
| | - Rachel Seymour
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nimitt Patel
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - William Ricci
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jennifer J Freeman
- Department of Surgery, TCU and UNTHSC School of Medicine, Fort Worth, Texas, USA
| | - Krista L Haines
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Brian K Yorkgitis
- Department of Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA
| | - Brandy B Padilla-Jones
- Department of General Surgery, Sunrise Hospital and Medical Center, Las Vegas, Nevada, USA
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To M, Goudreau B, Raizman J, Higgins T, Tsui A. M108 Developing approaches to reagent lot-to-lot validation for an integrated health network of ortho-clinical vitros chemistry analyzers in suburban centers. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.206] [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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10
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Rogers MJ, King T, Kim J, Adeyemi TF, Higgins T, Maak TG. Femoral Neck Shaft Angle and Management of Proximal Femur Fractures: Is the Contralateral Femur a Reliable Template? J Orthop Trauma 2021; 35:529-534. [PMID: 33813545 PMCID: PMC10506416 DOI: 10.1097/bot.0000000000002069] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To (1) assess interrater reliability of a novel technique for measurement of neck shaft angle (NSA); (2) use pelvic anteroposterior (AP) radiographs of unaffected hips to assess variability of NSA; and (3) evaluate the side-to-side variability of NSA to determine reliability of using the contralateral hip as a template. DESIGN Retrospective cohort study. SETTING Academic Level 1 regional trauma center. PATIENTS/PARTICIPANTS Four hundred six femora (203 patients) with standing AP pelvis radiographs were selected. Exclusions included lack of acceptable imaging, congenital abnormalities, or prior hip surgery. INTERVENTION An AP pelvis radiograph in the standing position. MAIN OUTCOME MEASUREMENTS Bilateral NSA measurements obtained in a blinded fashion between 2 reviewers. Pearson coefficients and coefficient of determination assessed correlations and variability between left and right NSA. Concordance correlation coefficients assessed the interrater reliability between measurements performed by the 2 reviewers. RESULTS Two hundred three patients (406 femora) were assessed. Male patients had a lower overall NSA mean of 131.56 degrees ± 4.74 than females with 133.61 degrees ± 5.17. There was no significant difference in NSA side-to-side in females (P = 0.18), 0.3 degrees [95% confidence interval (-0.15 to 0.75)], or males (P = 0.68), 0.19 degrees [95% confidence interval (-0.74 to 1.12)]. There was a strong linear relationship between left and right femora (r2 = 0.70). Forty-one percent of patients fell within the 131-135 degrees range bilaterally. Eighty-eight percent of patients had <5 degrees difference in NSA bilaterally and 0% had >10 degrees difference. CONCLUSIONS There is no significant variability between bilateral femora in males and females. Use of this measurement method and contralateral NSA for proximal femur fracture planning is supported.
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Affiliation(s)
- Miranda J. Rogers
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108, USA
| | - Taylor King
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, Utah 84132, USA
| | - Jaewhan Kim
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, Utah 84108, USA
| | - Temitope F. Adeyemi
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108, USA
| | - Thomas Higgins
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108, USA
| | - Travis G. Maak
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108, USA
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11
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Deshpande A, Richter SS, Haessler S, Lindenauer PK, Yu PC, Zilberberg MD, Imrey PB, Higgins T, Rothberg MB. De-escalation of Empiric Antibiotics Following Negative Cultures in Hospitalized Patients With Pneumonia: Rates and Outcomes. Clin Infect Dis 2021; 72:1314-1322. [PMID: 32129438 DOI: 10.1093/cid/ciaa212] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND For patients at risk for multidrug-resistant organisms, IDSA/ATS guidelines recommend empiric therapy against methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas. Following negative cultures, the guidelines recommend antimicrobial de-escalation. We assessed antibiotic de-escalation practices across hospitals and their associations with outcomes in hospitalized patients with pneumonia with negative cultures. METHODS We included adults admitted with pneumonia in 2010-2015 to 164 US hospitals if they had negative blood and/or respiratory cultures and received both anti-MRSA and antipseudomonal agents other than quinolones. De-escalation was defined as stopping both empiric drugs on day 4 while continuing another antibiotic. Patients were propensity adjusted for de-escalation and compared on in-hospital 14-day mortality, late deterioration (ICU transfer), length-of-stay (LOS), and costs. We also compared adjusted outcomes across hospital de-escalation rate quartiles. RESULTS Of 14 170 patients, 1924 (13%) had both initial empiric drugs stopped by hospital day 4. Hospital de-escalation rates ranged from 2-35% and hospital de-escalation rate quartile was not significantly associated with outcomes. At hospitals in the top quartile of de-escalation, even among patients at lowest risk for mortality, the de-escalation rates were <50%. In propensity-adjusted analysis, patients with de-escalation had lower odds of subsequent transfer to ICU (adjusted odds ratio, .38; 95% CI, .18-.79), LOS (adjusted ratio of means, .76; .75-.78), and costs (.74; .72-.76). CONCLUSIONS A minority of eligible patients with pneumonia had antibiotics de-escalated by hospital day 4 following negative cultures and de-escalation rates varied widely between hospitals. To adhere to recent guidelines will require substantial changes in practice.
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Affiliation(s)
- Abhishek Deshpande
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Infectious Diseases, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sandra S Richter
- Department of Clinical Pathology, Pathology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah Haessler
- Division of Infectious Diseases, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Peter K Lindenauer
- Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Pei-Chun Yu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marya D Zilberberg
- University of Massachusetts, Amherst, Massachusetts, USA.,EviMed Research Group, LLC, Goshen, Massachusetts, USA
| | - Peter B Imrey
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, USA
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12
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Newman C, Egan AM, Ahern T, Al-Kiyumi M, Balan G, Brassill MJ, Brosnan E, Carmody L, Clarke H, Coogan Kelly C, Culliney L, Davern R, Durkan M, Fenlon M, Ferry P, Hanlon G, Higgins T, Hoashi S, Khamis A, Kinsley B, Kirwan B, Kyithar P, Liew A, Matthews L, McGurk C, McHugh C, Murphy MS, Murphy P, Nagodra D, Noctor E, Nolan M, O'Connor E, O'Halloran D, O'Mahoney L, O'Sullivan E, Peters M, Roberts G, Rooney H, Smyth A, Tarachand B, Todd M, Tuthill A, Wan Mahmood WA, Yousif O, Dunne FP. Diabetes care and pregnancy outcomes for women with pregestational diabetes in Ireland. Diabetes Res Clin Pract 2021; 173:108685. [PMID: 33548336 DOI: 10.1016/j.diabres.2021.108685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
AIMS Pre-gestational diabetes mellitus (PGDM) is associated with adverse outcomes. We aimed to examine pregnancies affected by PGDM; report on these pregnancy outcomes and compare outcomes for patients with type 1 versus type 2 diabetes mellitus; compare our findings to published Irish and United Kingdom (UK) data and identify potential areas for improvement. METHODS Between 2016 and 2018 information on 679 pregnancies from 415 women with type 1 Diabetes Mellitus and 244 women with type 2 diabetes was analysed. Data was collected on maternal characteristics; pregnancy preparation; glycaemic control; pregnancy related complications; foetal and maternal outcomes; unscheduled hospitalisations; congenital anomalies and perinatal deaths. RESULTS Only 15.9% of women were adequately prepared for pregnancy. Significant deficits were identified in availability and attendance at pre-pregnancy clinic, use of folic acid, attaining appropriate glycaemic targets and appropriate retinal screening. The majority of pregnancies (n = 567, 83.5%) resulted in a live birth but the large number of infants born large for gestational age (LGA) (n = 280, 49.4%), born prematurely <37 weeks and requiring neonatal intensive care unit (NICU) admission continue to be significant issues. CONCLUSIONS This retrospective cohort study identifies multiple targets for improvements in the provision of care to women with pre-gestational DM which are likely to translate into better pregnancy outcomes.
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Affiliation(s)
- C Newman
- Galway University Hospital, Galway, Ireland.
| | - A M Egan
- Division of Endocrinology Mayo Clinic, Rochester, United States
| | - T Ahern
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland
| | - M Al-Kiyumi
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - G Balan
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - M J Brassill
- South Tipperary General Hospital, Clonmel, Co Tipperary, Ireland
| | - E Brosnan
- Mayo University Hospital, Castlebar, Co Mayo, Ireland
| | - L Carmody
- Galway University Hospital, Galway, Ireland
| | - H Clarke
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - C Coogan Kelly
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - L Culliney
- Cork University Hospital, Cork, Co Cork, Ireland
| | - R Davern
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - M Durkan
- Bons Secours Hospital, Cork, Co Cork, Ireland
| | - M Fenlon
- Wexford General Hospital, Co Wexford, Ireland
| | - P Ferry
- Letterkenny General Hospital, Letterkenny, Co Donegal, Ireland
| | - G Hanlon
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - T Higgins
- University Hospital Kerry, Tralee, Co Kerry, Ireland
| | - S Hoashi
- Mullingar Regional Hospital, Mullingar, Co Westmeath, Ireland
| | - A Khamis
- Letterkenny General Hospital, Letterkenny, Co Donegal, Ireland
| | - B Kinsley
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - B Kirwan
- Galway University Hospital, Galway, Ireland
| | - P Kyithar
- Portlaoise General Hospital, Portlaoise, Co Laois, Ireland
| | - A Liew
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - L Matthews
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland
| | - C McGurk
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - C McHugh
- Sligo University Hospital, Co Sligo, Ireland
| | - M S Murphy
- South Infirmary Victoria Hospital, Cork, Co Cork, Ireland
| | - P Murphy
- Cork University Hospital, Cork, Co Cork, Ireland
| | - D Nagodra
- Portlaoise General Hospital, Portlaoise, Co Laois, Ireland
| | - E Noctor
- Limerick University Hospital, Co Limerick, Ireland
| | - M Nolan
- University Hospital Kerry, Tralee, Co Kerry, Ireland
| | - E O'Connor
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - D O'Halloran
- Cork University Hospital, Cork, Co Cork, Ireland
| | - L O'Mahoney
- Cork University Hospital, Cork, Co Cork, Ireland
| | | | - M Peters
- University Hospital Waterford, Co Waterford, Ireland
| | - G Roberts
- University Hospital Waterford, Co Waterford, Ireland
| | - H Rooney
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - A Smyth
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - B Tarachand
- University Hospital Waterford, Co Waterford, Ireland
| | - M Todd
- Mayo University Hospital, Castlebar, Co Mayo, Ireland
| | - A Tuthill
- Cork University Hospital, Cork, Co Cork, Ireland
| | - W A Wan Mahmood
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - O Yousif
- Wexford General Hospital, Co Wexford, Ireland
| | - F P Dunne
- Galway University Hospital, Galway, Ireland
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13
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Itamura K, Wu A, Illing E, Ting J, Higgins T. YouTube Videos Demonstrating the Nasopharyngeal Swab Technique for SARS-CoV-2 Specimen Collection: Content Analysis. JMIR Public Health Surveill 2021; 7:e24220. [PMID: 33406478 PMCID: PMC7813578 DOI: 10.2196/24220] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Real-time polymerase chain reaction using nasopharyngeal swabs is currently the most widely used diagnostic test for SARS-CoV-2 detection. However, false negatives and the sensitivity of this mode of testing have posed challenges in the accurate estimation of the prevalence of SARS-CoV-2 infection rates. OBJECTIVE The purpose of this study was to evaluate whether technical and, therefore, correctable errors were being made with regard to nasopharyngeal swab procedures. METHODS We searched a web-based video database (YouTube) for videos demonstrating SARS-CoV-2 nasopharyngeal swab tests, posted from January 1 to May 15, 2020. Videos were rated by 3 blinded rhinologists for accuracy of swab angle and depth. The overall score for swab angle and swab depth for each nasopharyngeal swab demonstration video was determined based on the majority score with agreement between at least 2 of the 3 reviewers. We then comparatively evaluated video data collected from YouTube videos demonstrating the correct nasopharyngeal swab technique with data from videos demonstrating an incorrect nasopharyngeal swab technique. Multiple linear regression analysis with statistical significance set at P=.05 was performed to determine video data variables associated with the correct nasopharyngeal swab technique. RESULTS In all, 126 videos met the study inclusion and exclusion criteria. Of these, 52.3% (66/126) of all videos demonstrated the correct swab angle, and 46% (58/126) of the videos demonstrated an appropriate swab depth. Moreover, 45.2% (57/126) of the videos demonstrated both correct nasopharyngeal swab angle and appropriate depth, whereas 46.8% (59/126) of the videos demonstrated both incorrect nasopharyngeal swab angle and inappropriate depth. Videos with correct nasopharyngeal swab technique were associated with the swab operators identifying themselves as a medical professional or as an Ear, Nose, Throat-related medical professional. We also found an association between correct nasopharyngeal swab techniques and recency of video publication date (relative to May 15, 2020). CONCLUSIONS Our findings show that over half of the videos documenting the nasopharyngeal swab test showed an incorrect technique, which could elevate false-negative test rates. Therefore, greater attention needs to be provided toward educating frontline health care workers who routinely perform nasopharyngeal swab procedures.
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Affiliation(s)
- Kyohei Itamura
- Division of Otolaryngology - Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Arthur Wu
- Division of Otolaryngology - Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, United States
| | - Elisa Illing
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, United States
| | - Jonathan Ting
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, United States
| | - Thomas Higgins
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, KY, United States
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, and Throat, Louisville, KY, United States
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14
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Attjioui M, Ryan S, Ristic AK, Higgins T, Goñi O, Gibney ER, Tierney J, O'Connell S. Comparison of edible brown algae extracts for the inhibition of intestinal carbohydrate digestive enzymes involved in glucose release from the diet. J Nutr Sci 2021; 10:e5. [PMID: 33889388 PMCID: PMC8057513 DOI: 10.1017/jns.2020.56] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/11/2020] [Indexed: 01/04/2023] Open
Abstract
Type II diabetes is considered the most common metabolic disorder in the developed world and currently affects about one in ten globally. A therapeutic target for the management of type II diabetes is the inhibition of α- glucosidase, an essential enzyme located at the brush border of the small intestinal epithelium. The inhibition of α-glucosidase results in reduced digestion of carbohydrates and a decrease in postprandial blood glucose. Although pharmaceutical synthetic inhibitors are available, these are usually associated with significant gastrointestinal side effects. In the present study, the impact of inhibitors derived from edible brown algae is being investigated and compared for their effect on glycaemic control. Carbohydrate- and polyphenolic-enriched extracts derived from Ascophyllum nodosum, Fucus vesiculosus and Undaria pinnatifida were characterised and screened for their inhibitory effects on maltase and sucrase enzymes. Furthermore, enzyme kinetics and the mechanism of inhibition of maltase and sucrase were determined using linear and nonlinear regression methods. All tested extracts showed a dose-dependent inhibitory effect of α-glucosidase with IC50 values ranging from 0⋅26 to 0⋅47 mg/ml for maltase; however, the only extract that was able to inhibit sucrase activity was A. nodosum, with an IC50 value of 0⋅83 mg/ml. The present study demonstrates the mechanisms in which different brown seaweed extracts with varying composition and molecular weight distribution differentially inhibit α-glucosidase activities. The data highlight that all brown seaweed extracts are not equal in the inhibition of carbohydrate digestive enzymes involved in postprandial glycaemia.
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Affiliation(s)
- Maha Attjioui
- Shannon Applied Biotechnology Centre, Institute of Technology Tralee, Tralee, Ireland
| | | | | | - Thomas Higgins
- Shannon Applied Biotechnology Centre, Institute of Technology Tralee, Tralee, Ireland
| | | | - Eileen R. Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Joanna Tierney
- Shannon Applied Biotechnology Centre, Institute of Technology Tralee, Tralee, Ireland
| | - Shane O'Connell
- Shannon Applied Biotechnology Centre, Institute of Technology Tralee, Tralee, Ireland
- Marigot Ltd., Carrigaline, Ireland
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15
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Egan AM, Brassill MJ, Brosnan E, Carmody L, Clarke H, Coogan Kelly C, Culliney L, Durkan M, Fenlon M, Ferry P, Hanlon G, Higgins T, Hoashi S, Khamis A, Kinsley B, Kinsley T, Kirwan B, Liew A, McGurk C, McHugh C, Murphy MS, Murphy P, O'Halloran D, O'Mahony L, O'Sullivan E, Nolan M, Peter M, Roberts G, Smyth A, Todd M, Tuthill A, Wan Mahmood WA, Yousif O, P Dunne F. An Irish National Diabetes in Pregnancy Audit: aiming for best outcomes for women with diabetes. Diabet Med 2020; 37:2044-2049. [PMID: 30710451 DOI: 10.1111/dme.13923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 12/16/2022]
Abstract
AIMS The purpose of this study was to identify the number of pregnancies affected by pre-gestational diabetes in the Republic of Ireland; to report on pregnancy outcomes and to identify areas for improvement in care delivery and clinical outcomes. METHODS Healthcare professionals caring for women with pre-gestational diabetes during pregnancy were invited to participate in this retrospective study. Data pertaining to 185 pregnancies in women attending 15 antenatal centres nationally were collected and analysed. Included pregnancies had an estimated date of delivery between 1 January and 31 December 2015. RESULTS The cohort consisted of 122 (65.9%) women with Type 1 diabetes and 56 (30.3%) women with Type 2 diabetes. The remaining 7 (3.8%) pregnancies were to women with maturity-onset diabetes of the young (MODY) (n = 6) and post-transplant diabetes (n = 1). Overall women were poorly prepared for pregnancy and lapses in specific areas of service delivery including pre-pregnancy care and retinal screening were identified. The majority of pregnancies 156 (84.3%) resulted in a live birth. A total of 103 (65.5%) women had a caesarean delivery and 58 (36.9%) infants were large for gestational age. CONCLUSIONS This audit identifies clear areas for improvement in delivery of care for women with diabetes in the Republic of Ireland before and during pregnancy.
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Affiliation(s)
- A M Egan
- University Hospital Galway, Galway, Republic of Ireland
| | - M J Brassill
- South Tipperary General Hospital, Clonmel, Republic of Ireland
| | - E Brosnan
- Mayo University Hospital, Castlebar, Republic of Ireland
| | - L Carmody
- University Hospital Galway, Galway, Republic of Ireland
| | - H Clarke
- Portiuncla University Hospital, Ballinasloe, Republic of Ireland
| | - C Coogan Kelly
- St Luke's General Hospital, Kilkenny, Republic of Ireland
| | - L Culliney
- Cork University Hospital, Cork, Republic of Ireland
| | - M Durkan
- Bon Secours Hospital, Cork, Republic of Ireland
| | - M Fenlon
- Wexford General Hospital, Wexford, Republic of Ireland
| | - P Ferry
- Letterkenny University Hospital, Letterkenny, Republic of Ireland
| | - G Hanlon
- St Luke's General Hospital, Kilkenny, Republic of Ireland
| | - T Higgins
- University Hospital Kerry, Tralee, Republic of Ireland
| | - S Hoashi
- Midland Regional Hospital, Mullingar, Republic of Ireland
| | - A Khamis
- Letterkenny University Hospital, Letterkenny, Republic of Ireland
| | - B Kinsley
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - T Kinsley
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - B Kirwan
- University Hospital Galway, Galway, Republic of Ireland
| | - A Liew
- Portiuncla University Hospital, Ballinasloe, Republic of Ireland
| | - C McGurk
- St Luke's General Hospital, Kilkenny, Republic of Ireland
| | - C McHugh
- Sligo University Hospital, Sligo, Republic of Ireland
| | - M S Murphy
- South Infirmary Victoria University Hospital, Cork, Republic of Ireland
| | - P Murphy
- Cork University Hospital, Cork, Republic of Ireland
| | - D O'Halloran
- Cork University Hospital, Cork, Republic of Ireland
| | - L O'Mahony
- Cork University Hospital, Cork, Republic of Ireland
| | | | - M Nolan
- University Hospital Kerry, Tralee, Republic of Ireland
| | - M Peter
- University Hospital Waterford, Waterford, Republic of Ireland
| | - G Roberts
- University Hospital Waterford, Waterford, Republic of Ireland
| | - A Smyth
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - M Todd
- Mayo University Hospital, Castlebar, Republic of Ireland
| | - A Tuthill
- Cork University Hospital, Cork, Republic of Ireland
| | - W A Wan Mahmood
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - O Yousif
- Wexford General Hospital, Wexford, Republic of Ireland
| | - F P Dunne
- University Hospital Galway, Galway, Republic of Ireland
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16
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Schultz B, Fogel N, Finlay A, Collinge C, Githens MF, Higgins T, Mehta S, O'Toole RV, Summers H, Bishop JA, Gardner MJ. Orthopedic Surgeons Have Inadequate Knowledge of the Cost of Trauma-Related Imaging Studies. Orthopedics 2019; 42:e454-e459. [PMID: 31269218 DOI: 10.3928/01477447-20190627-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023]
Abstract
Radiographic imaging is integral to the diagnosis and treatment of orthopedic injuries. Previous studies have shown that orthopedists consistently underestimate the price of implants, but their knowledge of imaging charges is unknown. This study evaluated whether orthopedic residents and faculty could accurately estimate charges of imaging modalities at their respective institutions. A survey with 10 common imaging studies was sent to 8 academic level I trauma centers. Participants estimated the total charge of each imaging modality. This was compared with the actual charge at their institution. Seven centers produced 162 responders: 74 faculty and 88 residents. The differences between the estimated cost and the billing charge were calculated and broken down by training level and imaging modality. Overall, imaging charges were underestimated by 31% (P<.001), with 19.4% of estimates being within 20% of actual charges (95% confidence interval, 19.1-19.9). There was no difference between training levels (P=.69). There was greater than 1000% variation in charges between institutions. Orthopedists across training levels underestimate hospital charges associated with common imaging studies, and there is a large variation in charges between centers. Awareness of charges is important because charges affect clinical decision making and are relevant to practicing both cost-conscious and clinically sound medicine. [Orthopedics. 2019; 42(5):e454-e459.].
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17
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Pham M, Higgins T, Wilkinson-Ryan I. The effect of New Hampshire State legislation changes on opioid prescribing practices for gynecologic oncology surgery in a tertiary care setting. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND In the past 2 decades, overdoses and deaths from prescription opioids have reached epidemic proportions in the United States. The widespread use of opioids complicates management of the orthopaedic surgery patient in the acute and chronic settings. Orthopaedic surgeons are some of the top prescribers of opioids in the complex setting of chronic use, abuse, and diversion. METHODS The literature regarding the basic science of pharmacologic options for pain management (e.g., opioids and nonsteroidal anti-inflammatory drugs), the impact of strategies on bone and soft-tissue healing, and pain relief are summarized as they relate to the management of orthopaedic injuries and conditions. Additionally, a section on designing solutions to address the current opioid crisis is presented. RESULTS The mechanism of action of different classes of analgesic medications is discussed, as well as the basic scientific evidence regarding the impact of narcotic and nonnarcotic analgesic medications on bone-healing and on other organ systems. Differences between pain and nociception, various treatment strategies, and clinical comparisons of the effectiveness of various analgesics compared with opioids are summarized. Finally, options for addressing the opioid crisis, including the description of a large system-wide intervention to impact prescriber behavior at the point of care using health-information solutions, are presented. CONCLUSIONS Orthopaedic leaders, armed with information and strategies, can help lead the way to solutions to the opioid epidemic in their respective communities, institutions, and subspecialty societies. Through leadership and education, orthopaedic surgeons can help shape the solution for this critical public health issue.
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Affiliation(s)
- Rachel B Seymour
- 1Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina 2Department of Orthopaedic Surgery, University of Texas at Austin, Austin, Texas 3Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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Sagi HC, Donohue D, Cooper S, Barei DP, Siebler J, Archdeacon MT, Sciadini M, Romeo M, Bergin PF, Higgins T, Mir H. Institutional and Seasonal Variations in the Incidence and Causative Organisms for Posttraumatic Infection following Open Fractures. J Orthop Trauma 2017; 31:78-84. [PMID: 27755339 DOI: 10.1097/bot.0000000000000730] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 02/02/2023]
Abstract
OBJECTIVES The current literature focuses on wound severity, time to debridement, and antibiotic administration with respect to risk of infection after open fracture. The purpose of this analysis was to determine if either the incidence of posttraumatic infection or causative organism varies with treating institution or the season in which the open fracture occurred. DESIGN Retrospective review. SETTING Seven level 1 regional referral trauma centers located in each of the 7 climatic regions of the continental United States (Northwest, High Plains, Midwest/Ohio Valley, New England/Mid-Atlantic, Southeast, South, and Southwest). PATIENTS/PARTICIPANTS Five thousand one hundred twenty-seven skeletally mature patients with open extremity fractures treated between 2008 and 2012 at one of the 7 institutions. INTERVENTION Open reduction and internal fixation of fracture following institutional protocol for antibiotic prophylaxis, debridement, and soft-tissue management. MAIN OUTCOME MEASUREMENTS Seasonal variation on the incidence of infection and the causative organism after treatment for open fracture as recorded by each individual treating institution. Charts were analyzed to extract information regarding date of injury, Gustilo-Anderson type of open fracture, subsequent treatment for a posttraumatic wound infection, and the causative organisms. Patients were placed into one of the 4 groups based on the time of year that the injury occurred: spring (March-May), summer (June-August), fall (September-November), and winter (December-February). Univariate/multivariate analyses and Fisher test were used to assess whether any observed differences were of statistical significance. RESULTS The overall incidence of infection for all open fractures across the 7 different institutions was 7.6% and this did not vary significantly by season. There were, however, significant differences in overall infection rates between the different institutions: Southeast 4.3%, Northwest 13%, Northeast 7.7%, Southwest 9.3%, Midwest/Ohio Valley 5.5%, High Plains 14.6%, and South 7.4%. The following institutions demonstrated a significant seasonal variation in the incidence of infection: Northwest = fall 11% versus winter 18.5%, Southwest = winter 1.5% and fall 17.3%, Northeast = winter 5.2% and spring 9.7%, and Southeast = fall 2.8% and spring 6.0%. The High Plains, Midwest/Ohio Valley, and Southern institutions did not demonstrate a significant seasonal variation in infection rates. Finally, the most commonly encountered causative organism varied not only by region, but by season as well. Staphylococcus aureus (both methicillin sensitive and resistant) continues to be the most prevalent organism in the continental United States. CONCLUSIONS A substantial seasonal and institutional variation exists regarding the incidence of infection and causative organisms for posttraumatic wound infection after open fractures. Although this may represent a difference in treatment regimens between individual surgeons and institutions, a decades-old general nation-wide empiric antibiotic prophylaxis regimen for all open fractures may in fact be outdated and suboptimal. We recommend that surgeons consult with their infectious disease colleagues to better understand the seasonal variation of infection and causative organism for their individual hospital, and adjust their prophylactic and treatment regimens accordingly. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- H Claude Sagi
- *Department of Orthopedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA; †Department of Orthopedic Surgery, Florida Orthopaedic Institute/University of South Florida, Tampa, FL; ‡Department of Orthopedic Surgery, University of Nebraska, Omaha, NE; §Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, OH; ‖Department of Orthopedic Surgery, University of Maryland, Baltimore, MD; ¶Department of Orthopedic Surgery, University of Mississippi, Jackson, MS; and **University of Utah, Salt Lake City, UT
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Deshpande A, Richter SS, Haessler S, Brizendine K, Lindenauer P, Yu PC, Zilberberg MD, Imrey P, Higgins T, Rothberg M. Impact of Appropriate Empiric Antibiotic Therapy on Outcomes in Patients with Pneumonia and Positive Blood vs. Respiratory Cultures. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1518] [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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Deshpande A, Richter SS, Haessler S, Brizendine K, Lindenauer P, Yu PC, Zilberberg MD, Imrey P, Higgins T, Rothberg M. Antimicrobial De-escalation Rates following Positive Cultures in Pneumonia. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1486] [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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Deshpande A, Haessler S, Brizendine K, Richter SS, Lindenauer P, Yu PC, Zilberberg MD, Imrey P, Higgins T, Rothberg M. Predicting Risk of Drug-Resistant Pathogens in Patients with Pneumonia. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Teres D, Higgins T, Steingrub J, Loiacono L, Mcgee W, Circeo L, Brunton M, Giuliano K, Burns M, Le Gall JR, Artigas A, Strosberg M, Lemeshow S. Defining a High-Performance ICU System for the 21st Century: A Position Paper. J Intensive Care Med 2016. [DOI: 10.1177/088506669801300407] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In the fall of 1997 George D. Lundberg and John E. Wennberg wrote an editorial in JAMA calling for comprehensive quality improvement programs to become the driver of the American health care system. The suggestion came during the Second European Forum on Quality Improvement in Health Care held in Paris, France, in April 1997 and was based on comments made by Donald Berwick. The concept was to focus on an organized response to problem identification and proposed solutions to improve patient care and protect the health of the public. Critical care medicine represents a large segment of health care and is undergoing dramatic changes during our managed care revolution. General ICU severity of illness models have been developed, tested, and shown to provide a useful estimate of hospital mortality for populations of critically ill patients. These systems have captured the imagination of clinical researchers and have become an integral component of a large number of publications as well as a part of many ICU databases. These risk adjustment severity models are remarkably robust for heterogeneous patient populations but the models have not been shown to validate well in new settings. We feel that by focusing on the episode of critical illness rather than each individual ICU admission and by going beyond the traditional acute hospital discharge to determine whether the patient lives or dies, we can better evaluate critical care system performance and cost-effectiveness. The incentives for high quality/low cost should favor integrated comprehensive critical care delivery systems. Programs that score well should be identified as high quality and be honored as medallion level 1 ICUs. We challenge national and international critical care societies to evaluate and then debate the described definitions and recommendations as a call to action.
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Affiliation(s)
- Daniel Teres
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - Thomas Higgins
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - Jay Steingrub
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - Laurie Loiacono
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - William Mcgee
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - Lori Circeo
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - Mary Brunton
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - Karen Giuliano
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - Marty Burns
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - Jean Roger Le Gall
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - Antonio Artigas
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - Martin Strosberg
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA, Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
| | - Stanley Lemeshow
- Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA, Center for Health Services Research, Departments of Medicine, Surgery, Anesthesia, and Nursing, Baystate Medical Center, Springfield, MA, and the Tufts University School of Medicine, Boston, MA
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Deshpande A, Haessler S, Brizendine K, Lindenauer P, Lagu T, Yu PC, Bakaki P, Zilberberg MD, Higgins T, Rothberg M. Community-Acquired Pneumonia (CAP) Therapy Is Insufficient for Most Patients With Culture-Positive Healthcare-Associated Pneumonia (HCAP). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Abhishek Deshpande
- Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sarah Haessler
- Infectious Diseases, Baystate Medical Center, Springfield, Massachusetts
| | | | - Peter Lindenauer
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
| | - Tara Lagu
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
| | - Pei-Chun Yu
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Paul Bakaki
- Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Marya D. Zilberberg
- University of Massachusetts and Evimed Research Group, LLC, Goshen, Massachusetts
| | - Thomas Higgins
- Medicine, Baystate Medical Center, Greenfield, Massachusetts
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Deshpande A, Haessler S, Brizendine K, Lindenauer P, Yu PC, Zilberberg MD, Bakaki P, Higgins T, Rothberg M. Epidemiology of Healthcare-Associated Pneumonia (HCAP) as Assessed by Blood Cultures Versus Respiratory Cultures. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Abhishek Deshpande
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
- Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Sarah Haessler
- Infectious Diseases, Baystate Medical Center, Springfield, Massachusetts
| | | | - Peter Lindenauer
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
| | - Pei-Chun Yu
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Marya D. Zilberberg
- University of Massachusetts and Evimed Research Group, LLC, Goshen, Massachusetts
| | - Paul Bakaki
- Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Thomas Higgins
- Medicine, Baystate Medical Center, Greenfield, Massachusetts
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McGee W, Nathanson B, Higgins T. 574: EXTREME BODY MASS INDICES ARE ASSOCIATED WITH GREATER MORTALITY IN PATIENTS WITH C DIFF INFECTIONS. Crit Care Med 2016. [DOI: 10.1097/01.ccm.0000509252.97530.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Lewis S, Beard L, McDerby M, Taylor R, Higgins T, Knowles C. Developing a Data Vault. IJDC 2016. [DOI: 10.2218/ijdc.v11i1.406] [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: 11/21/2022] Open
Abstract
Research data is being generated at an ever-increasing rate. This brings challenges in how to store, analyse, and care for the data. A component of this problem is the stewardship of data and associated files that need a safe and secure home for the medium to long-term. As part of typical suites of Research Data Management services, researchers are provided with large allocations of ‘active data storage’. This is often stored on expensive and fast disks to enable efficient transfer and working with large amounts of data. However, over time this active data store fills up, and researchers need a facility to move older but still valuable data to cheaper storage for long-term care. In addition, research funders are increasingly requiring data to be stored in forms that allow it to be described and retrieved in the future. For data that can’t be shared publicly in an open repository, a closed solution is required that can make use of offline or near-line storage for cost efficiency. This paper describes a solution to these requirements, called the Data Vault.
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Higgins T, Dougherty A, Heil S. Does a two-visit protocol for long-acting reversible contraception differentially impact socioeconomically disadvantaged women? Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.113] [Citation(s) in RCA: 2] [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: 10/21/2022]
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Söderlund C, Löfdahl E, Nilsson J, Reitan Ö, Higgins T, Rådegran G. Chronic kidney disease after heart transplantation: a single-centre retrospective study at Skåne University Hospital in Lund 1988-2010. Transpl Int 2016; 29:529-39. [DOI: 10.1111/tri.12710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/15/2015] [Accepted: 10/27/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Carl Söderlund
- Department of Clinical Sciences Lund; Cardiology; Lund University; Lund Sweden
- The Haemodynamic Lab; The Section for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
| | - Eveline Löfdahl
- Department of Clinical Sciences Lund; Cardiology; Lund University; Lund Sweden
- The Haemodynamic Lab; The Section for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
| | - Johan Nilsson
- Department of Clinical Sciences Lund; Cardiothoracic Surgery; Lund University and Skåne University Hospital; Lund Sweden
| | - Öyvind Reitan
- Department of Clinical Sciences Lund; Cardiology; Lund University; Lund Sweden
- The Haemodynamic Lab; The Section for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
| | - Thomas Higgins
- Children's Heart Centre and Pediatric Surgery; Skåne University Hospital; Lund Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund; Cardiology; Lund University; Lund Sweden
- The Haemodynamic Lab; The Section for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
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31
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Griesenbach U, Alton EWFW, Beekman JM, Boyd AC, Chan M, Davies JC, Davies LA, Davidson HE, Dekkers JF, Gea-Sorli S, Gill DR, Hasegawa M, Higgins T, Hyndman L, McLachlan G, Inoue M, Hyde SC, Moran C, Meng C, Paul-Smith MC, Pringle IA, Pytel KM, Rodriguez-Martinez A, Stevenson BJ, Tsugumine S. S56 Moving lentiviral-based gene therapy into a first-in-man CF trial. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.62] [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: 11/04/2022]
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Torres O, Rothberg MB, Garb J, Ogunneye O, Onyema J, Higgins T. Risk Factor Model to Predict a Missed Clinic Appointment in an Urban, Academic, and Underserved Setting. Popul Health Manag 2015; 18:131-6. [DOI: 10.1089/pop.2014.0047] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Orlando Torres
- Department of Medicine, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts
| | - Michael B. Rothberg
- Department of Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jane Garb
- Department of Epidemiology and Biostatistics, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts
| | - Owolabi Ogunneye
- Department of Medicine, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts
| | - Judepatricks Onyema
- Department of Medicine, Orlando Regional Medical Center, Orlando Health, Orlando, Florida
| | - Thomas Higgins
- Department of Medicine, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts
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Griesenbach U, Boyd A, Calcedo R, Cheng S, Cunningham S, Davies J, Dewar M, Gill D, Doherty A, Higgins T, Hyde S, Manvell M, Meng C, Innes J, Limberis M, Punch E, Scheule R, Soussi N, Soussi S, Wilson J, Alton E. P204 Immune Responses To Single And Repeated Administration Of Pgm169/gl67a: The Uk Cf Gene Therapy Consortium Clinical Trials. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.333] [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: 11/04/2022]
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Armstrong D, Bayfield K, Alton E, Boyd A, Cunningham S, Elgmati H, Gill D, Griesenbach U, Higgins T, Hyde S, Innes J, Saunders C, Spearing E, Davies J. P209 Standardisation Of Lung Clearance Index In A Multicentre Clinical Trial. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chernick L, Schnall R, Stockwell M, Castaño P, Higgins T, Westhoff C, Santelli J, Dayan P. Adolescent females’ preferences for a pregnancy prevention intervention using text messaging. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.194] [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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Söderlund C, Öhman J, Nilsson J, Higgins T, Kornhall B, Johansson L, Rådegran G. Acute cellular rejection the first year after heart transplantation and its impact on survival: a single-centre retrospective study at Skåne University Hospital in Lund 1988-2010. Transpl Int 2014; 27:482-92. [DOI: 10.1111/tri.12284] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 10/29/2013] [Accepted: 02/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Carl Söderlund
- Department of Cardiology, Clinical Sciences; Lund University; Lund Sweden
- The Haemodynamic Lab; The Clinic for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
| | - Jenny Öhman
- Department of Cardiology, Clinical Sciences; Lund University; Lund Sweden
| | - Johan Nilsson
- Department of Thoracic Surgery, Anesthesiology and Intensive Care; Skåne University Hospital; Lund Sweden
| | - Thomas Higgins
- Children's Heart Centre and Pediatric Surgery; Skåne University Hospital; Lund Sweden
| | - Björn Kornhall
- The Haemodynamic Lab; The Clinic for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
| | - Leif Johansson
- Department of Pathology; Skåne University Hospital; Lund Sweden
| | - Göran Rådegran
- Department of Cardiology, Clinical Sciences; Lund University; Lund Sweden
- The Haemodynamic Lab; The Clinic for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
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Liang J, Higgins T, Ishman SL, Boss EF, Benke JR, Lin SY. Medical management of chronic rhinosinusitis in cystic fibrosis: A systematic review. Laryngoscope 2013; 124:1308-13. [DOI: 10.1002/lary.24503] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/23/2013] [Accepted: 10/30/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Jonathan Liang
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Thomas Higgins
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Stacey L. Ishman
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Emily F. Boss
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - James R. Benke
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Sandra Y. Lin
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
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Liuba P, Johansson S, Pesonen E, Odermarsky M, Kornerup-Hansen A, Forslid A, Aburawi EH, Higgins T, Birck M, Perez-de-Sa V. Coronary flow and reactivity, but not arrhythmia vulnerability, are affected by cardioplegia during cardiopulmonary bypass in piglets. J Cardiothorac Surg 2013; 8:157. [PMID: 23777554 PMCID: PMC3716963 DOI: 10.1186/1749-8090-8-157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 01/08/2013] [Accepted: 06/04/2013] [Indexed: 01/18/2023] Open
Abstract
Background Surgery under cardiopulmonary bypass (CPB) is still associated with significant cardiovascular morbidity in both pediatric and adult patients but the mechanisms are not fully understood. Abnormalities in coronary flow and function have been suggested to play an important role. Prior studies suggest protective effects on coronary and myocardial function by short intravenous (i.v.) infusion of cyclosporine A before CPB. Methods Barrier-bred piglets (10–12 kg, n=20) underwent CPB for 45 min, with or without antegrade administration of cardioplegic solution. Prior to CPB, half of the animals in each group received an i.v. infusion of 100 mg/kg cyclosporine A. The left anterior descending coronary flow velocity responses to adenosine, serotonin, and atrial pacing, as well as left ventricular function and postsurgical vulnerability to atrial fibrillation (Afib) were assessed by intracoronary Doppler, epicardial echocardiography, and in vivo electrophysiological study, before and 8 hours after surgery. Plasma C-reactive protein (CRP) and fibrinogen were measured at both time-points. Results Cyclosporine infusion did not influence any of the studied variables (p>0.4). Coronary peak flow velocity (cPFV) rose significantly after surgery especially in the cardioplegia group (p<0.01 vs. non-cardioplegia group and pre-surgery). cPFV responses to adenosine, but not to serotonin, tended to decrease (p=0.06) after surgery only in cardioplegia group (p=0.06; p=0.8 in non-cardioplegia group vs pre-surgery). Also, cPFV response to atrial pacing was lower in the cardioplegia than in the non-cardioplegia group (p=0.02). Neither vulnerability nor duration of induced Afib after CPB differed between groups (Chi-square p=0.4). Cyclosporine had no significant effect on coronary indexes or arrhythmia vulnerability (p>0.4). There was no difference in systolic myocardial function between groups at any time point. Conclusion In piglets, CPB with cardioplegia was associated with profound abnormalities in coronary vasomotor tone and receptor-related flow regulation, whereas arrhythmia vulnerability appeared to be comparable with that in non-cardioplegia group. In this study, preconditioning with cyclosporine had no detectable protective effect on coronary circulation or arrhythmia vulnerability after CPB.
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Affiliation(s)
- Petru Liuba
- Division of Cardiology, Children's Heart Center, Skåne University Hospital, Lund, Sweden.
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Hakacova N, Klingel K, Kandolf R, Engdahl E, Fogdell-Hahn A, Higgins T. First therapeutic use of Artesunate in treatment of human herpesvirus 6B myocarditis in a child. J Clin Virol 2013; 57:157-60. [DOI: 10.1016/j.jcv.2013.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 02/02/2013] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
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40
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Söderlund C, Öhman J, Nilsson J, Higgins T, Johansson L, Kornhall B, Rådegran G. Patterns of Acute Cellular Rejection the First Year after Heart Transplantation: A Single Center Retrospective Study at Skåne University Hospital in Lund 1988-2010. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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41
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Higgins T, Ocal B, Gallia G, Reh D. Long-Term Outcomes of Endonasal Endoscopic Cerebrospinal Fluid Leak Repairs: A Pooled Data Analysis Using Kaplan-Meier Techniques. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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42
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Abstract
Proximal humeral fractures are common, with low-energy injuries occurring in the elderly population and less frequent high-energy fractures striking young people. This article discusses the anatomy, clinical evaluation, and treatment of these fractures.
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Affiliation(s)
- David Rothberg
- Orthopaedic Traumatology, University of California at Davis, Sacramento, CA 95817, USA.
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43
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Alton EWFW, Ashby D, Boyd C, Cheng S, Cunningham S, Davies JC, Gill D, Griesenbach U, Higgins T, Hyde S, Innes JA, Murray G, Porteous D. S120 Update on the UK CF Gene Therapy Consortium Multidose, Non-Viral, Gene Therapy Trial. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.125] [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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44
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Alton EWFW, Boyd AC, Cheng SH, Davies J, Davies LA, Dayan A, Gill DR, Griesenbach U, Higgins T, Hyde SC, Innes A, McLachlan G, Porteous D, Pringle IA, Scheule RK, Sumner-Jones SG. P96 Repeat Administration of GL67A/pGM169 is Feasible, Safe, and Produces Endogenous Levels of CFTR Expression After 12 Doses. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.338] [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: 11/04/2022]
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45
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Higgins T, Johansson S, Nilsson J, Hallhagen S, Wahlander H. [Mechanical circulatory support devices save lives of children awaiting heart transplantation]. Lakartidningen 2012; 109:1745-1746. [PMID: 23097881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Thomas Higgins
- Barnkardiologiska kliniken, Skånes universitetssjukhus, Lund.
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46
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Davies G, Davies JC, Gill DR, Hyde SC, Boyd C, Innes JA, Porteous DJ, Cheng SH, Scheule RK, Higgins T, Griesenbach U, Alton EWFW. T4 Safety and expression of a single dose of lipid-mediated CFTR gene therapy to the upper and lower airways of patients with Cystic Fibrosis. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054a.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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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47
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Abstract
AIMS To evaluate outcome in the first generation of children with end-stage heart disease to whom heart transplantation was available. METHODS Retrospective review of all 135 Swedish children <18 years old listed for heart transplantation 1989-2009, followed to December 31, 2009, including 74 (55%) with cardiomyopathy and 61 (45%) with congenital heart disease; 34 (25%) were infants (<1 year). Cumulative risk of requiring heart transplantation was 1:17,300 (11 patients who improved were omitted from outcome analysis). RESULTS Waiting-list mortality was 31% (44% in infants). Median waiting time in 82 transplanted patients was 57 days (0-585 days). Post-transplant follow-up time was median 5.9 years (0.03-20.1 years), and actuarial survival was 92% at 1 year, 82% at 5 years, 76% at 10 years and 58% at 15 years. Survival after listing was 64% at 1 year, 58% at 5 years, 52% at 10 years and 40% at 15 years. Post-transplant complications included rejections (34%), malignancies (12%), renal failure (8%), coronary artery vasculopathy (6%) and re-transplantation (5%). Among 64 survivors, 84% were free of complications affecting prognosis. CONCLUSION High waiting-list mortality and post-transplant attrition precluded 60% of this pioneer population from reaching adulthood. Functional status in survivors is generally good.
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Affiliation(s)
- Thomas Gilljam
- Pediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska Academy, Gothenburg University, Sweden.
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48
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Abstract
Influenza infection most commonly affects the upper and lower respiratory tracts, but can involve extrapulmonary sites, including the myocardium. We report on a case of myocarditis caused by documented 2009 pandemic H1N1 influenza in a previously healthy adult, and review the literature on influenza myocarditis.
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Affiliation(s)
- S Haessler
- Infectious Diseases Division, Tufts University School of Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
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49
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Saulnier Sholler GL, Eslin D, Roberts WD, Kaplan J, Bergendahl G, Ashikaga T, Higgins T, Lenox S, Silberman S, Ferguson W. Phase I trial of TPI 287 as a single agent and in combination with temozolomide (TMZ) in patients with refractory or recurrent neuroblastoma (NB) or medulloblastoma (MB). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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50
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McGee W, Higgins T, Echols J, Nelson H, Tidswell M. Automated reporting of safety bundles: streamlining the performance improvement process. Crit Care 2011. [PMCID: PMC3068408 DOI: 10.1186/cc9899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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