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Lund S, Schmitz JJ, Foster T, Dy B, McKenzie T, Castro MR, Lyden ML. Ethanol ablation of papillary thyroid carcinoma nodal metastases: Long-term outcomes. Surgery 2024; 175:1034-1039. [PMID: 38195302 DOI: 10.1016/j.surg.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Percutaneous ethanol ablation has emerged as a treatment for recurrent papillary thyroid carcinoma in the lateral neck after compartment-oriented therapeutic lymphadenectomy. However, the safety and utility of percutaneous ethanol ablation as a primary treatment modality for lateral neck metastases remains undefined. We aimed to investigate long-term outcomes of percutaneous ethanol ablation of lateral neck papillary thyroid carcinoma recurrence both with and without prior lymphadenectomy. METHODS We conducted a retrospective study of patients with lateral neck papillary thyroid carcinoma treated with percutaneous ethanol ablation from 2013 to 2018. Patient characteristics, disease volume, morbidity, and recurrence (development of new lymphadenopathy within a percutaneous ethanol ablation-treated nodal compartment) were assessed. RESULTS We identified 117 patients who underwent percutaneous ethanol ablation for papillary thyroid carcinoma lateral neck metastases-67 (57%) had a prior lateral neck dissection. Median follow-up after percutaneous ethanol ablation was 5.5 years (interquartile range 3.1-7.5). On average, 1.4 lymph nodes (range: 1-6) were treated. Three patients (3%) developed transient nerve-related complications after percutaneous ethanol ablation. Of 15 patients who underwent lateral neck dissection after percutaneous ethanol ablation (including patients undergoing repeat lateral neck dissection), dissection was "difficult" in 8 (53%) (7 of whom had previously undergone lateral neck dissection), and 4 (27%) developed complications (transient nerve dysfunction = 3, lymphatic leak = 1). Thirty-three patients (28%) developed recurrent papillary thyroid carcinoma. No difference in recurrence was seen between patients who did or did not undergo pre-percutaneous ethanol ablation lateral neck dissection (no pre-percutaneous ethanol ablation lateral neck dissection: 24%, pre-percutaneous ethanol ablation lateral neck dissection, 31%; hazard ratio = 1.27, 95% confidence interval 0.62-2.58; P = .514). CONCLUSION Percutaneous ethanol ablation may be a safe primary treatment modality for papillary thyroid carcinoma lateral neck nodal recurrence in selected patients with low-volume nodal disease.
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Affiliation(s)
- Sarah Lund
- Mayo Clinic Department of Surgery, Rochester, MN.
| | - John J Schmitz
- Mayo Clinic Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Rochester, MN
| | - Trenton Foster
- Mayo Clinic Division of Endocrine and Metabolic Surgery, Rochester, MN
| | - Benzon Dy
- Mayo Clinic Division of Endocrine and Metabolic Surgery, Rochester, MN
| | - Travis McKenzie
- Mayo Clinic Division of Endocrine and Metabolic Surgery, Rochester, MN
| | - M Regina Castro
- Mayo Clinic Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Rochester, MN
| | - Melanie L Lyden
- Mayo Clinic Division of Endocrine and Metabolic Surgery, Rochester, MN
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Zhang C, Shariq O, Bews K, Poruk K, Mrdutt MM, Foster T, Etzioni DA, Habermann EB, Thiels C. Outpatient surgery benchmarks and practice variation patterns: Case controlled study. Int J Surg 2024:01279778-990000000-01245. [PMID: 38526509 DOI: 10.1097/js9.0000000000001392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Despite numerous potential benefits of outpatient surgery, there is currently a lack of national benchmarking data available for hospitals and surgeons to compare their own outcomes as they transition toward outpatient surgery. MATERIALS AND METHODS Patients who underwent 14 common general surgery operations from 2016-2020 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Operations were selected based on frequency and the ability to be performed both in- and outpatient. Postoperative complications and readmissions were compared between patients who underwent inpatient vs outpatient surgery. After adjusting for patient comorbidities, multivariable models assessed the effect of patient characteristics on the odds of experiencing postoperative complications. A separate multiinstitutional study of 21 affiliated hospitals assessed practice variation. RESULTS In 13 of the 14 studied procedures, complications were lower for patients who were selected for outpatient surgery (all P<0.01); minimally invasive (MIS) adrenalectomy showed no difference (P=0.61). Multivariable analysis confirmed these findings; the odds of experiencing any adverse events were lower following outpatient surgery in all operations but MIS adrenalectomy (OR 0.97; 95% CI 0.47-2.02). Analysis of institutional practices demonstrated variation in the rate of outpatient surgery in certain breast, endocrine, and hernia repair operations. CONCLUSIONS Institutional practice patterns may explain the national variation in the rate of outpatient surgery. While the present data does not support the adoption of outpatient surgery to less optimal candidates, addressing unexplained practice variations could result in improved utilization of outpatient surgery.
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Affiliation(s)
- Chi Zhang
- Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester, Rochester, MN
| | - Omair Shariq
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester, Rochester, MN
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic Rochester, Rochester MN
| | - Katherine Bews
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester, Rochester, MN
| | - Katherine Poruk
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL
| | - Mary M Mrdutt
- Division of Breast & Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic Rochester, Rochester MN
| | - Trenton Foster
- Division of Endocrine & Metabolic Surgery, Department of Surgery, Mayo Clinic Rochester, Rochester MN
| | | | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester, Rochester, MN
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic Rochester, Rochester MN
| | - Cornelius Thiels
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic Rochester, Rochester MN
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Dogra P, Chinthapalli M, Sandooja R, Rahimi L, Iniguez-Ariza NM, Foster T, Bancos I. Adrenal Hemorrhage: A Comprehensive Analysis of a Heterogeneous Entity-Etiology, Presentation, Management, and Outcomes. Mayo Clin Proc 2024; 99:375-386. [PMID: 38432745 PMCID: PMC10917120 DOI: 10.1016/j.mayocp.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To investigate the etiology, presentation, management, and outcomes of patients with adrenal hemorrhage (AH). PATIENTS AND METHODS Longitudinal study of consecutive adult patients with radiologically confirmed AH (January 1, 2017, through December 31, 2021). RESULTS Of the 363 patients with AH (median age, 62 years [interquartile range (IQR, 52-70 years]; 128 women [35%]), 338 (93%) had unilateral AH and 25 (7%) had bilateral AH. It was discovered incidentally in 152 patients (42%) and during the evaluation of trauma in 103 (28%), abdominal/back pain in 90 (25%), critical illness in 13 (4%), and symptoms of adrenal insufficiency in 5 (1%). Etiologies included postoperative complications in 150 patients (41%), trauma in 107 (30%), coagulopathy in 22 (6%), anticoagulant/antiplatelet therapy in 39 (11%), adrenal neoplasm in 22 (6%), and sepsis in 11, (3%). Overall, 165 patients (46%) were hospitalized, and no deaths occurred due to AH. Median (IQR) baseline AH size was 34 mm (24-40 mm) on the right and 29 mm (22-37 mm) on the left. Among 246 patients with follow-up imaging, AH resolution was complete in 155 (63%) and incomplete in 74 (30%) at a median of 15 months (IQR, 6-31 months). Patients with bilateral AH were more likely to have underlying coagulopathy (44% vs 3%) and to develop primary adrenal insufficiency (72% vs 0%) than those with unilateral AH (P<.001). CONCLUSION Often, AH presents as an incidental unilateral lesion with normal adrenal function, commonly attributed to postoperative complications or trauma. In contrast, bilateral AH is rare and typically linked to underlying coagulopathy, with primary adrenal insufficiency developing in most patients.
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Affiliation(s)
- Prerna Dogra
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin School of Medicine and Public Health, Madison
| | - Mrunal Chinthapalli
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Rashi Sandooja
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Leili Rahimi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Nicole M Iniguez-Ariza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Medicine, American British Cowdray Medical Center, Mexico City, Mexico
| | | | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
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Keightley P, Foster T, Eggins K, Reay RE. The impact of adolescent suicide on clinicians: a mixed-methods study. Occup Med (Lond) 2023; 73:398-403. [PMID: 37499056 DOI: 10.1093/occmed/kqad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Clinician reactions to client suicide may include shock, grief, guilt, self-doubt, shame, anger, and fears of blame and medico-legal consequences. Clinicians will often differ in their reactions to the suicide and the type of supports required. Adolescent suicide-specific literature is limited. AIMS We sought to explore clinician reactions and perceptions of support following child and adolescent suicide. METHODS One hundred and fifteen staff working for a Child and Adolescent Mental Health Service were invited to complete an online survey with quantitative and qualitative components, and an in-depth semi-structured interview. Results were presented to teams for reflection and further feedback. RESULTS Eight clinicians participated in the semi-structured interview, and 33 in the online survey. Thirteen were the primary clinician, and 21 were part of a multi-disciplinary team when a client suicided. Respondents were predominantly female, from a range of disciplines. Fifty per cent of primary clinicians found the support good to very good. The rest were neutral. However, 26% of team members found support poor to very poor. Clinicians reported questioning their clinical effectiveness and chosen vocation. Some reported a need to disconnect or withdraw to preserve motivation and empathy for the work. They received significant support from their team, and teams were very anxious for the well-being of primary clinicians. CONCLUSIONS Health services must find ways of helping staff feel that their sense of vocation is valued and nurtured. These strategies will likely include fostering team cohesiveness and mutual support and allowing opportunities to temporarily step back and recover after challenging experiences.
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Affiliation(s)
- P Keightley
- Child and Adolescent Mental Health Service, Mental Health, Justice Health, Drug and Alcohol Service, Canberra Health Services, Garran, ACT, Australia
- Academic Unit of Psychiatry & Addiction Medicine, Canberra Hospital, Australian National University (ANU) School of Medicine and Psychology, Garran, ACT, Australia
| | - T Foster
- Child and Adolescent Mental Health Service, Mental Health, Justice Health, Drug and Alcohol Service, Canberra Health Services, Garran, ACT, Australia
| | - K Eggins
- Child and Adolescent Mental Health Service, Mental Health, Justice Health, Drug and Alcohol Service, Canberra Health Services, Garran, ACT, Australia
| | - R E Reay
- Academic Unit of Psychiatry & Addiction Medicine, Canberra Hospital, Australian National University (ANU) School of Medicine and Psychology, Garran, ACT, Australia
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Dogra P, Navin PJ, McKenzie TJ, Foster T, Dy B, Lyden M, Young WF, Bancos I. Clinical, imaging and biochemical presentation of cystic pheochromocytomas. Clin Endocrinol (Oxf) 2023; 98:32-40. [PMID: 35445428 PMCID: PMC9585148 DOI: 10.1111/cen.14743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/03/2022] [Accepted: 04/10/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Cystic adrenal mass is a rare imaging presentation of pheochromocytoma. We aimed to describe the clinical, biochemical and imaging characteristics of patients with cystic pheochromocytoma. DESIGN Single-centre, retrospective study, 2000-2020. PATIENTS Consecutive patients with cystic pheochromocytoma were identified from our institutional pathology and adrenal tumour database. RESULTS Of the 638 patients with pheochromocytomas, 21 (3.2%) had cystic pheochromocytomas (median age: 57 years, 57% women). Most pheochromocytomas were discovered incidentally (57%) or due to symptoms of catecholamine excess (24%). The median tumour size was 6.4 cm. On imaging, cystic pheochromocytomas were round or oval (90%), heterogeneous lesions (86%) with a thick solid rim (median rim thickness 13.9 mm, unenhanced computed tomography (CT) attenuation 40 Hounsfield units (HU), venous-phase CT attenuation 83 HU), and a median cystic component of 40% (unenhanced CT attenuation 17.6 HU, venous-phase CT attenuation 20.4 HU), and rarely with calcifications (15%). All 20 patients with biochemical testing had functioning tumours (adrenergic in 80%, noradrenergic in 20%). Total urinary metanephrine excretion correlated with the volume of the solid component (R2 = .75, p < .0001) but not the cystic component (R2 = .04, p = .4386). All patients underwent adrenalectomy (48% laparoscopic, 52% open), and the median duration of hospital stay was 4 days. CONCLUSIONS Cystic pheochromocytomas are rare, large tumours with a phenotypic appearance that can masquerade as other adrenal cystic lesions. The degree of biochemical abnormality in cystic pheochromocytomas is associated with the volume of the solid component. All patients with adrenal cysts that have a solid component or an unenhanced attenuation >10 HU should undergo biochemical testing for pheochromocytoma.
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Affiliation(s)
- Prerna Dogra
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Benzon Dy
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Melanie Lyden
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - William F. Young
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, USA
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Yalon T, Yalon M, Assaf D, Lenartowicz K, Foster T, Lyden M, Dy B, Bancos I, McKenzie T. Differentiating between adrenocortical carcinoma and lipid-poor cortical adenoma: A novel cross-sectional imaging-based score. Surgery 2023; 173:35-42. [PMID: 36244817 DOI: 10.1016/j.surg.2022.07.029] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/03/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Discrimination between adrenocortical carcinoma and lipid-poor cortical adenoma preoperatively is frequently difficult as these two entities have overlapping imaging characteristics. Differentiation will allow for the selection of the most appropriate operative approach and may help prevent over-treatment. We aimed to identify imaging features that could preoperatively differentiate adrenocortical carcinoma from lipid-poor cortical adenoma and use them in a novel imaging-based score. METHODS We conducted a retrospective analysis of patients with pathologically proven adrenocortical carcinoma and lipid-poor cortical adenoma who underwent resection in a single tertiary referral center between March 1998 and August 2020. The inclusion criteria were diameter >1 cm, attenuation >10 Hounsfield units on nonenhanced computed tomography, and histopathologic diagnosis. Patients with metastatic or locally advanced adrenocortical carcinoma adenoma (stages 3-4) were excluded. We developed a score using binary logistic multivariate regression model in 5-fold derivation (∼70%) cohorts with stepwise backward conditional regression as feature selection. Standardized mean regression weight was used as variable score points. RESULTS We identified 232 adrenals resected across 211 patients. By comparing the imaging characteristics of adrenocortical carcinoma (n = 56) and lipid-poor cortical adenoma (n = 156), we revealed statistically significant differences between the groups in 9 parameters: size, attenuation, thin and thick rim enhancement patterns, heterogeneity, calcification, necrosis, fat infiltration, and lymph node prominence. The score mean performance was 100% sensitivity for the exclusion of adrenocortical carcinoma, 80% specificity (95% confidence interval, 68.3-91.5), 66% positive predictive value (95% confidence interval, 52.3-78.7), and 100% negative predictive value with area under the curve of 0.974. CONCLUSION We defined and evaluated a novel 9-variable, imaging-based score. This score outperformed any single variable and could facilitate safe preoperative discrimination of adrenocortical carcinoma and lipid-poor cortical adenoma.
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Affiliation(s)
- Tal Yalon
- Endocrine Surgery, Mayo Clinic, Rochester, MN.
| | - Mariana Yalon
- CT Clinical Innovation Center, Department of Radiology, Mayo Clinic, Rochester, MN. https://twitter.com/YalonMariana
| | - Dan Assaf
- Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | | | | | | | - Benzon Dy
- Endocrine Surgery, Mayo Clinic, Rochester, MN
| | - Irina Bancos
- Division of Endocrinology, Mayo Clinic, Rochester, MN
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Saha S, Vierkant RA, Johnson GB, Parvinian A, Wermers RA, Foster T, McKenzie T, Dy B, Lyden M. C 11 choline PET/CT succeeds when conventional imaging for primary hyperparathyroidism fails. Surgery 2023; 173:117-123. [PMID: 36229257 DOI: 10.1016/j.surg.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/14/2022] [Accepted: 08/09/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Focused parathyroidectomy in primary hyperparathyroidism is possible with accurate preoperative localization. A growing body of data exists regarding the role of radio-labeled C11 choline positron emission tomography/computed tomography. In cases of nonlocalized disease, it may be a useful adjunct to ultrasound, (123)I/(99)Tc-sestamibi (I-123 sestamibi), or 4-dimensional computed tomography imaging. METHODS Patients who received a neck and chest limited coverage C11 choline positron emission tomography/computed tomography for evaluation of primary hyperparathyroidism from 2017 to 2021 at a single institution were retrospectively reviewed. We assessed the sensitivity, positive predictive value, and false negative rate. We also compared these rates to the standard modalities of ultrasound, I-123 sestamibi, 4-dimensional computed tomography, and examined concordance rates. RESULTS We identified 43 patients, of whom 33 had a positive C11 choline positron emission tomography/computed tomography finding. This cohort of patients had failed to localize on multiple standard imaging modalities. Twenty-five patients proceeded to surgery, 72% of whom were reoperative cases. Twenty (80%) achieved an intraoperative cure. Analysis showed that C11 choline positron emission tomography/computed tomography achieved a sensitivity of 64% (95% confidence interval 47%-82%) and positive predictive value of 72% (95% confidence interval 54%-90%). There were 5/25 (20%) false positive positron emission tomography C11 choline results found to be lymph nodes, normal parathyroid, and 1 recurrent laryngeal nerve neuroma. CONCLUSION C11 choline positron emission tomography/computed tomography is a useful adjunct for parathyroid localization in a complex population of patients who have failed standard localization techniques including ultrasound, I-123 sestamibi, or 4-dimensional computed tomography and/or prior operations. Although routine inclusion of C11 choline positron emission tomography/computed tomography imaging may not be necessary, it may aid in preoperative localization in the reoperative setting.
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Affiliation(s)
- Sujata Saha
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN
| | | | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology and Department of Immunology, Mayo Clinic, Rochester, MN
| | - Ahmad Parvinian
- Division of Nuclear Medicine, Department of Radiology and Department of Immunology, Mayo Clinic, Rochester, MN
| | - Robert A Wermers
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition and Department of Medicine, Mayo Clinic, Rochester, MN
| | - Trenton Foster
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN
| | - Travis McKenzie
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN
| | - Benzon Dy
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN
| | - Melanie Lyden
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN.
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Young WF, Dogra P, Rivera M, McKenzie T, Lyden M, Foster T, Dy B, Bancos I. RF33 | PSUN01 Clinical Course of Benign Adrenal Cysts: A Single-Center Experience of 90 Patients. J Endocr Soc 2022. [PMCID: PMC9624645 DOI: 10.1210/jendso/bvac150.289] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction Benign adrenal cysts (BACs) comprise 1% of adrenal incidentalomas. Scarce data are available to guide hormonal evaluation and management. We aimed to describe the clinical presentation, imaging characteristics and outcomes of patients with BACs. Methods This was a single center retrospective study of patients with histologically or radiologically confirmed BACs evaluated between 1995-2021. Other cystic adrenal lesions (such as cystic pheochromocytoma and adrenocortical cancer) were excluded. Medical records were reviewed for clinical, biochemical, radiological, and surgical information. Subgroup analyses based on surgical versus nonsurgical management was performed. Results BACs were diagnosed in 92 patients (53, 57% women) at a median age of 45 years. Mode of discovery was incidental on imaging in 81 (88%), symptoms of mass effect in 9 (9.8%), and other in 2 (2.2%). Majority (89, 97%) of patients had unilateral cysts (45 right, 44 left) with a median size of 48 mm (range 4-200) at diagnosis. On imaging, most cysts were round/oval (85.4%), homogenous (83.2%) lesions with calcifications (64.0%) and no vascular enhancement (97.7%). During a median follow-up of 65 months (range 7-288), adrenal cysts demonstrated minimal enlargement (median size change 6 mm, median growth rate 2 mm/year).Age of diagnosis, sex, site and initial size of BAC were not associated with an increase in size during follow up. On hormonal evaluation, 10% (5/50 tested) had an abnormal overnight dexamethasone suppression test, and 9.5% (4/42 tested) had an abnormal case detection testing for primary aldosteronism. Adrenalectomy was performed in 46 (51%) patients. Patients treated with adrenalectomy (46, 50%) were younger (36.9 vs 50.8 years, P=0.0009) and had more rapidly enlarging cysts (median growth rate 5.5 vs 0.4 mm/year, P=0.0002). Conclusions BACs are usually incidentally discovered and nonfunctional lesions with excellent prognosis, irrespective of management. On imaging, benign adrenal cysts appear as large, homogenous lesions without vascular enhancement that demonstrate slow growth. Adrenalectomy should be reserved for the minority of patients with abnormal hormonal evaluation or imaging characteristics (heterogenous, vascular enhancement) concerning for an alternate etiology, or those who develop symptoms of mass effect. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:42 p.m. - 12:47 p.m.
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Shariq O, McKenna N, Glasgow A, Foster T, Dy B, Lyden M, Habermann E, McKenzie T. RF09 | PSAT94 Challenging the Status Quo: Are Routine Post-Operative Day 1 Non-Endocrine Labs Necessary After Adrenalectomy? J Endocr Soc 2022. [PMCID: PMC9624578 DOI: 10.1210/jendso/bvac150.270] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The Choosing Wisely campaign from the American Board of Internal Medicine (ABIM) Foundation has scrutinized the practice of routinely ordering tests that offer limited or no benefit to patients, and have the potential to cause harm. Although postoperative day 1 (POD1) hormonal testing is necessary for certain patients who undergo adrenalectomy (i.e. those with functional tumors), the clinical utility of routinely checking POD1 non-endocrine labs is unclear, particularly in patients with non-functional adenomas. We sought to investigate how often these non-endocrine labs were abnormal after adrenalectomy and whether they represent value-added care. Methods Patients who underwent open or laparoscopic adrenalectomy at our institution from 2011-2020 were identified, and those with non-endocrine serum labs (hemoglobin, potassium, creatinine, or glucose) obtained before 0800 on POD1 were analysed. The frequency of abnormal labs, and any associated intervention(s), was recorded. Exclusion criteria varied by lab type and included: preoperative hemoglobin <8 g/dL or intraoperative blood transfusion (hemoglobin analysis), presence of chronic kidney disease (potassium and creatinine analyses), diagnosis of primary aldosteronism (potassium analysis), and pheochromocytoma or diabetes mellitus (glucose analysis). Costs were calculated using the 2020 Medicare Clinical Laboratory Fee Schedule. Results Of 936 patients (56% female) who underwent adrenalectomy (92% laparoscopic), 91% (n=847) had ≥1 POD1 non-endocrine lab drawn. Only 0.4% (n=3) of 785 eligible patients had an abnormal POD1 hemoglobin (<8 g/dL), and 1 patient received a blood transfusion. Potassium abnormalities were present in 3.4% (n=21) of 624 eligible patients, including 9 with hypokalemia (<3.5 mmol/L) and 12 with mild hyperkalemia (5.5-5.9 mmol/L). Specific interventions for hypo/hyperkalemia were required in 5 patients (0.8% of all potassium values). AKI (creatinine increase of 0.3 g/dL or ≥1.5x baseline) was diagnosed in 4% of 759 eligible patients (n=28) and all were stage 1. Hyperglycemia (>180 mg/dL) was identified in 1% (n=6) of 577 eligible patients, and 1 patient received short-acting insulin. Of a total of 2,745 lab values, while only 2% were abnormal, the total aggregate cost of routine POD1 labs was ∼$17,000 during the study period. Conclusions Routine POD1 hemoglobin and creatinine testing are rarely abnormal after adrenalectomy and infrequently impact clinical management. Although patients with functional disease may require monitoring of electrolytes and/or glucose on POD1, in the current era of value-based healthcare, routine ordering of these labs may be unnecessary in selected patients with non-functioning tumors. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:18 p.m. - 1:23 p.m.
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Albargi H, Mallett S, Berhane S, Booth S, Hawkes C, Perkins GD, Norton M, Foster T, Scholefield B. Bystander cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest in England: An observational registry cohort study. Resuscitation 2021; 170:17-25. [PMID: 34748765 DOI: 10.1016/j.resuscitation.2021.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Bystander cardiopulmonary resuscitation (BCPR) is strongly advocated by resuscitation councils for paediatric out-of-hospital cardiac arrests (OHCAs). However, there are limited reports on rates of BCPR in children and its relationship with return of spontaneous circulation (ROSC) or survival outcomes. OBJECTIVE We describe the rate of BCPR and its association with any ROSC and survival- to- hospital-discharge. METHODS We conducted retrospective analysis of prospectively collected paediatric (<18 years of age) OHCA cases in England; we included specialist registry patients treated by emergency medical services (EMS) with known BCPR status and outcome between January 2014 and November 2018. Data included patient demographics, aetiology, witness status, initial rhythm, EMS, season, time of day and bystander status. Associations between BCPR, and any ROSC and survival-to-hospital-discharge outcomes were explored using multivariable logistic regression. RESULTS There were 2363 paediatric OHCAs treated across 11 EMS regions. BCPR was performed in 69.6% (1646/2363) of the cases overall (range 57.7% (206/367) to 83.7% (139/166) across EMS regions). Only 34.9% (550/1572) of BCPR cases were witnessed. Overall, any ROSC was achieved in 22.8% (523/2289) and survival to hospital discharge in 10.8% (225/2066). Adjusted odds ratio (aOR) for any ROSC was significantly improved following BCPR compared to no BCPR (aOR 1.37, 95% CI 1.03-1.81), but adjusted odds ratio for survival-to-hospital-discharge were similar (aOR 1.01, 95% CI 0.66-1.55). CONCLUSIONS BCPR was associated with improved rates of any ROSC but not survival-to-hospital-discharge. Variations in EMS BCPR rates may indicate opportunities for regional targeted increase in public BCPR education.
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Affiliation(s)
- H Albargi
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; Emergency Medical Services Department, Faculty of Applied Medical Science, Jazan University, Jazan, Saudi Arabia
| | - S Mallett
- UCL Centre for Medical, University College London, London W1W 7TY, UK
| | - S Berhane
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK; Institute of Applied Health Research, University of Birmingham, UK
| | - S Booth
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - C Hawkes
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - G D Perkins
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK; Department of Critical Care Medicine, Heartlands Hospital, University Hospitals Birmingham, B9 5SS, UK
| | - M Norton
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK; School of Medicine, University of Sunderland, Chester Road, Sunderland SR1 3SD, UK
| | - T Foster
- East of England Ambulance Service NHS Trust, Whiting Way, Melbourn, Cambs SG8 6EN, UK
| | - B Scholefield
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham B4 6NH, UK.
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Sada A, Ahmed E, Bancos I, Lyden ML, Dy B, Foster T, Habermann EB, McKenzie T. Understanding Characteristics and Survival of the Various Secretory Types of Adrenocortical Carcinoma. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Polycarpou A, Sada A, Dy B, Lyden M, Foster T, Bancos I, McKenzie T. Single Institutional Experience in Minimally Invasive Transperitoneal Adrenalectomy: A Series of 544 Cases Over 10 Years. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Merten MM, Foster T, Lyden M, Henry M, Regina Castro M. Favorable Early Outcomes With Thyroid Lobectomy for Low-Risk Papillary Thyroid Cancer: The Mayo Clinic Experience. Am Surg 2021; 87:1374-1378. [PMID: 34468234 DOI: 10.1177/00031348211038557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Until 2015, standard of care for low-risk papillary thyroid cancer (PTC) >1 cm was a total or near-total thyroidectomy. Despite changes in guidelines and surgical management of low-risk PTC since 2015, little data are available regarding the effect on the need for additional surgery or risk for development of lymph node metastases. Our aim was to determine outcomes in patients who underwent initial thyroid lobectomy for low-risk PTC at a high-volume tertiary care institution. METHODS Retrospective review of patients ≥18 years old with biopsy proven low-risk PTC 1-4 cm who underwent partial thyroidectomy (eg, lobectomy/isthmusectomy) at Mayo Clinic, Rochester, MN, between March 2016 and June 30, 2019. RESULTS From 1481 thyroidectomies performed during study period, 940 contained PTC on final pathology. Of these, 87 (of 123) patients who had an initial thyroid lobectomy met inclusion criteria. Five (6%) of these patients proceeded to completion thyroidectomy (CT), with 3 requiring CT and radioactive iodine in the first postoperative year and 2 undergoing only CT in the second postoperative year. No postoperative complications were reported. No patient in this cohort required additional surgery or treatment for newly discovered lymph node metastases during the follow-up period. 43 (of 72, 60%) patients not on thyroxine therapy preoperatively were started on thyroxine therapy postoperatively. CONCLUSIONS Early outcomes for those undergoing thyroid lobectomy for low-risk PTC at our institution have been favorable. These results support the 2015 American Thyroid Association guidelines to offer lobectomy for those with low-risk PTC 1-4 cm.
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Affiliation(s)
| | - Trenton Foster
- Department of Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - Melanie Lyden
- Department of Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - Michael Henry
- Department of Anatomic Pathology, 6915Mayo Clinic, Rochester, MN, United States
| | - M Regina Castro
- Division of Endocrinology, 6915Mayo Clinic, Rochester, MN, USA
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Dages KN, Kohlenberg JD, Young WF, Murad MH, Prokop L, Rivera M, Dy B, Foster T, Lyden M, McKenzie T, Thompson G, Bancos I. Presentation and outcomes of adrenal ganglioneuromas: A cohort study and a systematic review of literature. Clin Endocrinol (Oxf) 2021; 95:47-57. [PMID: 33721367 PMCID: PMC8178203 DOI: 10.1111/cen.14460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/20/2021] [Accepted: 03/09/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the presentation and outcomes of patients with adrenal ganglioneuromas (AGNs). DESIGN Single-centre retrospective cohort study (1 January 1995 to 31 December 2019) and systematic review of literature (1 January 1980 to 19 November 2019). PATIENTS Diagnosed with histologically confirmed AGN. MEASUREMENTS Baseline clinical, imaging and biochemical characteristics, recurrence rates and mortality. Subgroup analysis was performed on tumours with histologic elements of ganglioneuroma and pheochromocytoma (ie composite tumours). RESULTS The cohort study included 45 patients with AGN, 20 (44%) of which had composite tumours. Compared to pure AGN, patients with composite tumour were older (median age, 62.5 vs. 35 years, p < .001), had smaller tumours (median size, 3.9 vs. 5.7 cm, p = .016) and were discovered incidentally less frequently (65% vs. 84%, p = .009). No recurrences or ganglioneuroma-specific mortality occurred during follow-up (range, 0-266 months). The systematic review included 14 additional studies and 421 patients. The mean age of diagnosis was 39 years, and 47% were women. AGNs were discovered incidentally in 72% of patients, were predominantly unilateral (99%) and had a mean diameter of 5.8 cm and an unenhanced computed tomography (CT) attenuation of -118 to 49 Hounsfield units (HU). On imaging, 69% of AGNs were homogenous, 41% demonstrated calcifications, and 40% were lobulated. CONCLUSIONS AGNs are rare benign tumours that present with variable imaging features including large size, unenhanced CT attenuation >20 HU, calcifications and lobulated shape. Imaging characteristics can assist in establishing a diagnosis and avoiding an unnecessary adrenalectomy. The association of pheochromocytomas with AGNs is frequent. Diagnosis should include biochemical testing.
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Affiliation(s)
- Kelley N. Dages
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jacob D. Kohlenberg
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - William F. Young
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohammad Hassan Murad
- Evidence-Based Practice Center, Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | - Larry Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Rivera
- Department of Laboratory Medicine and Pathology, Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Benzon Dy
- Division of Breast, Endocrine, Metabolic and GI Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Trenton Foster
- Division of Breast, Endocrine, Metabolic and GI Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Melanie Lyden
- Division of Breast, Endocrine, Metabolic and GI Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Travis McKenzie
- Division of Breast, Endocrine, Metabolic and GI Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Geoffrey Thompson
- Division of Breast, Endocrine, Metabolic and GI Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Foster T, Dy B, Rocco R, Mckenzie T, Thompson G, Wermers R, Lyden M. Routine Use of Preoperative Neck Ultrasound in Primary Hyperparathyroidism Identifies Coexisting Thyroid Disease and Improves Parathyroid Localization. Am Surg 2021; 88:254-259. [PMID: 33517698 DOI: 10.1177/0003134821991991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND In Jan 2018, we began routinely obtaining neck ultrasound (US) with 123I/99Tc-sestamibi (MIBI) for parathyroid gland localization and to identify thyroid pathology in the setting of primary hyperparathyroidism (1HPT). The aim of this study is to assess if routine neck US is a useful adjunct to 123I/99Tc-MIBI in 1HPT. METHODS Patients undergoing surgery for 1HPT with both 123I/99Tc-MIBI and US at our institution after implementation of routine US were reviewed. Biopsy and surgical management of thyroid pathology was evaluated. 123I/99Tc-MIBI and US results were compared to intraoperative findings to determine sensitivity and positive predictive value (PPV) for parathyroid localization. RESULTS From January 2018 to September 2019, there were 423 patients (mean, 61 years) that met inclusion criteria (80% women). Thyroid nodules were found on US in 57%, mean size 1.3 + 0.8 cm. Fine needle aspiration (FNA) was performed in 87 patients with nodules (36%). 35 patients (8.5%) required total or partial thyroidectomy for diagnoses/treatment. Papillary thyroid cancer (PTC) was found in 3.5% of the cohort with micro-PTC 53% and PTC 1-2 cm 40%. A successful parathyroid operation for 1HPT was achieved in 98.6% of patients. Positive predictive value for localization of abnormal parathyroid glands was 97% when US and 123I/99Tc-MIBI had concordant findings. DISCUSSION Routine use of US in 1HPT commonly identifies nodules that are benign or low-risk PTC. Ultrasound is less sensitive for parathyroid localization but when used with 123I/99Tc-MIBI, concordant imaging has a high PPV.
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Affiliation(s)
- Trenton Foster
- Department of Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - Benzon Dy
- Department of Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - Raffaele Rocco
- Department of Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | | | | | - Robert Wermers
- Department of Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - Melanie Lyden
- Department of Surgery, 6915Mayo Clinic, Rochester, MN, USA
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Foster T, Bancos I, McKenzie T, Dy B, Thompson G, Lyden M. Early assessment of postoperative adrenal function is necessary after adrenalectomy for mild autonomous cortisol secretion. Surgery 2020; 169:150-154. [PMID: 32693952 DOI: 10.1016/j.surg.2020.05.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/26/2020] [Accepted: 05/27/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND The diagnostic threshold for mild autonomous cortisol secretion using low dose, overnight, dexamethasone suppression testing is recognized widely as a serum cortisol ≥1.8 mcg/dL. The degree to which these patients require postoperative glucocorticoid replacement is unknown. METHODS We reviewed adult patients with corticotropin (ACTH)-independent hypercortisolism who underwent unilateral laparoscopic adrenalectomy for benign disease with a dexamethasone suppression testing ≥1.8 mcg/dL at our institution from 1996 to 2018. Patients with a dexamethasone suppression testing of 1.8 to 5 mcg/dL were compared with those with a dexamethasone suppression testing >5 mcg/dL. RESULTS We compared 68 patients with a preoperative dexamethasone suppression testing of 1.8 to 5 mcg/dL to 53 patients with a preoperative dexamethasone suppression testing >5 mcg/dL. Preoperative serum ACTH (mean 10.0 vs 9.2 pg/mL), adenoma size (mean 3.4 vs 3.5 cm), and side of adrenalectomy (37 and 47% right) were similar between groups (P > .05 each). Patients with a dexamethasone suppression testing 1.8 to 5 mcg/dL were older (mean values 58 ± 11 vs 52 ± 16 years ; P = .01), less likely to be female (63 vs 81%; P = .03), had greater body mass indexes (33.1 ± 8.4 vs 29.1 ± 5.6; P = .01), and had lesser 24 hour preoperative urine cortisol excretions (32.6 ± 26.7 vs 76.1 ± 129.4 mcg; P = .03). Postoperative serum cortisol levels were compared in 22 patients with a dexamethasone suppression testing of 1.8 to 5 mcg/dL to 14 patients with a dexamethasone suppression testing >5 mcg/dL. Those with dexamethasone suppression testing 1.8 to 5 mcg/dL had greater postoperative serum cortisol levels (8.0 ± 5.7 vs 5.0 ± 2.6 mcg/dL; P = .03), were less likely to be discharged on glucocorticoid replacement (59% vs 89%; P = .003), and had a decreased duration of treatment (4.4 ± 3.8 vs 10.7 ± 18.0 months; P = .04). CONCLUSION Assessment of early postoperative adrenal function with mild autonomous cortisol secretion is necessary to minimize unnecessary glucocorticoid replacement.
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Affiliation(s)
| | - Irina Bancos
- Department of Surgery, Mayo Clinic, Rochester, MN
| | | | - Benzon Dy
- Department of Surgery, Mayo Clinic, Rochester, MN
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Gangar V, Curiale MS, D’Onorio A, Schultz A, Johnson RL, Atrache V, Agin J, Allen M, Armstrong T, Chaney T, Chang P, Chavey C, Clark T, Clover J, Cook P, Copeland F, Courtney T, Davis B, D’Onorio A, Downs D, Fender M, Foster T, Fox W, Hagen H, Hall C, High E, Kalik M, Kallstrom C, Keith M, Kruegel W, Lee J, Lewus C, Light D, Lindgren S, Mills J, Minor J, Murphy M, Muzzy T, Raghubeer E, Robbins R, Salinitro A, Saunders L, Sayer T, Schultz A, Sumpter R, Traux T, Vought K, Witt J, Yonker D. VIDAS® Enzyme-Linked Immunofluorescent Assay for Detection of Listeria in Foods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/83.4.903] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
The VIDAS LIS method and the traditional culture methods for detection of Listeria species in food were evaluated in a multilaboratory comparative study. The 6 foods tested were either naturally contaminated or inoculated with 3 different concentrations of Listeria. Results for each food and each contamination level with the VIDAS LIS method were as good as or better than those obtained with the traditional culture method. Of 1558 samples tested, 935 were positive: 839 by the VIDAS method and 809 by standard culture methods. Overall false negative rates were 10.3 and 13.5% for the VIDAS LIS and culture methods, respectively. The false positive rate for the VIDAS LIS assay was 1.4% based on 9 VIDAS LIS positive assays that did not confirm positive by isolation of Listeria. The agreement between the VIDAS LIS and culture methods for all samples tested was 86%.
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Affiliation(s)
- Vidhya Gangar
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Michael S Curiale
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Armando D’Onorio
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Ann Schultz
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
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Berz D, Spira A, Gadgeel S, Anderson I, Goldman J, Thompson J, Foster T, Pritchett Y, Cisneros C, Li C, Sorrentino J, Malik R, Beelen A. Lerociclib (G1T38), an oral CDK4/6 inhibitor, dosed continuously in combination with osimertinib for EGFRmut non-small cell lung cancer: Initial phase Ib results. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.059] [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: 11/14/2022] Open
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Arensman E, Larkin C, McCarthy J, Leitao S, Corcoran P, Williamson E, McAuliffe C, Perry IJ, Griffin E, Cassidy EM, Bradley C, Kapur N, Kinahan J, Cleary A, Foster T, Gallagher J, Malone K, Ramos Costa AP, Greiner BA. Psychosocial, psychiatric and work-related risk factors associated with suicide in Ireland: optimised methodological approach of a case-control psychological autopsy study. BMC Psychiatry 2019; 19:275. [PMID: 31492119 PMCID: PMC6728991 DOI: 10.1186/s12888-019-2249-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 08/20/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls. METHODS The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners' registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners' records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources. CONCLUSIONS The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicide.
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Affiliation(s)
- E. Arensman
- 0000000123318773grid.7872.aNational Suicide Research Foundation and School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - C. Larkin
- 0000 0001 0742 0364grid.168645.8Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, 01655 USA
| | | | - S. Leitao
- 0000 0004 0617 6269grid.411916.aSchool of Public Health, College of Medicine and Health and National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, Cork University Hospital Maternity Hospital, Wilton, Cork, Ireland
| | - P. Corcoran
- 0000000123318773grid.7872.aNational Suicide Research Foundation and School of Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. Williamson
- 0000000123318773grid.7872.aNational Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - C. McAuliffe
- St. Patrick’s Mental Health Services, Cork, Ireland
| | - I. J. Perry
- 0000000123318773grid.7872.aSchool of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. Griffin
- 0000000123318773grid.7872.aNational Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. M. Cassidy
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Liaison Psychiatry Service, Cork University Hospital, Cork, Ireland
| | - C. Bradley
- 0000000123318773grid.7872.aDepartment of General Practice, University College Cork, Western Gateway Building, Cork, Ireland
| | - N. Kapur
- 0000 0004 0430 6955grid.450837.dCentre for Mental Health and Safety, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - J. Kinahan
- 0000 0004 0575 9497grid.411785.eNorth Lee Psychiatric Services, Mercy University Hospital, Cork, Ireland
| | - A. Cleary
- 0000 0001 0768 2743grid.7886.1Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
| | - T. Foster
- Consultant Psychiatrist, Omagh and Fermanagh, Northern Ireland
| | - J. Gallagher
- 0000000123318773grid.7872.aSchool of Public Health, University College Cork, Cork, Ireland
| | - K. Malone
- 0000 0001 0768 2743grid.7886.1School of Medicine, University College Dublin, Dublin, Ireland
| | - A. P. Ramos Costa
- 0000000123318773grid.7872.aSchool of Public Health and National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - B. A. Greiner
- 0000000123318773grid.7872.aSchool of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
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Wang M, Foster T, Baran T, Butani D, Xue J. Abstract No. 571 Effective dose comparison between computed tomography– versus fluoroscopy-guided bone marrow biopsies. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Díaz-Calderón P, MacNaughtan B, Hill S, Foster T, Enrione J, Mitchell J. Changes in gelatinisation and pasting properties of various starches (wheat, maize and waxy maize) by the addition of bacterial cellulose fibrils. Food Hydrocoll 2018. [DOI: 10.1016/j.foodhyd.2018.02.023] [Citation(s) in RCA: 16] [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] [Indexed: 01/05/2023]
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Ratziu V, Harrison SA, Francque S, Bedossa P, Lehert P, Serfaty L, Romero-Gomez M, Boursier J, Abdelmalek M, Caldwell S, Drenth J, Anstee QM, Hum D, Hanf R, Roudot A, Megnien S, Staels B, Sanyal A, Gournay J, Nguyen-Khac E, De Ledinghen V, Larrey D, Tran A, Bourliere M, Maynard-Muet M, Asselah T, Henrion J, Nevens F, Cassiman D, Geerts A, Moreno C, Beuers U, Galle P, Spengler U, Bugianesi E, Craxi A, Angelico M, Fargion S, Voiculescu M, Gheorghe L, Preotescu L, Caballeria J, Andrade R, Crespo J, Callera J, Ala A, Aithal G, Abouda G, Luketic V, Huang M, Gordon S, Pockros P, Poordad F, Shores N, Moehlen M, Bambha K, Clark V, Satapathy S, Parekh S, Reddy R, Sheikh M, Szabo G, Vierling J, Foster T, Umpierrez G, Chang C, Box T, Gallegos-Orozco J. Elafibranor, an Agonist of the Peroxisome Proliferator-Activated Receptor-α and -δ, Induces Resolution of Nonalcoholic Steatohepatitis Without Fibrosis Worsening. Gastroenterology 2016; 150:1147-1159.e5. [PMID: 26874076 DOI: 10.1053/j.gastro.2016.01.038] [Citation(s) in RCA: 719] [Impact Index Per Article: 89.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Elafibranor is an agonist of the peroxisome proliferator-activated receptor-α and peroxisome proliferator-activated receptor-δ. Elafibranor improves insulin sensitivity, glucose homeostasis, and lipid metabolism and reduces inflammation. We assessed the safety and efficacy of elafibranor in an international, randomized, double-blind placebo-controlled trial of patients with nonalcoholic steatohepatitis (NASH). METHODS Patients with NASH without cirrhosis were randomly assigned to groups given elafibranor 80 mg (n = 93), elafibranor 120 mg (n = 91), or placebo (n = 92) each day for 52 weeks at sites in Europe and the United States. Clinical and laboratory evaluations were performed every 2 months during this 1-year period. Liver biopsies were then collected and patients were assessed 3 months later. The primary outcome was resolution of NASH without fibrosis worsening, using protocol-defined and modified definitions. Data from the groups given the different doses of elafibranor were compared with those from the placebo group using step-down logistic regression, adjusting for baseline nonalcoholic fatty liver disease activity score. RESULTS In intention-to-treat analysis, there was no significant difference between the elafibranor and placebo groups in the protocol-defined primary outcome. However, NASH resolved without fibrosis worsening in a higher proportion of patients in the 120-mg elafibranor group vs the placebo group (19% vs 12%; odds ratio = 2.31; 95% confidence interval: 1.02-5.24; P = .045), based on a post-hoc analysis for the modified definition. In post-hoc analyses of patients with nonalcoholic fatty liver disease activity score ≥4 (n = 234), elafibranor 120 mg resolved NASH in larger proportions of patients than placebo based on the protocol definition (20% vs 11%; odds ratio = 3.16; 95% confidence interval: 1.22-8.13; P = .018) and the modified definitions (19% vs 9%; odds ratio = 3.52; 95% confidence interval: 1.32-9.40; P = .013). Patients with NASH resolution after receiving elafibranor 120 mg had reduced liver fibrosis stages compared with those without NASH resolution (mean reduction of 0.65 ± 0.61 in responders for the primary outcome vs an increase of 0.10 ± 0.98 in nonresponders; P < .001). Liver enzymes, lipids, glucose profiles, and markers of systemic inflammation were significantly reduced in the elafibranor 120-mg group vs the placebo group. Elafibranor was well tolerated and did not cause weight gain or cardiac events, but did produce a mild, reversible increase in serum creatinine (effect size vs placebo: increase of 4.31 ± 1.19 μmol/L; P < .001). CONCLUSIONS A post-hoc analysis of data from trial of patients with NASH showed that elafibranor (120 mg/d for 1 year) resolved NASH without fibrosis worsening, based on a modified definition, in the intention-to-treat analysis and in patients with moderate or severe NASH. However, the predefined end point was not met in the intention to treat population. Elafibranor was well tolerated and improved patients' cardiometabolic risk profile. ClinicalTrials.gov number: NCT01694849.
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Affiliation(s)
- Vlad Ratziu
- Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France; Institute of Cardiometabolism and Nutrition, INSERM, UMRS 938, Paris, France.
| | - Stephen A Harrison
- Department of Medicine, Gastroenterology and Hepatology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Sven Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Pierre Bedossa
- Department of Pathology, Hôpital Beaujon, University Paris-Denis Diderot, Paris, France
| | - Philippe Lehert
- Department of Psychiatry, the University of Melbourne, Melbourne, Australia; Faculty of Economics, University of Louvain UCL, Belgique, Belgium
| | - Lawrence Serfaty
- Université Pierre et Marie Curie, Hôpital Saint-Antoine, Paris, France
| | - Manuel Romero-Gomez
- Unit for the Clinical Management of Digestive Diseases and CIBERehd, Hospital Universitario de Valme, Sevilla
| | - Jérôme Boursier
- Hepatology Department, University Hospital and LUNAM University, Angers, France
| | | | - Steve Caldwell
- Gastroenterology and Hepatology Division, University of Virginia, Charlottesville, Virginia
| | - Joost Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Quentin M Anstee
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | | | - Bart Staels
- University of Lille, INSERM UMR1011, Institut Pasteur de Lille, European Genomic Institute for Diabetes, Lille, France
| | - Arun Sanyal
- Virginia Commonwealth University, Richmond, Virginia
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Foster T, Protack C, Hashimoto T, Bai H, Hanisch J, Hu H, Wang M, Santana J, Dardik A. Abstract 367: Eph-B4 Mediates Arteriovenous Fistula Maturation via Akt-1. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Although the arteriovenous fistula (AVF) is the gold standard for dialysis access, low rates of fistula maturation prevent optimal fistula use. We have previously shown that stimulation of Eph-B4 in vein grafts prevents wall thickening during venous remodeling. Since Akt-1 is a downstream mediator of Eph-B4 signaling in endothelial cells, we hypothesized that Akt-1 mediates Eph-B4 function during AVF maturation.
Methods:
The infrarenal aorto-caval AVF model was created in wild type C57BL/6 mice and Akt-1 knockout mice as previously described. To stimulate Eph-B4 activity, mice were treated with either EphrinB2/Fc (20 μg IP) or a control vehicle at 48 hr intervals over a 21 day study period. Fistula maturation was monitored with weekly ultrasound measurements; AVF were harvested at day 21 and infrarenal IVC wall thickness was measured using computerized morphometry. Eph-B4, phospho-tyrosine, and Akt-1 immunoreactivity were measured with immunofluorescence.
Results:
In WT mice, Eph-B4 expression increased 4.6-fold after AVF compared to sham operation (p=0.007, t-test). IF revealed unmerged Eph-B4 and p-tyr signal at days 7 and 21. Stimulation of Eph-B4 in WT mice increased Eph-B4 and p-tyr merged signal 6-fold (p=0.005, ANOVA) at 21 days and resulted in a 49% decrease in phospho-Akt-1 signal (p=0.0013, t-test). Eph-B4 stimulation in WT mice was associated with reduced fistula diameter (45% vs. 98.6%; p<0.05, ANOVA) and reduced fistula wall thickness (8.9μm vs. 20.0μm; p=0.0261, t-test). However, in Akt-1 KO mice, Eph-B4 stimulation resulted in no change in fistula diameter (38% vs 22%; p=0.09, ANOVA) and no change in fistula wall thickness (15.3 vs 17μm; p=0.46, t-test).
Conclusion:
There is increased Eph-B4 expression in an AVF, although the Eph-B4 is not phosphorylated. Stimulation of Eph-B4 increases the percentage of phosphorylated Eph-B4 resulting in reduced Akt-1 phosphorylation with consequent reduced fistula diameter and wall thickness. Akt-1 knockout abolishes the effects of Eph-B4 stimulation on wall thickness and diameter. These findings suggest Eph-B4 is an inhibitor of Akt-1 activity and that Akt-1 mediates the effect of Eph-B4 on venous adaptation to the arterial environment.
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Affiliation(s)
| | | | | | - Hualong Bai
- Vascular Biology and Therapeutics, Yale Univ, New Haven, CT
| | | | - Haidi Hu
- Vascular Biology and Therapeutics, Yale Univ, New Haven, CT
| | - Mo Wang
- Vascular Biology and Therapeutics, Yale Univ, New Haven, CT
| | - Jeans Santana
- Vascular Biology and Therapeutics, Yale Univ, New Haven, CT
| | - Alan Dardik
- Vascular Biology and Therapeutics, Yale Univ, New Haven, CT
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Hashimoto T, Yamamoto K, Foster T, Bai H, Shigematsu K, Dardik A. Intraluminal Drug Delivery to the Mouse Arteriovenous Fistula Endothelium. J Vis Exp 2016:e53905. [PMID: 26967580 DOI: 10.3791/53905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Delivery of therapeutic agents to enhance arteriovenous fistula (AVF) maturation can be administered either via intraluminal or external routes. The simple murine AVF model was combined with intraluminal administration of drug solution to the venous endothelium at the same time as fistula creation. Technical aspects of this model are discussed. Under general anesthesia, an abdominal incision is made and the aorta and inferior vena cava (IVC) are exposed. The infra-renal aorta and IVC are dissected for clamping. After proximal and distal clamping, the puncture site is exposed and a 25 G needle is used to puncture both walls of the aorta and into the IVC. Immediately after the puncture, a reporter gene-expressing viral vector was infused in the IVC via the same needle, followed by 15 min of incubation. The intraluminal administration method enabled more robust viral gene delivery to the venous endothelium compared to administration by the external route. This novel method of delivery will facilitate studies that explore the role of the endothelium in AVF maturation and enable intraluminal drug delivery at the time of surgical operation.
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Affiliation(s)
- Takuya Hashimoto
- Department of Surgery and the Vascular Biology and Therapeutics Program, Yale University; Department of Vascular Surgery, University of Tokyo; Department of Vascular Surgery, VA Connecticut Healthcare Systems
| | - Kota Yamamoto
- Department of Surgery and the Vascular Biology and Therapeutics Program, Yale University; Department of Vascular Surgery, University of Tokyo; Department of Vascular Surgery, VA Connecticut Healthcare Systems
| | - Trenton Foster
- Department of Surgery and the Vascular Biology and Therapeutics Program, Yale University
| | - Hualong Bai
- Department of Surgery and the Vascular Biology and Therapeutics Program, Yale University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Alan Dardik
- Department of Surgery and the Vascular Biology and Therapeutics Program, Yale University; Department of Vascular Surgery, VA Connecticut Healthcare Systems;
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Foster T, Bouchard-Fortier A, Olivotto I, Quan ML. Abstract P5-02-07: Effect of multidisciplinary case conferences on physician decision making: Breast diagnostic rounds. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-02-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Participation in multidisciplinary case conferences (MCCs) continues to be highly variable, in spite of proven benefits. One contention is the lack of perceived utility on patient management.
Purpose: To evaluate the utility of MCCs on physician decision making in benign and malignant breast disease management.
Methods: At the Foothills Medical Centre, diagnostic breast MCCs occur biweekly. Patients with interesting or challenging diagnostic or management issues were discussed by attending surgeons, radiologists, pathologists, nurse coordinators and oncologists. Prior to case discussion, the presenting physician was asked to specify his/her management plan. Their response was recorded and compared to the management plan consensus after the MCC discussion. For each case a clinical summary and question was provided by the presenting physician, followed by a review of diagnostic images and/or pathology. After group discussion, a management consensus was achieved and documented. A management change was defined as a difference compared to the pre-MCC plan or if there was no definite management plan prior to MCC.
Results: From November 5th, 2014 to May 6th, 2015, 52 patients were discussed in 11 MCCs (1 to 8 patients per MCC). No MCCs were cancelled due to insufficient patients. Of these, 23 (44%) had a change in the management plan compared to the pre-MCC intent including 7 cases where there was no clear plan prior to MCC. Among the 23 cases with a management change, 12 (52%) were due to new or clarified information from radiology review, 6 (26%) were due to new or clarified details from pathology review and 5 (22%) changes occurred from both radiology and pathology review. All cases presented resulted in a consensus management recommendation.
Conclusion: The MCCs had a substantial impact on physician decision making. Nearly half of cases presented resulted in a change in clinical recommendation, the majority of which were based on new/clarified diagnostic imaging or pathology information. Presentation of cases at MCCs should be encouraged given their clinical impact on patient care, especially for challenging diagnostic or management issues.
Citation Format: Foster T, Bouchard-Fortier A, Olivotto I, Quan ML. Effect of multidisciplinary case conferences on physician decision making: Breast diagnostic rounds. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-02-07.
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Affiliation(s)
- T Foster
- University of Calgary, Calgary, AB, Canada
| | | | - I Olivotto
- University of Calgary, Calgary, AB, Canada
| | - ML Quan
- University of Calgary, Calgary, AB, Canada
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Wang M, Collins M, Bai H, Brownson K, Foster T, Hashimoto T, He H, Hu H, Shalaby S, Dardik A. Eph-B4 Mediates Vein Graft Adaptation By Regulation of eNOS. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.06.057] [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: 11/16/2022]
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Sasson T, Gilani S, Brhel D, Mitra S, Foster T, Kashyap R, Wing R, Rubens D, Waldman D. Assisted maturation for dialysis access: are the ends worth the means? A retrospective analysis of our institutional experience. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Nelson J, Collins A, Foster T, Cooper S. Religious beliefs and attitudes toward suicide in a cohort of medical students at Queen's University Belfast. Ulster Med J 2013; 82:194-5. [PMID: 24505159 PMCID: PMC3913414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Foster T, Dickson N, Saxton P. P3.217 International Comparison of Recent Trends in the Rates of HIV Diagnoses Among Men Who Have Sex with Men (MSM). Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0674] [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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Aguirre-Álvarez G, Foster T, Hill S. Modelling of isotherms and their hysteresis analysis in gelatin from different sources. CyTA - Journal of Food 2013. [DOI: 10.1080/19476337.2012.692122] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Murphy TM, Mullins N, Ryan M, Foster T, Kelly C, McClelland R, O'Grady J, Corcoran E, Brady J, Reilly M, Jeffers A, Brown K, Maher A, Bannan N, Casement A, Lynch D, Bolger S, Buckley A, Quinlivan L, Daly L, Kelleher C, Malone KM. Genetic variation in DNMT3B and increased global DNA methylation is associated with suicide attempts in psychiatric patients. Genes Brain Behav 2013; 12:125-32. [PMID: 23025623 DOI: 10.1111/j.1601-183x.2012.00865.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/17/2012] [Accepted: 09/27/2012] [Indexed: 11/28/2022]
Abstract
Recently, a significant epigenetic component in the pathology of suicide has been realized. Here we investigate candidate functional SNPs in epigenetic-regulatory genes, DNMT1 and DNMT3B, for association with suicide attempt (SA) among patients with co-existing psychiatric illness. In addition, global DNA methylation levels [5-methyl cytosine (5-mC%)] between SA and psychiatric controls were quantified using the Methylflash Methylated DNA Quantification Kit. DNA was obtained from blood of 79 suicide attempters and 80 non-attempters, assessed for DSM-IV Axis I disorders. Functional SNPs were selected for each gene (DNMT1; n = 7, DNMT3B; n = 10), and genotyped. A SNP (rs2424932) residing in the 3' UTR of the DNMT3B gene was associated with SA compared with a non-attempter control group (P = 0.001; Chi-squared test, Bonferroni adjusted P value = 0.02). Moreover, haplotype analysis identified a DNMT3B haplotype which differed between cases and controls, however this association did not hold after Bonferroni correction (P = 0.01, Bonferroni adjusted P value = 0.56). Global methylation analysis showed that psychiatric patients with a history of SA had significantly higher levels of global DNA methylation compared with controls (P = 0.018, Student's t-test). In conclusion, this is the first report investigating polymorphisms in DNMT genes and global DNA methylation quantification in SA risk. Preliminary findings suggest that allelic variability in DNMT3B may be relevant to the underlying diathesis for suicidal acts and our findings support the hypothesis that aberrant DNA methylation profiles may contribute to the biology of suicidal acts. Thus, analysis of global DNA hypermethylation in blood may represent a biomarker for increased SA risk in psychiatric patients.
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Affiliation(s)
- T M Murphy
- Department of Psychiatry and Mental Health Research & Education and Research Centre, St Vincent's University Hospital, and School of Medicine & Medical Science, University College Dublin, Dublin 4, Ireland
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Foster T, Gore E, Ochoa J. "Standard" Post-Ictal Treatment: Is There Such a Thing? (P01.064). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.064] [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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34
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Aguirre-Alvarez G, Pimentel-González DJ, Campos-Montiel RG, Foster T, Hill SE. The effect of drying temperature on mechanical properties of pig skin gelatin films El efecto de la temperatura de secado sobre las propiedades mecánicas de películas de gelatina de cerdo. CyTA - Journal of Food 2011. [DOI: 10.1080/19476337.2010.523902] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Eads JR, Albrecht TL, Egleston B, Buzaglo JS, Cohen RB, Fleisher L, Foster T, Katz M, Kinzy T, Manne S, Miller DM, Miller SM, Raivitch S, Roach N, Silver A, Meropol NJ. Identification of barriers to clinical trials: The impact of education level. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6003] [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: 11/20/2022] Open
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36
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Prairie BA, Foster T. Improving prenatal HIV screening with tailored educational interventions: an approach to guideline implementation. Qual Saf Health Care 2010; 19:e52. [PMID: 20702439 DOI: 10.1136/qshc.2008.031922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A healthy, uncomplicated pregnancy undergoes approximately 13 tests performed over an average of 12.5 prenatal visits. Published rates of compliance with routine prenatal testing are generally >90%, with lower rates for newer tests or those that require additional inputs prior to ordering. New CDC guidelines for prenatal HIV testing highlight the importance of prenatal testing and motivated the authors to explore our routine prenatal testing performance. The authors found the conceptual framework of simple/complicated/complex problems in healthcare helpful in understanding the rates for tests and for developing interventions. METHODS The setting for this work was a single, rural, academic tertiary care centre. Baseline rates of four routine prenatal tests (HBsAg, 1 h GTT, GBS, HIV) were determined by analysing 12 months of data from a web-based delivery registry. All rates were >90% except HIV, which was 79.2%. Process mapping and discussions with ordering providers were performed to plan the improvement intervention. Targeted educational interventions specific to each ordering provider type were followed by audit and feedback. HIV testing rates were monitored and analysed monthly using process control charts. RESULTS The HIV testing rate increased significantly from 79.2% to 94.2%. Rates greater than 90% were maintained for 10 of 11 months reported. CONCLUSIONS Targeted educational interventions combined with audit and feedback can increase rates of routine testing successfully in an outpatient setting. These interventions can be used to improve implementation and compliance with new guidelines when informed by an understanding of local context and processes coupled with an appropriate conceptual framework.
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Affiliation(s)
- B A Prairie
- Department of Obstetrics, University of Pittsburgh, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA.
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Hopkins C, Whetstone S, Foster T, Blaney S, Morrison G. The impact of paediatric tracheostomy on both patient and parent. Int J Pediatr Otorhinolaryngol 2009; 73:15-20. [PMID: 19019462 DOI: 10.1016/j.ijporl.2008.09.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [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] [Received: 07/02/2008] [Revised: 08/31/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We set out to assess the impact of paediatric tracheostomy, performed in a central London hospital, on patients and their families. METHODS We conducted structured interviews with caregivers of tracheostomised children using the Pediatric Tracheotomy Health Status Instrument during all in-patient admissions for airway endoscopy over a 6-month period. RESULTS Completed questionnaires were received from 26 caregivers, 7 (27%) of whose children had been successfully decannulated. Carers reported adverse effects on all aspects of their quality of life, including sleep, relationships, social life and ability to work. The families included in the study had gross household incomes below the mean for SE London. There is a shortfall in the provision of home nursing when compared with the needs of the caregivers. CONCLUSIONS Tracheostomy has wide ranging effects on the quality of life of both the patient and their caregivers. We identified the need for better pre-operative preparation where possible, and greater support for such families in the community.
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Affiliation(s)
- C Hopkins
- Evelina Children's Hosptial, London SE1 7EH, UK.
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Ogrinc G, Mooney SE, Estrada C, Foster T, Goldmann D, Hall LW, Huizinga MM, Liu SK, Mills P, Neily J, Nelson W, Pronovost PJ, Provost L, Rubenstein LV, Speroff T, Splaine M, Thomson R, Tomolo AM, Watts B. The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Qual Saf Health Care 2008; 17 Suppl 1:i13-32. [PMID: 18836062 PMCID: PMC2602740 DOI: 10.1136/qshc.2008.029058] [Citation(s) in RCA: 282] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
As the science of quality improvement in health care advances, the importance of sharing its accomplishments through the published literature increases. Current reporting of improvement work in health care varies widely in both content and quality. It is against this backdrop that a group of stakeholders from a variety of disciplines has created the Standards for QUality Improvement Reporting Excellence, which we refer to as the SQUIRE publication guidelines or SQUIRE statement. The SQUIRE statement consists of a checklist of 19 items that authors need to consider when writing articles that describe formal studies of quality improvement. Most of the items in the checklist are common to all scientific reporting, but virtually all of them have been modified to reflect the unique nature of medical improvement work. This "Explanation and Elaboration" document (E & E) is a companion to the SQUIRE statement. For each item in the SQUIRE guidelines the E & E document provides one or two examples from the published improvement literature, followed by an analysis of the ways in which the example expresses the intent of the guideline item. As with the E & E documents created to accompany other biomedical publication guidelines, the purpose of the SQUIRE E & E document is to assist authors along the path from completion of a quality improvement project to its publication. The SQUIRE statement itself, this E & E document, and additional information about reporting improvement work can be found at http://www.squire-statement.org.
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Affiliation(s)
- G Ogrinc
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, VT 05009, USA.
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Osunkoya A, Foster T, Pitha J. Ectopic Meningothelial Hamartoma of the Scalp. J Cutan Pathol 2008. [DOI: 10.1111/j.0303-6987.2005.320fe.x] [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: 11/29/2022]
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Barry WT, Datto M, Geradts J, Foster T, Olson J, Marcom PK, Dressman HK, Nevins JR, Ginsburg G, Potti A. Genomic-based signatures of chemosensitivity and ER/HER2 status in biologic replicate breast cancer samples. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11068] [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: 11/20/2022] Open
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Boulanger L, Kim J, Friedman M, Hauch O, Foster T, Menzin J. Patterns of use of antithrombotic therapy and quality of anticoagulation among patients with non-valvular atrial fibrillation in clinical practice. Int J Clin Pract 2006; 60:258-64. [PMID: 16494639 DOI: 10.1111/j.1368-5031.2006.00790.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [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] [Indexed: 11/26/2022] Open
Abstract
We conducted a retrospective cohort study of thromboprophylaxis rates and the quality of anticoagulation control among patients with atrial fibrillation (AF) using a large, geographically diverse database of electronic medical records. The study population consisted of 13,709 AF patients treated in US outpatient physician practices. Approximately two-thirds were prescribed warfarin alone or in combination with another drug. Older patients, males, and those with congestive heart failure (CHF) or prior stroke were more likely to receive antithrombotic therapy. Among 6454 patients treated with warfarin who had at least two valid prothrombin time/international normalised ratio test results, approximately half of study days were spent in target range. Female sex, CHF and residence in the Northeast were associated with more time out of range. Our study confirms that, in routine medical practice, warfarin is not prescribed for substantial numbers of eligible patients, and anticoagulation control with warfarin is suboptimal for many of those at risk for thromboembolism.
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Affiliation(s)
- L Boulanger
- Boston Health Economics, Waltham, MA 02451, USA
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Karnas S, Mosalaei H, Foster T, Chen J. SU-FF-T-331: Use of Photon IMRT Fields to Sharpen the Penumbra of Electron Fields Shaped with Photon MLC. Med Phys 2005. [DOI: 10.1118/1.1998060] [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: 11/07/2022] Open
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Snooks H, Foster T, Nicholl J. Results of an evaluation of the effectiveness of triage and direct transportation to minor injuries units by ambulance crews. Emerg Med J 2005; 21:105-11. [PMID: 14734396 PMCID: PMC1756342 DOI: 10.1136/emj.2003.009050] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate triage and transportation to a minor injury unit (MIU) by emergency ambulance crews. METHODS Ambulance crews in two services were asked to transport appropriate patients to MIU during randomly selected weeks of one year. During all other weeks they were to treat such patients according to normal practice. Patients were followed up through ambulance service, hospital and/or MIU records, and by postal questionnaire. Semi-structured interviews were undertaken with crews (n = 15). Cases transferred from MIU to accident and emergency (A&E) were reviewed. RESULTS 41 intervention cluster patients attended MIU, 303 attended A&E, 65 were not conveyed. Thirty seven control cluster patients attended MIU, 327 attended A&E, 61 stayed at scene. Because of low study design compliance, outcomes of patients taken to MIU were compared with those taken to A&E, adjusted for case mix. MIU patients were 7.2 times as likely to rate their care as excellent (95% CI 1.99 to 25.8). Ambulance service job-cycle time and time in unit were shorter for MIU patients (-7.8, 95% CI -11.5 to -4.1); (-222.7, 95%CI -331.9 to -123.5). Crews cited patient and operational factors as inhibiting MIU use; and location, service, patient choice, job-cycle time, and handover as encouraging their use. Of seven patients transferred by ambulance from MIU to A&E, medical reviewers judged that three had not met the protocol for conveyance to MIU. No patients were judged to have suffered adverse consequences. CONCLUSIONS MIUs were only used for a small proportion of eligible patients. When they were used, patients and the ambulance service benefited.
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Affiliation(s)
- H Snooks
- Clinical School, University of Wales Swansea, UK.
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Dale J, Williams S, Foster T, Higgins J, Snooks H, Crouch R, Hartley-Sharpe C, Glucksman E, George S. Safety of telephone consultation for "non-serious" emergency ambulance service patients. Qual Saf Health Care 2004. [PMID: 15465940 DOI: 10.1136/qshc.2003.008003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the safety of nurses and paramedics offering telephone assessment, triage, and advice as an alternative to immediate ambulance dispatch for emergency ambulance service callers classified by lay call takers as presenting with "non-serious" problems (category C calls). DESIGN Data for this study were collected as part of a pragmatic randomised controlled trial reported elsewhere. The intervention arm of the trial comprised nurse or paramedic telephone consultation using a computerised decision support system to assess, triage, and advise patients whose calls to the emergency ambulance service had been classified as "non-serious" by call takers applying standard priority dispatch criteria. A multidisciplinary expert clinical panel reviewed data from ambulance service, accident and emergency department, hospital inpatient and general practice records, and call transcripts for patients triaged by nurses and paramedics into categories that indicated that dispatch of an emergency ambulance was unnecessary. All cases for which one or more members of the panel rated that an emergency ambulance should have been dispatched were re-reviewed by the entire panel for an assessment of the "life risk" that might have resulted. SETTING Ambulance services in London and the West Midlands, UK. STUDY POPULATION Of 635 category C patients assessed by nurses and paramedics, 330 (52%) cases that had been triaged as not requiring an emergency ambulance were identified. MAIN OUTCOME MEASURES Assessment of safety of triage decisions. RESULTS Sufficient data were available from the routine clinical records of 239 (72%) subjects to allow review by the specialist panel. For 231 (96.7%) sets of case notes reviewed, the majority of the panel concurred with the nurses' or paramedics' triage decision. Following secondary review of the records of the remaining eight patients, only two were rated by the majority as having required an emergency ambulance within 14 minutes. For neither of these did a majority of the panel consider that the patient would have been at "life risk" without an emergency ambulance being immediately dispatched. However, the transcripts of these two calls indicated that the correct triage decision had been communicated to the patient, which suggests that the triage decision had been incorrectly entered into the decision support system. CONCLUSIONS Telephone advice may be a safe method of managing many category C callers to 999 ambulance services. A clinical trial of the full implementation of this intervention is needed, large enough to exclude the possibility of rare adverse events.
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Affiliation(s)
- J Dale
- Centre for Primary Health Care Studies, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
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Dale J, Williams S, Foster T, Higgins J, Snooks H, Crouch R, Hartley-Sharpe C, Glucksman E, George S. Safety of telephone consultation for "non-serious" emergency ambulance service patients. Qual Saf Health Care 2004; 13:363-73. [PMID: 15465940 PMCID: PMC1743899 DOI: 10.1136/qhc.13.5.363] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the safety of nurses and paramedics offering telephone assessment, triage, and advice as an alternative to immediate ambulance dispatch for emergency ambulance service callers classified by lay call takers as presenting with "non-serious" problems (category C calls). DESIGN Data for this study were collected as part of a pragmatic randomised controlled trial reported elsewhere. The intervention arm of the trial comprised nurse or paramedic telephone consultation using a computerised decision support system to assess, triage, and advise patients whose calls to the emergency ambulance service had been classified as "non-serious" by call takers applying standard priority dispatch criteria. A multidisciplinary expert clinical panel reviewed data from ambulance service, accident and emergency department, hospital inpatient and general practice records, and call transcripts for patients triaged by nurses and paramedics into categories that indicated that dispatch of an emergency ambulance was unnecessary. All cases for which one or more members of the panel rated that an emergency ambulance should have been dispatched were re-reviewed by the entire panel for an assessment of the "life risk" that might have resulted. SETTING Ambulance services in London and the West Midlands, UK. STUDY POPULATION Of 635 category C patients assessed by nurses and paramedics, 330 (52%) cases that had been triaged as not requiring an emergency ambulance were identified. MAIN OUTCOME MEASURES Assessment of safety of triage decisions. RESULTS Sufficient data were available from the routine clinical records of 239 (72%) subjects to allow review by the specialist panel. For 231 (96.7%) sets of case notes reviewed, the majority of the panel concurred with the nurses' or paramedics' triage decision. Following secondary review of the records of the remaining eight patients, only two were rated by the majority as having required an emergency ambulance within 14 minutes. For neither of these did a majority of the panel consider that the patient would have been at "life risk" without an emergency ambulance being immediately dispatched. However, the transcripts of these two calls indicated that the correct triage decision had been communicated to the patient, which suggests that the triage decision had been incorrectly entered into the decision support system. CONCLUSIONS Telephone advice may be a safe method of managing many category C callers to 999 ambulance services. A clinical trial of the full implementation of this intervention is needed, large enough to exclude the possibility of rare adverse events.
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Affiliation(s)
- J Dale
- Centre for Primary Health Care Studies, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
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Menzin J, Lang K, Earle C, Foster T, Dixon D, Van Gool R. Treatment patterns and costs associated with acute myeloid leukemia in the elderly: A population-based analysis. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Menzin
- Boston Health Economics, Inc, Waltham, MA; Harvard Medical School, Boston, MA; Johnson & Johnson Pharmaceutical Services, Beerse, Belgium
| | - K. Lang
- Boston Health Economics, Inc, Waltham, MA; Harvard Medical School, Boston, MA; Johnson & Johnson Pharmaceutical Services, Beerse, Belgium
| | - C. Earle
- Boston Health Economics, Inc, Waltham, MA; Harvard Medical School, Boston, MA; Johnson & Johnson Pharmaceutical Services, Beerse, Belgium
| | - T. Foster
- Boston Health Economics, Inc, Waltham, MA; Harvard Medical School, Boston, MA; Johnson & Johnson Pharmaceutical Services, Beerse, Belgium
| | - D. Dixon
- Boston Health Economics, Inc, Waltham, MA; Harvard Medical School, Boston, MA; Johnson & Johnson Pharmaceutical Services, Beerse, Belgium
| | - R. Van Gool
- Boston Health Economics, Inc, Waltham, MA; Harvard Medical School, Boston, MA; Johnson & Johnson Pharmaceutical Services, Beerse, Belgium
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