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Lewis TAJ, Kaiser ME, Goldshteyn N, Sepkowitz D, Briggs WM. A Retrospective Analysis of the Disruptions in the HIV Continuum of Care During the COVID-19 Pandemic: Lessons From a Clinic-Based Study. Cureus 2024; 16:e53416. [PMID: 38314380 PMCID: PMC10834068 DOI: 10.7759/cureus.53416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic profoundly affected healthcare services, including HIV patient care. This study assessed the impact of the pandemic on diverse aspects of care for individuals living with HIV (PLWH). METHODS Patient data from 2019 to 2021 were collected using the Cascades template, provided by the New York State Department of Health, focusing on viral testing and suppression outcomes. Age, ethnicity, sex, and race were considered variables and analyzed via chi-square analysis, logistic regression model, and F test. RESULTS The pandemic significantly reduced viral testing in 2020 due to restrictions and closures, but telemedicine and tele-pharmacy helped maintain care. Age was a crucial factor, predicting higher viral testing and suppression odds for older individuals, but no significant differences were observed between patient gender, race, or ethnicity in obtaining viral testing or achieving suppression. CONCLUSIONS While limitations existed, this study provides insights into sustaining care during crises, highlighting the importance of innovative healthcare delivery methods and age-sensitive approaches for PLWH.
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Affiliation(s)
- Toni-Ann J Lewis
- Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, New York, USA
| | - Michael E Kaiser
- Internal Medicine, St. George's University School of Medicine, Brooklyn, USA
| | - Natalya Goldshteyn
- Infectious Disease, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Douglas Sepkowitz
- Infectious Disease, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
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Jamorabo DS, Koulouris V, Briggs WM, Buscaglia JM, Renelus BD. Higher Author Fees in Gastroenterology Journals Are Not Associated with Faster Processing Times or Higher Impact. Dig Dis Sci 2022; 67:3562-3567. [PMID: 34505255 DOI: 10.1007/s10620-021-07247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/23/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Publications are an important component of academic careers. AIMS We investigated the financial costs to authors for submitting and publishing manuscripts in gastroenterology (GI) journals in the United States (US), United Kingdom (UK), and elsewhere. METHODS This was a cross-sectional study carried out from 11/1/2020 to 12/31/2020. We used the SCImago Journal and Country Rankings site to compile a list of gastroenterology and hepatology journals to analyze. We gathered information on the journals' Hirsch indices (h indices), SCImago Journal Rank (SJR), Impact Factor (IF), and base countries as of 2019, processing and publication fees, open access fees, time to first decision, and time from acceptance to publication. We used t-testing and linear regression modeling to evaluate the effect of geography and journal quality metrics on processing fees and times. RESULTS We analyzed 97 GI journals, of which 51/97 (52.6%) were based in the US/UK while the other 46/97 (47.4%) were based elsewhere. The mean IF (5.67 vs 3.53, p = 0.08), h index (90.5 vs 41.8, p < 0.001), and SJR (1.82 vs 0.83, p < 0.001) for the US/UK journals were higher than those for non-US/UK journals. We also found that 11/51 (21.6%) of US/UK journals and 15/46 (32.6%) of non-US/UK journals had mandatory processing and publication fees. These tended to be significantly larger in the US/UK group than in the non-US/UK group (USD 2380 vs USD 1470, p = 0.04). CONCLUSIONS Publication-related fees may preclude authors from smaller or socioeconomically disadvantaged institutions and countries from publishing and disseminating their work.
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Affiliation(s)
- Daniel S Jamorabo
- Division of Gastroenterology and Hepatology, Stony Brook Medicine, 101 Nicolls Road, HSC T17-060, Stony Brook, NY, 11794, USA.
| | | | - William M Briggs
- Department of Biostatistics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215, USA
| | - Jonathan M Buscaglia
- Division of Gastroenterology and Hepatology, Stony Brook Medicine, 101 Nicolls Road, HSC T17-060, Stony Brook, NY, 11794, USA
| | - Benjamin D Renelus
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA
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Briggs WM, Hanekamp JC. Nitrogen Critical Loads: Critical Reflections on Past Experiments, Ecological Endpoints, and Uncertainties. Dose Response 2022; 20:15593258221075513. [PMID: 35185419 PMCID: PMC8855399 DOI: 10.1177/15593258221075513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
Nitrogen Critical Loads (NCL), as purported ecological dose-response outcomes for
nitrogen deposition from anthropogenic sources, play a central role in
environmental policies around the world. In the Netherlands, these NCL are used
to assess, via calculations using the model AERIUS, to what extent NCL are
exceeded for different habitats as a result of different sources such as
industry, agriculture, traffic. NCL are, however, not well defined, and are
subject to hitherto unrecognized forms of uncertainty. We will address this with
reference to a number of key studies that forms the basis for several NCL. We
will subsequently propose amendments that could be applicable to future nitrogen
studies and their enhanced relevancy in decision making.
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Hanekamp JC, Briggs WM. Nitrogen Critical Loads: Critical Reflections on Past Experiments, Ecological Endpoints and Uncertainties. Dose Response 2022; 20:15593258221075512. [PMID: 35173564 PMCID: PMC8842244 DOI: 10.1177/15593258221075512] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jaap C. Hanekamp
- Science Department, University College Roosevelt, Middelburg, Netherlands
- Department of Environmental Health Sciences, University of Massachusetts, Amherst, U.S.A
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Jamorabo DS, Deek MP, Yom SS, Rehman H, Zietman AL, Motwani SB, Briggs WM, Kim S, Chang DT, Jabbour SK. Can Sex and Seniority Predict the Quality of a Journal Reviewer's Manuscript Critique? Int J Radiat Oncol Biol Phys 2021; 111:312-316. [PMID: 34044095 PMCID: PMC10845841 DOI: 10.1016/j.ijrobp.2021.05.111] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate reviewers' timeliness and review quality for the International Journal of Radiation Oncology, Biology, Physics (IJROBP) by sex and seniority. METHODS AND MATERIALS The IJROBP editorial office provided data on 3962 individuals invited to review manuscripts from 2011 through 2014. We identified 1657 reviewers who had been invited to provide a review on at least 3 occasions during the study period and compared review timeliness and scoring between male and female reviewers. We confirmed the reviewers' sex after having unblinded their names based on our personal acquaintance with them and via an Internet search on their department websites. We then did a subset analysis of 124 US-based reviewers who had returned a "major revision" decision. We used the Review Quality Instrument (RQI) to rate their reviews. We used odds ratios and t tests to look for differences in mean RQI scores and factors that might be associated with quality-in particular, Hirsch indices (h indices) and year of first certification. RESULTS Of the 1657 reviewers of interest, 1245 (75.1%) were men and 412 (24.9%) were women. We found no statistically significant differences between men and women in the time to respond to invitations. There were no statistically significant differences in timeliness or review reminders based on sex. Our subset analysis showed no difference in quality (RQI scores) based on the reviewers' sex, h index, or year of first certification. CONCLUSIONS Women and men render reviews of equal quality regardless of seniority and h index, yet women have been invited less frequently to review. This is likely because of the underrepresentation of women in radiation oncology. A more balanced academic population is needed to address this continuing disparity of women's representation in academic publishing.
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Affiliation(s)
| | - Matthew P Deek
- Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Sue S Yom
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, California
| | - Hasan Rehman
- Department of Medicine, North Shore University Hospital, Manhasset, New York
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sabin B Motwani
- Department of Radiation Oncology, St. Joseph's University Medical Center, Paterson, New Jersey
| | - William M Briggs
- Department of Biostatistics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Sinae Kim
- Rutgers School of Public Health, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
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Jamorabo DS, Chen R, Gurm H, Jahangir M, Briggs WM, Mohanty SR, Renelus BD. Women remain underrepresented in leadership positions in academic gastroenterology throughout the United States. Ann Gastroenterol 2021; 34:316-322. [PMID: 33948055 PMCID: PMC8079863 DOI: 10.20524/aog.2021.0597] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background Publication history is a key factor in securing academic promotion, but historical underrepresentation of women in gastroenterology may be an ongoing obstacle to achieving gender parity in leadership positions. Methods We carried out a cross-sectional study of gastroenterology programs in the United States, with data including faculty and trainee names, leadership positions, Hirsch indices, and year of first gastroenterology certification gathered from 1 February 2020 to 1 March 2020. Our outcomes of interest were: 1) sex representation in various leadership positions in academic gastroenterology departments; and 2) mean difference in Hirsch indices between men and women, for which we used univariate and multivariate regression models. Results Our cohort included 3655 faculty members and trainees across 163 academic gastroenterology programs in the United States. Women comprised 28.7% (1049/3655) of the cohort, including 713/2657 (26.8%) of faculty and 56/289 (19.4%) of all fellowship program directors and divisional/departmental chairs and chiefs. Male faculty had higher mean Hirsch indices compared to women (11.4 vs. 5.5, P<0.001), and when adjusted for year of first gastroenterology certification, men had a larger Hirsch index by 2.8 (95% confidence interval 1.3-4.1, P<0.001). Women were also underrepresented in various subspecialties of gastroenterology, particularly advanced endoscopy. Conclusions Women in academic gastroenterology remain underrepresented in leadership positions and have lower Hirsch indices than men. Our findings may stem not only from differences in mentorship and career goals, but also from underlying structural factors that disadvantage women.
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Affiliation(s)
- Daniel S Jamorabo
- Division of Gastroenterology and Hepatology, Stony Brook Medicine, Stony Brook, NY (Daniel S. Jamorabo)
| | - Richy Chen
- Department of Gastroenterology and Hepatology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY (Richy Chen, Smruti R. Mohanty)
| | - Hashroop Gurm
- Division of Gastroenterology and Hepatology, University of Oklahoma College of Medicine, Oklahoma City, OK (Hashroop Gurm)
| | - Muntasir Jahangir
- Department of Internal Medicine, Memorial Hermann Hospital, Houston, TX (Muntasir Jahangir)
| | - William M Briggs
- Department of Biostatistics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY (William M. Briggs)
| | - Smruti R Mohanty
- Department of Gastroenterology and Hepatology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY (Richy Chen, Smruti R. Mohanty)
| | - Benjamin D Renelus
- Division of Gastroenterology and Hepatology, Morehouse School of Medicine, Atlanta, GA (Benjamin D. Renelus), USA
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Renelus BD, Khoury N, Chandrasekaran K, Bekele E, Briggs WM, Jamorabo DS. Hospitalized coronavirus disease-2019 (COVID-19) patients with gastrointestinal symptoms have improved survival to discharge. Dig Liver Dis 2020; 52:1403-1406. [PMID: 32948489 PMCID: PMC7472976 DOI: 10.1016/j.dld.2020.08.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Benjamin D. Renelus
- Division of Gastroenterology and Hepatology, Morehouse School of Medicine, Atlanta, GA, United States
| | - Neil Khoury
- Department of Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Karthik Chandrasekaran
- Department of Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Ezana Bekele
- Department of Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - William M. Briggs
- Department of Biostatistics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Daniel S. Jamorabo
- Division of Gastroenterology and Hepatology, Stony Brook Medicine, 101 Nicolls Road, HSC T17-060, Stony Brook, NY 11794, United States,Corresponding author
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Renelus BD, Khoury NC, Chandrasekaran K, Bekele E, Briggs WM, Ivanov A, Mohanty SR, Jamorabo DS. Racial Disparities in COVID-19 Hospitalization and In-hospital Mortality at the Height of the New York City Pandemic. J Racial Ethn Health Disparities 2020; 8:1161-1167. [PMID: 32946070 PMCID: PMC7500250 DOI: 10.1007/s40615-020-00872-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022]
Abstract
Objectives Investigate whether or not race is associated with differences in hospitalization and survival to discharge among patients with coronavirus disease-2019 (COVID-19) at the height of the pandemic in New York City (NYC). Methods Single-center retrospective cohort study of COVID-19 patients hospitalized at our university-affiliated NYC hospital from 3/10/20 through 4/13/20 with follow-up to 5/1/20. Our primary endpoint was hospitalization rate among patients with confirmed COVID-19 compared with the regional population based on race. Our secondary endpoint survival to discharge among hospitalized COVID-19 patients. NYC Department of Health data were used to calculate hospitalization odds ratios. Chi-square and t tests were used to compare categorial and continuous variables, respectively. Cox proportional hazards regression and predictive analysis were used to investigate our endpoints further. Results Our cohort of 734 patients included 355 women (48.4%), 372 Blacks (50.7%), 214 Whites (29.2%), and 92 Hispanics (12.5%) in our analysis. Blacks were nearly twice as likely as Whites to require hospitalization for COVID-19 (OR 1.89, 95% CI, 1.59–2.24, p < 0.001). Hispanics were also more likely to suffer in-hospital mortality from COVID-19 compared with Whites (HR 1.84; 95% CI 1.21–2.80; p = 0.005). There was a non-significant increased hazard of in-hospital mortality among Blacks when compared with Whites (HR, 1.30; 95% CI, 0.95–1.78; p = 0.09). Conclusions and Relevance Blacks were more likely than Whites to require hospitalization for COVID-19 while Hispanics were more likely to experience in-hospital mortality. Further investigation into the socioeconomic factors underlying racial disparities in COVID-19 survival and severity requiring hospitalization is needed on a national scale.
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Affiliation(s)
- Benjamin D Renelus
- Division of Gastroenterology and Hepatology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Neil C Khoury
- Department of Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Karthik Chandrasekaran
- Department of Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Ezana Bekele
- Department of Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - William M Briggs
- Department of Biostatistics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Alexander Ivanov
- Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Smruti R Mohanty
- Division of Gastroenterology and Hepatology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Daniel S Jamorabo
- Division of Gastroenterology and Hepatology, Stony Brook Medicine, 101 Nicolls Road, HSC T17-060, Stony Brook, NY, 11794, USA.
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Renelus BD, Jamorabo DS, Boston I, Briggs WM, Poneros JM. Endoscopic Ultrasound-Guided Fine Needle Biopsy Needles Provide Higher Diagnostic Yield Compared to Endoscopic Ultrasound-Guided Fine Needle Aspiration Needles When Sampling Solid Pancreatic Lesions: A Meta-Analysis. Clin Endosc 2020; 54:261-268. [PMID: 32892519 PMCID: PMC8039752 DOI: 10.5946/ce.2020.101] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022] Open
Abstract
Background/Aims Studies comparing the utility of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for solid pancreatic lesions have been inconclusive with no clear superiority. The aim of this meta-analysis was to compare the diagnostic accuracy and safety between the two sampling techniques.
Methods We performed a systematic search of randomized controlled trials published between 2012 and 2019. The primary outcome was overall diagnostic accuracy. Secondary outcomes included adverse event rates, cytopathologic and histopathologic accuracy, and the mean number of passes required to obtain adequate tissue between FNA and FNB needles. Fixed and random effect models with pooled estimates of target outcomes were developed.
Results Eleven studies involving 1,365 participants were included for analysis. When compared to FNB, FNA had a significant reduction in diagnostic accuracy (81% and 87%, p=0.005). In addition, FNA provided reduced cytopathologic accuracy (82% and 89%, p=0.04) and an increased number of mean passes required compared to FNB (2.3 and 1.6, respectively, p<0.0001). There was no difference in adverse event rate between FNA and FNB needles (1.8% and 2.3% respectively, p=0.64).
Conclusions FNB provides superior diagnostic accuracy without compromising safety when compared to FNA. FNB should be readily considered by endosonographers when evaluating solid pancreatic masses.
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Affiliation(s)
- Benjamin D Renelus
- Division of Gastroenterology and Hepatobiliary Disease, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Daniel S Jamorabo
- Division of Gastroenterology and Hepatobiliary Disease, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Iman Boston
- Department of Internal Medicine, Wright State University, Dayton, OH, USA
| | - William M Briggs
- Department of Epidemiology and Biostatistics, Weill Cornell Medical College, New York, NY, USA
| | - John M Poneros
- Division of Gastroenterology and Hepatology, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
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Renelus BD, Jamorabo DS, Gurm HK, Dave N, Briggs WM, Arya M. Comparative outcomes of endoscopic ultrasound-guided cystogastrostomy for peripancreatic fluid collections: a systematic review and meta-analysis. Ther Adv Gastrointest Endosc 2019; 12:2631774519843400. [PMID: 31192314 PMCID: PMC6537502 DOI: 10.1177/2631774519843400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/16/2018] [Accepted: 03/20/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Endoscopic ultrasound–guided cystogastrostomy has become the first-line treatment for symptomatic peripancreatic fluid collections. The aim of this study is to analyze the efficacy and safety of cystogastrostomy via a meta-analysis of the literature. Methods: We performed a systematic search of PubMed and Medline databases for studies published from January 2005 to May 2018. We included randomized controlled trials along with retrospective and prospective observational studies reporting endoscopic ultrasound–guided cystogastrostomy stent placement for peripancreatic fluid collections. The primary outcome for our meta-analysis was complete peripancreatic fluid collection resolution on imaging. Our secondary outcomes included comparative efficacy and safety of the procedure for pseudocysts and walled-off pancreatic necrosis using metal and plastic stents. Results: Seventeen articles involving 1708 patients met our inclusion criteria for meta-analysis. Based upon the random effects model, the pooled technical success rate of cystogastrostomy was 88% (95% confidence interval = 83–92 with I2 = 85%). There was no difference in the technical success rate between pancreatic pseudocysts and walled-off pancreatic necrosis (91% and 86%, respectively p = nonsignificant). The adverse event rates for metal and plastic stents were equivalent (14% and 18%, respectively, p = nonsignificant). Conclusion: Endoscopic ultrasound–guided cystogastrostomy stents are effective in the treatment of pancreatic pseudocysts and walled-off pancreatic necrosis. We found no difference in technical success or adverse event rates of drainage based on peripancreatic fluid collection type or stent used.
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Affiliation(s)
- Benjamin D Renelus
- Division of Gastroenterology and Hepatobiliary Disease, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Daniel S Jamorabo
- Division of Gastroenterology and Hepatobiliary Disease, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Hashroop K Gurm
- Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Niel Dave
- Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - William M Briggs
- Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA
| | - Mukul Arya
- Division of Gastroenterology and Hepatobiliary Disease, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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Jamorabo DS, Renelus BD, Kancharla P, Briggs WM. Are patients with advanced colon cancer availing of palliative care services?: Findings from a high-volume urban center. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e23101] [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: 11/20/2022] Open
Abstract
e23101 Background: Palliative care is integral to cancer treatment. Our goal was to investigate the factors associated with palliative care service involvement for hospitalized colon cancer patients. Methods: We carried out a retrospective study of all colon cancer patients diagnosed and hospitalized at our institution from 1/1/2010 through 12/31/2017. We identified 667 patients, including 370 women (55%). We used Fisher’s exact test to find statistically significant differences in proportions of patients seen by the palliative care service based on sex, race, cancer stage, surgical intervention, and chemotherapy administration. Results: We found that 561/667 (84%) colon cancer patients were not evaluated by the palliative care service (including 301 women; 54%) and that overall they were unlikely to have been evaluated regardless of sex, race, cancer stage, or chemotherapy (Table). Patients who underwent surgery were equally likely to be seen by the team as those who did not have surgery. We found that 53% (150/285) of patients with Stage III and IV disease received neither chemotherapy nor palliative care evaluation. Conclusions: The palliative care service is underutilized at our facility even when patients with advanced stage disease are hospitalized. Even when patients are not on chemotherapy, the palliative care service remains uninvolved. This may be due to inadequate staffing, misconceptions that providers and patients have about palliative care, or lack of coordination between inpatient and outpatient providers. We did not find that palliative care service utilization led to a statistically significant difference in survival, but their involvement is critical to helping address patients’ goals of care and symptoms. It is also instrumental to improving cancer patients’ quality of life both in the outpatient and inpatient setting, regardless of cancer stage or survival, as in our patient population. More effort is needed to include the palliative care service in the care of patients with advanced colon cancer. [Table: see text]
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Renelus BD, Jamorabo DS, Kancharla P, Paul S, Dave N, Briggs WM, Peterson SJ. Racial Disparities with Esophageal Cancer Mortality at a High-Volume University Affiliated Center: An All ACCESS Invitation. J Natl Med Assoc 2019; 112:478-483. [PMID: 31072644 DOI: 10.1016/j.jnma.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Esophageal cancer (EC) has a dismal prognosis with 5-year survival < 19%. Black patients with EC have higher mortality than white patients, but the cause of this disparity is unclear. We sought to investigate the impact of race upon overall mortality (OM) among EC patients at our institution. METHODS We performed a single-center retrospective review of all patients diagnosed with EC between January 2010 through December 2016 with follow-up through October 2017. We compared the difference among categorical variables and mortality using Fisher's exact test. Odds ratios (OR) and hazard regression (HR) were constructed to analyze treatment options by race. The Kaplan-Meier method was used to plot OM curves by race. We also used a logistic regression analysis to construct a predictive model for mortality based on histology and race. RESULTS We identified 77 patients (62% male) diagnosed with EC. There was no difference in treatments offered based on race. After adjusting for age, histology and stage, we found mortality was significantly higher in blacks when compared to whites (HR 14.07, 95% CI [2.33-129.70] p < 0.008). Our predictive model revealed that blacks had a higher probability of mortality at all stages of EC. CONCLUSIONS We found race to be an independent risk factor for OM in EC patients. This likely reflects differences in healthcare utilization or access, as evidenced by higher prevalence of Stage IV EC in black patients. Continued investigation is needed to address this disparity locally and nationally.
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Affiliation(s)
- Benjamin D Renelus
- Division of Gastroenterology and Hepatobiliary Diseases, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
| | - Daniel S Jamorabo
- Division of Gastroenterology and Hepatobiliary Diseases, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Pragnan Kancharla
- Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Sonal Paul
- Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Niel Dave
- Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - William M Briggs
- Department of Epidemiology and Biostatistics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Stephen J Peterson
- Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA; Weill Cornell Medical College, New York, NY, USA
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Trafimow D, Amrhein V, Areshenkoff CN, Barrera-Causil CJ, Beh EJ, Bilgiç YK, Bono R, Bradley MT, Briggs WM, Cepeda-Freyre HA, Chaigneau SE, Ciocca DR, Correa JC, Cousineau D, de Boer MR, Dhar SS, Dolgov I, Gómez-Benito J, Grendar M, Grice JW, Guerrero-Gimenez ME, Gutiérrez A, Huedo-Medina TB, Jaffe K, Janyan A, Karimnezhad A, Korner-Nievergelt F, Kosugi K, Lachmair M, Ledesma RD, Limongi R, Liuzza MT, Lombardo R, Marks MJ, Meinlschmidt G, Nalborczyk L, Nguyen HT, Ospina R, Perezgonzalez JD, Pfister R, Rahona JJ, Rodríguez-Medina DA, Romão X, Ruiz-Fernández S, Suarez I, Tegethoff M, Tejo M, van de Schoot R, Vankov II, Velasco-Forero S, Wang T, Yamada Y, Zoppino FCM, Marmolejo-Ramos F. Manipulating the Alpha Level Cannot Cure Significance Testing. Front Psychol 2018; 9:699. [PMID: 29867666 PMCID: PMC5962803 DOI: 10.3389/fpsyg.2018.00699] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022] Open
Abstract
We argue that making accept/reject decisions on scientific hypotheses, including a recent call for changing the canonical alpha level from p = 0.05 to p = 0.005, is deleterious for the finding of new discoveries and the progress of science. Given that blanket and variable alpha levels both are problematic, it is sensible to dispense with significance testing altogether. There are alternatives that address study design and sample size much more directly than significance testing does; but none of the statistical tools should be taken as the new magic method giving clear-cut mechanical answers. Inference should not be based on single studies at all, but on cumulative evidence from multiple independent studies. When evaluating the strength of the evidence, we should consider, for example, auxiliary assumptions, the strength of the experimental design, and implications for applications. To boil all this down to a binary decision based on a p-value threshold of 0.05, 0.01, 0.005, or anything else, is not acceptable.
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Affiliation(s)
- David Trafimow
- Department of Psychology, New Mexico State University, Las Cruces, NM, United States
| | - Valentin Amrhein
- Zoological Institute, University of Basel, Basel, Switzerland.,Swiss Ornithological Institute, Sempach, Switzerland
| | | | - Carlos J Barrera-Causil
- Faculty of Applied and Exact Sciences, Metropolitan Technological Institute, Medellín, Colombia
| | - Eric J Beh
- School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Yusuf K Bilgiç
- Department of Mathematics, State University of New York at Geneseo, Geneseo, NY, United States
| | - Roser Bono
- Quantitative Psychology Unit, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain
| | - Michael T Bradley
- Department of Psychology, Faculty of Arts, University of New Brunswick, Saint John, NB, Canada
| | | | | | - Sergio E Chaigneau
- Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Daniel R Ciocca
- Oncology Laboratory, Instituto de Medicina y Biologia Experimental de Cuyo, CCT CONICET Mendoza, Mendoza, Argentina
| | - Juan C Correa
- School of Statistics, Faculty of Sciences, National University of Colombia, Medellín, Colombia
| | - Denis Cousineau
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Michiel R de Boer
- Department of Health Sciences, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Subhra S Dhar
- Department of Mathematics and Statistics, Indian Institute of Technology, Kanpur, India
| | - Igor Dolgov
- Department of Psychology, New Mexico State University, Las Cruces, NM, United States
| | - Juana Gómez-Benito
- Quantitative Psychology Unit, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institut de Neurociències, University of Barcelona, Barcelona, Spain
| | - Marian Grendar
- Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia.,Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - James W Grice
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Martin E Guerrero-Gimenez
- Oncology Laboratory, Instituto de Medicina y Biologia Experimental de Cuyo, CCT CONICET Mendoza, Mendoza, Argentina
| | - Andrés Gutiérrez
- Faculty of Statistics, Saint Thomas University, Bogotá, Colombia
| | - Tania B Huedo-Medina
- Department of Allied Health Sciences, College of Health, Agriculture, and Natural Resources, University of Connecticut, Storrs, CT, United States
| | - Klaus Jaffe
- Departamento de Biología de Organismos, Universidad Simón Bolívar, Caracas, Venezuela
| | - Armina Janyan
- Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria.,National Research Tomsk State University, Tomsk, Russia
| | - Ali Karimnezhad
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
| | | | - Koji Kosugi
- School of Human Sciences, Senshu University, Kawasaki, Japan
| | - Martin Lachmair
- Multimodal Interaction Lab, Leibniz-Institut für Wissensmedien, Tübingen, Germany
| | - Rubén D Ledesma
- Consejo Nacional de Investigaciones Científicas y Técnicas, Mar del Plata, Argentina.,Facultad de Psicología, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
| | - Roberto Limongi
- Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile.,Vicerrectoría de Investigación y Desarrollo, Universidad Tecnológica de Chile INACAP, Santiago, Chile
| | - Marco T Liuzza
- Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Rosaria Lombardo
- Economics Department, University of Campania "Luigi Vanvitelli", Capua, Italy
| | - Michael J Marks
- Department of Psychology, New Mexico State University, Las Cruces, NM, United States
| | - Gunther Meinlschmidt
- Department of Psychosomatic Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Ladislas Nalborczyk
- Université Grenoble Alpes, Centre National de la Recherche Scientifique, LPNC, Grenoble, France.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Hung T Nguyen
- Department of Mathematical Sciences, New Mexico State University, Las Cruces, NM, United States
| | - Raydonal Ospina
- Computational Statistics Laboratory (CAST), Department of Statistics, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Roland Pfister
- Department of Psychology III, University of Würzburg, Würzburg, Germany
| | - Juan J Rahona
- Multimodal Interaction Lab, Leibniz-Institut für Wissensmedien, Tübingen, Germany
| | | | - Xavier Romão
- CONSTRUCT-LESE, Faculty of Engineering, University of Porto, Porto, Portugal
| | - Susana Ruiz-Fernández
- Multimodal Interaction Lab, Leibniz-Institut für Wissensmedien, Tübingen, Germany.,FOM Hochschule für Oekonomie und Management, Essen, Germany.,LEAD Graduate School & Research Network, University of Tübingen, Tübingen, Germany
| | - Isabel Suarez
- Department of Psychology, Universidad del Norte, Barranquilla, Colombia
| | - Marion Tegethoff
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
| | - Mauricio Tejo
- Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valparaíso, Chile
| | - Rens van de Schoot
- Department of Methods and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands.,North-West University, Optentia Research Focus Area, Vanderbijlpark, South Africa
| | - Ivan I Vankov
- Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria
| | | | - Tonghui Wang
- Department of Mathematical Sciences, New Mexico State University, Las Cruces, NM, United States
| | - Yuki Yamada
- Faculty of Arts and Science, Kyushu University, Fukuoka, Japan
| | - Felipe C M Zoppino
- Oncology Laboratory, Instituto de Medicina y Biologia Experimental de Cuyo, CCT CONICET Mendoza, Mendoza, Argentina
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Ivanov A, Dabiesingh DS, Bhumireddy GP, Mohamed A, Asfour A, Briggs WM, Ho J, Khan SA, Grossman A, Klem I, Sacchi TJ, Heitner JF. Prevalence and Prognostic Significance of Left Ventricular Noncompaction in Patients Referred for Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006174. [PMID: 28899950 DOI: 10.1161/circimaging.117.006174] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [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: 01/10/2017] [Accepted: 07/07/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Presence of prominent left ventricular trabeculation satisfying criteria for left ventricular noncompaction (LVNC) on routine cardiac magnetic resonance examination is frequently encountered; however, the clinical and prognostic significance of these findings remain elusive. This registry aimed to assess LVNC prevalence by 4 current criteria and to prospectively evaluate an association between diagnosis of LVNC by these criteria and adverse events. METHODS AND RESULTS There were 700 patients referred for cardiac magnetic resonance: 42% were women, median age was 70 years (range, 45-71 years), mean left ventricular ejection fraction was 51% (±17%), and 32% had late gadolinium enhancement on cardiac magnetic resonance. The cohort underwent diagnostic assessment for LVNC by 4 separate imaging criteria-referenced by their authors as Petersen, Stacey, Jacquier, and Captur, with LVNC prevalence of 39%, 23%, 25% and 3%, respectively. Primary clinical outcome was combined end point of time to death, ischemic stroke, ventricular tachycardia/ventricular fibrillation, and heart failure hospitalization. Secondary clinical outcomes were (1) all-cause mortality and (2) time to the first occurrence of any of the following events: cardiac death, ischemic stroke, ventricular tachycardia/ventricular fibrillation, or heart failure hospitalization. During a median follow-up of 7 years, there were no statistically significant differences in assessed outcomes noted between patients with and without LVNC irrespective of the applied criteria. CONCLUSIONS Current criteria for the diagnosis of LVNC leads to highly variable disease prevalence in patients referred for cardiac magnetic resonance. The diagnosis of LVNC, by any current criteria, was not associated with adverse clinical events on nearly 7 years of follow-up. Limited conclusions can be made for Captur criteria due to low observed prevalence.
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Affiliation(s)
- Alexander Ivanov
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.)
| | - Devindra S Dabiesingh
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.)
| | - Geetha P Bhumireddy
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.)
| | - Ambreen Mohamed
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.)
| | - Ahmed Asfour
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.)
| | - William M Briggs
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.)
| | - Jean Ho
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.)
| | - Saadat A Khan
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.)
| | - Alexandra Grossman
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.)
| | - Igor Klem
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.)
| | - Terrence J Sacchi
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.)
| | - John F Heitner
- From the Division of Cardiology, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital (A.I., D.S.D., G.P.B., A.M., A.A., J.H., S.A.K., A.G., T.J.S., J.F.H.); Department of Statistical Sciences, NewYork-Presbyterian Cornell University, Ithaca (W.M.B.); and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (I.K.).
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Ivanov A, Kaczkowska BA, Khan SA, Ho J, Tavakol M, Prasad A, Bhumireddy G, Beall AF, Klem I, Mehta P, Briggs WM, Sacchi TJ, Heitner JF. Review and Analysis of Publication Trends over Three Decades in Three High Impact Medicine Journals. PLoS One 2017; 12:e0170056. [PMID: 28107475 PMCID: PMC5249065 DOI: 10.1371/journal.pone.0170056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 12/28/2016] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Over the past three decades, industry sponsored research expanded in the United States. Financial incentives can lead to potential conflicts of interest (COI) resulting in underreporting of negative study results. OBJECTIVE We hypothesized that over the three decades, there would be an increase in: a) reporting of conflict of interest and source of funding; b) percentage of randomized control trials c) number of patients per study and d) industry funding. DATA SOURCES AND STUDY SELECTION Original articles published in three calendar years (1988, 1998, and 2008) in The Lancet, New England Journal of Medicine and Journal of American Medical Association were collected. DATA EXTRACTION Studies were reviewed and investigational design categorized as prospective and retrospective clinical trials. Prospective trials were categorized into randomized or non-randomized and single-center or multi-center trials. Retrospective trials were categorized as registries, meta-analyses and other studies, mostly comprising of case reports or series. Study outcomes were categorized as positive or negative depending on whether the pre-specified hypothesis was met. Financial disclosures were researched for financial relationships and profit status, and accordingly categorized as government, non-profit or industry sponsored. Studies were assessed for reporting COI. RESULTS 1,671 original articles were included in this analysis. Total number of published studies decreased by 17% from 1988 to 2008. Over 20 year period, the proportion of prospective randomized trials increased from 22 to 46% (p < 0.0001); whereas the proportion of prospective non-randomized trials decreased from 59% to 27% (p < 0.001). There was an increase in the percentage of prospective randomized multi-center trials from 11% to 41% (p < 0.001). Conversely, there was a reduction in non-randomized single-center trials from 47% to 10% (p < 0.001). Proportion of government funded studies remained constant, whereas industry funded studies more than doubled (17% to 40%; p < 0.0001). The number of studies with negative results more than doubled (10% to 22%; p<0.0001). While lack of funding disclosure decreased from 35% to 7%, COI reporting increased from 2% to 84% (p < 0.0001). CONCLUSION Improved reporting of COI, clarity in financial sponsorship, increased publication of negative results in the setting of larger and better designed clinical trials represents a positive step forward in the scientific publications, despite the higher percentage of industry funded studies.
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Affiliation(s)
- Alexander Ivanov
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - Beata A. Kaczkowska
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - Saadat A. Khan
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - Jean Ho
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - Morteza Tavakol
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - Ashok Prasad
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - Geetha Bhumireddy
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - Allan F. Beall
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - Igor Klem
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - Parag Mehta
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - William M. Briggs
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - Terrence J. Sacchi
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - John F. Heitner
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
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Ivanov A, Bhumireddy GP, Dabiesingh DS, Khan SA, Ho J, Krishna N, Dontineni N, Socolow JA, Briggs WM, Klem I, Sacchi TJ, Heitner JF. Importance of papillary muscle infarction detected by cardiac magnetic resonance imaging in predicting cardiovascular events. Int J Cardiol 2016; 220:558-63. [PMID: 27390987 DOI: 10.1016/j.ijcard.2016.06.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/23/2016] [Accepted: 06/25/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies suggest that papillary muscle infarction (PMI) following recent myocardial infarction (MI) correlates with adverse cardiovascular outcomes. The purpose of this study is to determine the prevalence and prognostic significance of PMI by cardiac magnetic resonance (CMR) in a large cohort of patients. METHODS Retrospective study of patients who underwent CMR between January 2007 and December 2009 were evaluated for the presence of PMI in one or both of the left ventricle papillary muscles. The primary outcome was a time to a combined endpoint of all-cause mortality and worsening heart failure. Secondary outcomes were time to individual components of the combined outcome. RESULTS 419 patients were included in our analysis, 232 patients (55%) had ischemic cardiomyopathy. Patients were followed at six-month intervals for a median follow-up time of 3.7 (interquartile range (IQR): 1.6; 6.3) years after initial imaging. During this period 196 patients (46.8%) had a primary outcome and 92 patients (22%) died. PM infarct was identified in 204 (48.7%) patients with twice as many posteromedial (PRM) (27%) than anterolateral (ARL) lesions (11%) and a similar number with infarct in both (11%). There was no association between studied outcomes and the presence of PMI in either PRM or ARL PM. The presence of infarct in both PM was a predictor of both the primary outcome (HR 1.69, CI[1.01-2.86], p<0.049.) and mortality (HR 1.69, CI[1.01-4.2], p<0.046). CONCLUSION The presence of infarct in either papillary muscle was not associated with outcomes. However, infarct involving both papillary muscles was associated with worse outcomes.
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Affiliation(s)
- A Ivanov
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - G P Bhumireddy
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - D S Dabiesingh
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - S A Khan
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - J Ho
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - N Krishna
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - N Dontineni
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - J A Socolow
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - W M Briggs
- Department of Statistical Sciences, Cornell University, Ithaca, NY, United States
| | - I Klem
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - T J Sacchi
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - J F Heitner
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States.
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Ivanov A, Yossef J, Tailon J, Worku BM, Gulkarov I, Tortolani AJ, Sacchi TJ, Briggs WM, Brener SJ, Weingarten JA, Heitner JF. Do pulmonary function tests improve risk stratification before cardiothoracic surgery? J Thorac Cardiovasc Surg 2016; 151:1183-9.e3. [DOI: 10.1016/j.jtcvs.2015.10.102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/15/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
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Monckton of Brenchley C, Soon WWH, Legates DR, Briggs WM. Keeping it simple: the value of an irreducibly simple climate model. Sci Bull (Beijing) 2015; 60:1378-1390. [PMID: 26301116 PMCID: PMC4534509 DOI: 10.1007/s11434-015-0856-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/30/2015] [Indexed: 11/25/2022]
Abstract
Richardson et al. (Sci Bull, 2015. doi:10.1007/s11434-015-0806-z) suggest that the irreducibly simple climate model described in Monckton of Brenchley et al. (Sci Bull 60:122-135, 2015. doi:10.1007/s11434-014-0699-2) was not validated against observations, relying instead on synthetic test data based on underestimated global warming, illogical parameter choice and near-instantaneous response at odds with ocean warming and other observations. However, the simple model, informed by its authors' choice of parameters, usually hindcasts observed temperature change more closely than the general-circulation models, and finds high climate sensitivity implausible. With IPCC's choice of parameters, the model is further validated in that it duly replicates IPCC's sensitivity interval. Also, fast climate system response is consistent with near-zero or net-negative temperature feedback. Given the large uncertainties in the initial conditions and evolutionary processes determinative of climate sensitivity, subject to obvious caveats a simple sensitivity-focused model need not, and the present model does not, exhibit significantly less predictive skill than the general-circulation models.
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Affiliation(s)
| | - Willie W.-H. Soon
- />Harvard-Smithsonian Center for Astrophysics, Cambridge, MA 02138 USA
| | - David R. Legates
- />Department of Geography, University of Delaware, Newark, DE 19716 USA
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Chen O, Sharma A, Ahmad I, Bourji N, Nestoiter K, Hua P, Hua B, Ivanov A, Yossef J, Klem I, Briggs WM, Sacchi TJ, Heitner JF. Correlation between pericardial, mediastinal, and intrathoracic fat volumes with the presence and severity of coronary artery disease, metabolic syndrome, and cardiac risk factors. Eur Heart J Cardiovasc Imaging 2014; 16:37-46. [PMID: 25227267 DOI: 10.1093/ehjci/jeu145] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To investigate the association of pericardial, mediastinal, and intrathoracic fat volumes with the presence and severity of coronary artery disease (CAD), metabolic syndrome (MS), and cardiac risk factors (CRFs). METHODS AND RESULTS Two hundred and sixteen consecutive patients who underwent cardiac magnetic resonance (CMR) imaging and had a coronary angiogram within 12 months of the CMR were studied. Fat volume was measured by drawing region of interest curves, from short-axis cine views from base to apex and from a four-chamber cine view. Pericardial fat, mediastinal fat, intrathoracic fat (addition of pericardial and mediastinal fat volumes), and fat ratio (pericardial fat/mediastinal fat) were analysed for their association with the presence and severity of CAD (determined based on the Duke CAD Jeopardy Score), MS, CRFs, and death or myocardial infarction on follow-up. Pericardial fat volume was significantly greater in patients with CAD when compared with those without CAD [38.3 ± 25.1 vs. 31.9 ± 21.4 cm(3) (P = 0.04)]. A correlation between the severity of CAD and fat volume was found for pericardial fat (β = 1, P < 0.01), mediastinal fat (β = 1, P = 0.03), intrathoracic fat (β = 2, P = 0.01), and fat ratio (β = 0.005, P = 0.01). These correlations persisted for all four thoracic fat measurements even after performing a stepwise linear regression analysis for relevant risk factors. Patients with MS had significantly greater mediastinal and intrathoracic fat volumes when compared with those without MS [126 ± 33.5 vs. 106 ± 30.1 cm(3) (P < 0.01) and 165 ± 54.9 vs. 140 ± 52 cm(3) (P < 0.01), respectively]. However, there was no significant difference in pericardial fat, mediastinal fat, intrathoracic fat, or fat ratio between patients with or without myocardial infarction during the follow-up [33.6 ± 22.1 vs. 35.7 ± 23.8 cm(3) (P = 0.67); 115 ± 26.2 vs. 114 ± 33.8 cm(3) (P = 0.84); 149 ± 44.7 vs. 150 ± 55.7 cm(3) (P = 0.95); and 0.27 ± 0.15 vs. 0.28 ± 0.14 (P = 0.70), respectively]. There was no significant difference in pericardial fat, mediastinal fat, intrathoracic fat, or fat ratio between patients who were alive compared with those who died during follow-up [36.6 ± 26.6 vs. 35.3 ± 23.2 cm(3) (P = 0.76); 114 ± 40.2 vs. 114 ± 31.4 cm(3) (P = 0.95); 150 ± 64.7 vs. 149 ± 52.5 cm(3) (P = 0.92); and 0.29 ± 0.15 vs. 0.28 ± 0.14 (P = 0.85), respectively]. CONCLUSION Our study confirms an association between pericardial fat volume with the presence and severity of CAD. Furthermore, an association between mediastinal and intrathoracic fat volumes with MS was found.
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Affiliation(s)
- On Chen
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Abhishek Sharma
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ijaz Ahmad
- Division of Cardiology, New York Methodist Hospital, Brooklyn, NY, USA
| | - Naji Bourji
- Division of Cardiology, New York Methodist Hospital, Brooklyn, NY, USA
| | | | - Pauline Hua
- Division of Cardiology, New York Methodist Hospital, Brooklyn, NY, USA
| | - Betty Hua
- Division of Cardiology, New York Methodist Hospital, Brooklyn, NY, USA
| | - Alexander Ivanov
- Division of Cardiology, New York Methodist Hospital, Brooklyn, NY, USA
| | - James Yossef
- Division of Cardiology, New York Methodist Hospital, Brooklyn, NY, USA
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Durham, NC, USA
| | - William M Briggs
- Division of Cardiology, New York Methodist Hospital, Brooklyn, NY, USA
| | - Terrence J Sacchi
- Division of Cardiology, New York Methodist Hospital, Brooklyn, NY, USA
| | - John F Heitner
- Division of Cardiology, New York Methodist Hospital, Brooklyn, NY, USA
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Haines EJ, Chiricolo GC, Aralica K, Briggs WM, Van Amerongen R, Laudenbach A, O'Rourke K, Melniker L. Derivation of a pediatric growth curve for inferior vena caval diameter in healthy pediatric patients: brief report of initial curve development. Crit Ultrasound J 2012; 4:12. [PMID: 22871083 PMCID: PMC3463452 DOI: 10.1186/2036-7902-4-12] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/03/2012] [Indexed: 11/17/2022] Open
Abstract
Background A validated tool has long been sought to provide clinicians with a uniform and accurate method to assess hydration status in the pediatric emergency medicine population. Outpatient clinicians use CDC height- and weight-based curves for the assessment of physical development. In hospital, daily weights provide objective data; however, these are usually not available at presentation. One of the most promising techniques for the rapid assessment of volume is ultrasound (US) to obtain an indexed inferior vena cava diameter (IVCDi); as previously described. Prior studies have focused on IVCDi in dehydrated patients and have shown that it provides accurate estimates of right atrial pressure and volume status. The objective of this study is to derive an IVC growth curve in healthy pediatric patients. Methods Prospective cohort design enrolled healthy children between the ages of 4 weeks and 20 years. Patients presenting with fever, illnesses, or diagnoses known to affect the volume will be excluded. All eligible patients under 21, who have provided self or parental written consent, will undergo a brief ultrasound to obtain transverse and long images of both the IVC and the aorta; all scans will be digitally saved. Image quality will be subjectively rated as poor, fair, or good based on wall clarity. Poor quality images will be recorded but may be omitted from our analysis. Five clinicians completed a 1-h introduction to IVC-US and ten supervised scans prior to enrollment. Still images will be measured in order to determine IVCDi in both transverse and longitudinal planes. To assess inter-rater reliability, in 10% of cases, two clinicians will complete scans. All study scans will be over-read by a fellowship-trained sonologist. IVCDi will be plotted independently as functions of age, gender, BMI, and aortic diameter. Within each group, means with means or medians with 95% CIs will be calculated. Following uni- and bivariate analyses and assessment for colinearity, a variety of parametric and nonparametric regression procedures will be conducted. The smoothed curves will be approximated using a modified LMS estimation procedure. Results Data for the initial curve derivation includes 25 patients ranging from 13 months to 20 years (mean 102 months or 8.5 years). Sixty-five percent of patients were enrolled from the ED, while 35% were enrolled from well-child clinic visits. When evaluating the size of IVC as a function of time linear growth, increasing size was found to proportionately increase with age of patient in months. Conclusions Data suggest a linear correlation between IVC size and age. Such data, when plotted as a new growth curve, may allow clinicians to plot a patient's sonographic measurements in order to assess hydration health.
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Affiliation(s)
- Elizabeth J Haines
- Department of Emergency Medicine, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA.
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23
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Krystyna A, Safi T, Briggs WM, Schwalb MD. Correlation of hepatitis C and prostate cancer, inverse correlation of basal cell hyperplasia or prostatitis and epidemic syphilis of unknown duration. Int Braz J Urol 2012; 37:223-9; discussion 230. [PMID: 21557839 DOI: 10.1590/s1677-55382011000200009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The accuracy of prostate specific antigen (PSA) to detect prostate cancer has not yet been determined. Autopsy evidence suggests one-third of men have evidence of prostate cancer. Correlation between prostate cancer and sexually transmitted infection is indeterminate. MATERIALS AND METHODS A retrospective database was created of all men who underwent transrectal ultrasound guided prostate biopsy over 3 years. Men were 49% African or African Caribbean, and 51% Central or South American. Information about prostate specific antigen, cholesterol, hepatitis A, B and C, human immunodeficiency virus, syphilis, tuberculin skin testing and histology were collected. RESULTS Hepatitis C antibody detection correlated with prostate cancer OR 11.2 (95% CI 3.0 to 72.4). The odds of prostate cancer increased annually (p = 0.0003). However, no correlation was found between prostate cancer and the following: PSA, biopsy date, repeat biopsy, more than 12 cores at biopsy, total cholesterol, high density lipoprotein, triglycerides, low density lipoprotein, risk measure reported with free and total PSA, hepatitis B surface antibody, high grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. Histologic prostatitis and basal cell hyperplasia were inversely correlated with prostate cancer. Syphilis of unknown duration occurred in 17% of men with indeterminate correlation to prostate cancer. CONCLUSION In Inner City men of African and African-Caribbean, or Central and South American descent, prostate specific antigen levels did not correlate with prostate cancer. Hepatitis C antibody detection correlates significantly with prostate cancer. One prostate biopsy is sufficient to diagnose statistically significant prostate cancer. Histologic prostatitis and basal cell hyperplasia decrease odds of prostate cancer. Atypical small acinar proliferation may not correlate to prostate cancer and is pending further investigation. Men should be screened for epidemic syphilis of unknown duration.
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Affiliation(s)
- Annika Krystyna
- Lincoln Medical and Mental Health Center, Department of Urology, New York Medical College, Valhalla, NY 10452, USA.
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24
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Birkhahn RH, Wen W, Datillo PA, Briggs WM, Parekh A, Arkun A, Byrd B, Gaeta TJ. Improving patient flow in acute coronary syndromes in the face of hospital crowding. J Emerg Med 2011; 43:356-65. [PMID: 22015378 DOI: 10.1016/j.jemermed.2011.06.046] [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] [Received: 01/15/2011] [Revised: 05/06/2011] [Accepted: 06/11/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND The current paradigm for the evaluation of patients with suspected acute coronary syndromes (ACS) in the emergency department (ED) is focused on the identification of patients with active underlying coronary disease. The majority of patients evaluated in the ED setting do not have active underlying cardiac disease. OBJECTIVE To measure the effect of bedside point-of-care (POC) cardiac biomarker testing on telemetry unit admissions from the ED. Furthermore, to evaluate the effect telemetry admissions have on ED length of stay (LOS) and overall hospital LOS. METHODS Primary data were collected over two 6-month periods in an urban teaching hospital ED. This was an observational cohort study conducted pre- and post-availability of a POC testing platform for cardiac biomarkers. Major measures included number of overall telemetry admissions, ED LOS, hospital LOS, and disposition. Patients were followed at 30 days for significant cardiac events, repeat ED visit or admission, and death. RESULTS In the post-implementation period there was a 30% (95% confidence interval [CI] 36-44%) reduction in admissions to telemetry with a 33% (95% CI 26-39%) reduction in ED LOS and a 20% (95% CI 7-34%) reduction in hospital LOS. There was a 62% reduction in overall mortality between the pre-implementation period and the post-implementation period (p=0.001). CONCLUSION The focused use of a rapid cardiac disposition protocol can dramatically impact resource utilization, expedite patient flow, and improve short-term outcomes for patients with suspected ACS.
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Affiliation(s)
- Robert H Birkhahn
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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25
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Muniyappa R, Irving BA, Unni US, Briggs WM, Nair KS, Quon MJ, Kurpad AV. Limited predictive ability of surrogate indices of insulin sensitivity/resistance in Asian-Indian men. Am J Physiol Endocrinol Metab 2010; 299:E1106-12. [PMID: 20943755 PMCID: PMC3006259 DOI: 10.1152/ajpendo.00454.2010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [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] [Indexed: 01/16/2023]
Abstract
Insulin resistance is highly prevalent in Asian Indians and contributes to worldwide public health problems, including diabetes and related disorders. Surrogate measurements of insulin sensitivity/resistance are used frequently to study Asian Indians, but these are not formally validated in this population. In this study, we compared the ability of simple surrogate indices to accurately predict insulin sensitivity as determined by the reference glucose clamp method. In this cross-sectional study of Asian-Indian men (n = 70), we used a calibration model to assess the ability of simple surrogate indices for insulin sensitivity [quantitative insulin sensitivity check index (QUICKI), homeostasis model assessment (HOMA2-IR), fasting insulin-to-glucose ratio (FIGR), and fasting insulin (FI)] to predict an insulin sensitivity index derived from the reference glucose clamp method (SI(Clamp)). Predictive accuracy was assessed by both root mean squared error (RMSE) of prediction as well as leave-one-out cross-validation-type RMSE of prediction (CVPE). QUICKI, FIGR, and FI, but not HOMA2-IR, had modest linear correlations with SI(Clamp) (QUICKI: r = 0.36; FIGR: r = -0.36; FI: r = -0.27; P < 0.05). No significant differences were noted among CVPE or RMSE from any of the surrogate indices when compared with QUICKI. Surrogate measurements of insulin sensitivity/resistance such as QUICKI, FIGR, and FI are easily obtainable in large clinical studies, but these may only be useful as secondary outcome measurements in assessing insulin sensitivity/resistance in clinical studies of Asian Indians.
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Loizzo JJ, Peterson JC, Charlson ME, Wolf EJ, Altemus M, Briggs WM, Vahdat LT, Caputo TA. The effect of a contemplative self-healing program on quality of life in women with breast and gynecologic cancers. Altern Ther Health Med 2010; 16:30-37. [PMID: 20486622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Stress-related symptoms-intense fear, avoidance, intrusive thoughts--are common among breast and gynecologic cancer patients after chemotherapy and radiation. The objective of this pilot study was to determine the impact of a 20-week contemplative self-healing program among breast and gynecologic cancer survivors on self-reported quality of life (QOL), the main outcome. Assessments were performed at the first session and at 20 weeks, including QOL (FACIT-G, FACIT subscales, SF-36), anxiety, and depression (HADS). Biologic markers of immune function were obtained. A 20-week program was implemented: the initial 8 weeks addressed open-mindfulness, social-emotional self-care, visualization, and deep breathing followed by 12 weeks of exposing stress-reactive habits and developing self-healing insights. Daily practice involved CD-guided meditation and manual contemplations. Sixty-eight women were enrolled, and 46 (68%) completed the program. Participants had significant within-patient changes on FACIT-G, improving by a mean of 6.4 points. In addition, they reported clinically important improvement in emotional and functional domains and social, role-emotional, and mental health status domains on SF-36. Biologic data revealed significant improvement in maximum AM cortisol and a reduction in resting heart rate at 20 weeks. These findings suggest a contemplative self-healing program can be effective in significantly improving QOL and reducing distress and disability among female breast and gynecologic cancer survivors.
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Affiliation(s)
- Joseph J Loizzo
- Center for Complementary and Integrative Medicine, Weill Cornell Medical College, New York, New York, USA
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Birkhahn RH, Blomkalns A, Klausner H, Nowak R, Raja AS, Summers R, Weber JE, Briggs WM, Arkun A, Diercks D. The association between money and opinion in academic emergency medicine. West J Emerg Med 2010; 11:126-32. [PMID: 20823958 PMCID: PMC2908643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 10/05/2009] [Accepted: 10/31/2009] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Financial conflicts of interest have come under increasing scrutiny in medicine, but their impact has not been quantified. Our objective was to use the results of a national survey of academic emergency medicine (EM) faculty to determine if an association between money and personal opinion exists. METHODS We conducted a web-based survey of EM faculty. Opinion questions were analyzed with regard to whether the respondent had either 1) received research grant money or 2) received money from industry as a speaker, consultant, or advisor. Responses were unweighted, and tests of differences in proportions were made using Chi-squared tests, with p<0.05 set for significance. RESULTS We received responses from 430 members; 98 (23%) received research grants from industry, while 145 (34%) reported fee-for-service money. Respondents with research money were more likely to be comfortable accepting gifts (40% vs. 29%) and acting as paid consultants (50% vs. 37%). They had a more favorable attitude with regard to societal interactions with industry and felt that industry-sponsored lectures could be fair and unbiased (52% vs. 29%). Faculty with fee-for-service money mirrored those with research money. They were also more likely to believe that industry-sponsored research produces fair and unbiased results (61% vs. 45%) and less likely to believe that honoraria biased speakers (49% vs. 69%). CONCLUSION Accepting money for either service or research identified a distinct population defined by their opinions. Faculty engaged in industry-sponsored research benefitted socially (collaborations), academically (publications), and financially from the relationship.
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Affiliation(s)
- Robert H. Birkhahn
- New York Methodist Hospital, Department of Emergency Medicine, Brooklyn, NY,Address for Correspondence: Robert H. Birkhahn, MD, Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY 11791.
| | | | | | | | | | | | - Jim E. Weber
- University of Michigan, Hurley Medical Center, Flint, MI
| | - William M. Briggs
- New York Methodist Hospital, Department of Emergency Medicine, Brooklyn, NY
| | - Alp Arkun
- New York Methodist Hospital, Department of Emergency Medicine, Brooklyn, NY
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Zaretzki RL, Gilchrist MA, Briggs WM, Armagan A. Bias correction and Bayesian analysis of aggregate counts in SAGE libraries. BMC Bioinformatics 2010; 11:72. [PMID: 20128916 PMCID: PMC2829012 DOI: 10.1186/1471-2105-11-72] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 02/03/2010] [Indexed: 12/02/2022] Open
Abstract
Background Tag-based techniques, such as SAGE, are commonly used to sample the mRNA pool of an organism's transcriptome. Incomplete digestion during the tag formation process may allow for multiple tags to be generated from a given mRNA transcript. The probability of forming a tag varies with its relative location. As a result, the observed tag counts represent a biased sample of the actual transcript pool. In SAGE this bias can be avoided by ignoring all but the 3' most tag but will discard a large fraction of the observed data. Taking this bias into account should allow more of the available data to be used leading to increased statistical power. Results Three new hierarchical models, which directly embed a model for the variation in tag formation probability, are proposed and their associated Bayesian inference algorithms are developed. These models may be applied to libraries at both the tag and aggregate level. Simulation experiments and analysis of real data are used to contrast the accuracy of the various methods. The consequences of tag formation bias are discussed in the context of testing differential expression. A description is given as to how these algorithms can be applied in that context. Conclusions Several Bayesian inference algorithms that account for tag formation effects are compared with the DPB algorithm providing clear evidence of superior performance. The accuracy of inferences when using a particular non-informative prior is found to depend on the expression level of a given gene. The multivariate nature of the approach easily allows both univariate and joint tests of differential expression. Calculations demonstrate the potential for false positive and negative findings due to variation in tag formation probabilities across samples when testing for differential expression.
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Affiliation(s)
- Russell L Zaretzki
- Department of Statistics, Operations, and Management Science, The University of Tennessee, 331 Stokely Management Center, Knoxville, TN 37996, USA.
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Goldsmith YB, Ahmad I, Singh V, D'Ayala M, Klem I, Briggs WM, Ahmed M, Hayat M, Sacchi TJ, Heitner JF. Serum biomarkers and traditional risk factors as predictors of peripheral arterial disease assessed by magnetic resonance angiography. J Cardiovasc Magn Reson 2009. [PMCID: PMC7860809 DOI: 10.1186/1532-429x-11-s1-p124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
BACKGROUND National guidelines recommend 20 to 30 minutes of exercise 3 to 5 days a week. However, achieving these goals may be challenging for asthmatic patients whose symptoms are exacerbated by exercise. OBJECTIVE To describe relationships among exercise habits, weight, and asthma severity and control in adults with asthma. METHODS Self-reported exercise habits were obtained from 258 stable patients by using the Paffenbarger Physical Activity and Exercise Index. Disease status was measured by using the Asthma Control Questionnaire and the Severity of Asthma Scale. Exercise habits were evaluated in multivariate analyses with age, sex, education, body mass index, and asthma control and severity as independent variables. RESULTS The mean patient age was 42 years; 75% were women, 62% were college graduates, and 40% were obese. Only 44% of patients did any exercise. In bivariate analysis, patients with well-controlled asthma were more likely to exercise; however, in multivariate analysis, asthma control and severity were not associated, but male sex (P = .01), having more education (P = .04), and not being obese (P < .001) were associated. Asthma control and severity also were not associated with type, duration, or frequency of exercise, but not being obese was associated in multivariate analyses. Only 22% of all patients (49% of those who exercised) met national guidelines for weekly exercise. Not being obese was the only variable associated with meeting guidelines in multivariate analysis (P = .02). CONCLUSIONS Compared with the general population, a lower proportion of asthmatic patients did any routine exercise and met national exercise guidelines. Physicians need to manage asthma and obesity to help asthmatic patients meet exercise goals.
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Affiliation(s)
| | | | | | | | - Carol A. Mancuso
- Weill Cornell Medical College, New York, New York
- Hospital for Special Surgery, New York, New York
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Charlson ME, Peterson JC, Boutin-Foster C, Briggs WM, Ogedegbe GG, McCulloch CE, Hollenberg J, Wong C, Allegrante JP. Changing health behaviors to improve health outcomes after angioplasty: a randomized trial of net present value versus future value risk communication. Health Educ Res 2008; 23:826-839. [PMID: 18025064 PMCID: PMC2733803 DOI: 10.1093/her/cym068] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Accepted: 09/04/2007] [Indexed: 05/25/2023]
Abstract
Patients who have undergone angioplasty experience difficulty modifying at-risk behaviors for subsequent cardiac events. The purpose of this study was to test whether an innovative approach to framing of risk, based on 'net present value' economic theory, would be more effective in behavioral intervention than the standard 'future value approach' in reducing cardiovascular morbidity and mortality following angioplasty. At baseline, all patients completed a health assessment, received an individualized risk profile and selected risk factors for modification. The intervention randomized patients into two varying methods for illustrating positive effects of behavior change. For the experimental group, each selected risk factor was assigned a numeric biologic age (the net present value) that approximated the relative potential to improve current health status and quality of life when modifying that risk factor. In the control group, risk reduction was framed as the value of preventing future health problems. Ninety-four percent of patients completed 2-year follow-up. There was no difference between the rates of death, stroke, myocardial infarction, Class II-IV angina or severe ischemia (on non-invasive testing) between the net present value group and the future value group. Our results show that a net present risk communication intervention did not result in significant differences in health outcomes.
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Affiliation(s)
- M E Charlson
- Center for Complementary and Integrative Medicine, Weill Cornell Medical College, New York, NY 10065, USA.
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Boutin-Foster C, Ogedegbe G, Peterson J, Briggs WM, Allegrante JP, Charlson ME. Psychosocial mediators of the relationship between race/ethnicity and depressive symptoms in Latino and white patients with coronary artery disease. J Natl Med Assoc 2008; 100:849-55. [PMID: 18672563 DOI: 10.1016/s0027-9684(15)31380-8] [Citation(s) in RCA: 2] [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: 10/22/2022]
Abstract
BACKGROUND The high prevalence of depressive symptoms in patients with coronary artery disease has been well documented. However, little is known about the prevalence and correlates of depressive symptoms in Latino patients with coronary artery disease. PURPOSE Among Latino and white patients who had percutaneous transluminal coronary angioplasty (PTCA), this study examined whether differences in the prevalence of depressive symptoms exist and the degree to which psychosocial factors (years of education, employment status, stressful life events, emotional social support) explained any differences. METHODS Using a cross-sectional design, closed-format questionnaires were used to obtain clinical and psychosocial history. The definition of high depressive symptoms was based on a score of > or =16 on the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS Compared to whites (n=492), Latinos (n=59) were younger, and a greater proportion were female, but fewer completed high school and fewer were employed (P<0.05). More Latinos reported experiencing > or =2 recent stressful life events, but fewer reported having emotional social support (P<0.05). There was a significant association between race/ethnicity and depressive symptoms (OR=2.3, 95% CI: 1.3-4.5). In multivariate analyses, the significance of this association diminished when psychosocial variables were added to the model. CONCLUSIONS In this study, education, employment, stressful life events and emotional social support partially explained the observed racial/ethnic differences in depressive symptoms.
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Affiliation(s)
- C Boutin-Foster
- Center for Complementary and Integrative Medicine, Weill Medical College, Cornell University, New York, NY 10021, USA.
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Birkhahn RH, Blomkalns AL, Klausner HA, Nowak RM, Raja AS, Summers RL, Weber JE, Briggs WM, Arkun A, Diercks D. Academic emergency medicine faculty and industry relationships. Acad Emerg Med 2008; 15:819-24. [PMID: 19244632 DOI: 10.1111/j.1553-2712.2008.00196.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 11/29/2022]
Abstract
OBJECTIVES The authors surveyed the membership of the Society for Academic Emergency Medicine (SAEM) about their associations with industry and predictors of those associations. METHODS A national Web-based survey inviting faculty from the active member list of SAEM was conducted. Follow-up requests for participation were sent weekly for 3 weeks. Information was collected on respondents' personal and practice characteristics, industry interactions, and personal opinions regarding these interactions. Raw response rates were reported and a logistic regression was used to generate descriptive statistics. RESULTS Responses were received from 430 members, representing 14% of the 3,183 active members. Respondents were 83% male and 86% white, with 96% holding an MD degree (24% with an additional postdoctoral degree). Most were at the assistant (37%) or associate (25%) professor rank, with 51% holding at least one leadership position. Most respondents (82%) reported some type of industry interaction, most commonly the acceptance of food or beverages (67%). Respondents at the associate professor rank or higher were more likely to receive payments from industry (51% vs. 22%, odds ratio [OR] = 3.7). CONCLUSIONS This survey suggests that interactions between industry and academic EM faculty are common and increase with academic rank, but not with years in practice or leadership influence. The number and type of interactions are consistent with those reported by a national sampling of other physician specialties.
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Affiliation(s)
- Robert H Birkhahn
- Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY, USA.
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Briggs WM. Comments on: Assessing probabilistic forecasts of multivariate quantities, with an application to ensemble predictions of surface winds. TEST-SPAIN 2008. [DOI: 10.1007/s11749-008-0117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mancuso CA, Westermann H, Choi TN, Wenderoth S, Briggs WM, Charlson ME. Psychological and somatic symptoms in screening for depression in asthma patients. J Asthma 2008; 45:221-5. [PMID: 18415830 DOI: 10.1080/02770900701883766] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Correctly identifying asthma patients who need treatment for depression is part of comprehensive care. The objective of this study was to compare the prevalence of depressive symptoms measured by the short-form Center for Epidemiologic Studies Depression Scale (CESD-SF), which measures somatic and psychological symptoms, with the original and short-form Geriatric Depression Scale (GDS and GDS-SF), which measure only psychological symptoms. In total, 257 asthma patients (mean age 42 years, 75% women) completed the GDS (score range 0-30, positive screen > or = 11) and the CESD-SF (score range 0-30, positive screen > or = 10). The performance of each scale was compared to clinical diagnoses of depressive disorders reported by physicians using a skill score analysis. Twenty percent of patients had GDS scores > or = 11 and 32% had CESD-SF scores > or = 10. The somatic symptom of restless sleep was the most common CESD-SF symptom and the symptom that contributed most to the total score. The GDS had a skill score of +.16 (+1 = maximum possible, 0 = best guess) and the CESD-SF had a skill score of -.02 compared to physician-reported depressive disorders. Similar results were found for the GDS-SF. Thus, more patients had a positive CESD-SF screen, which was attributable mostly to a somatic sleep symptom that overlaps with asthma symptoms, and the GDS was more consistent with physicians' reports of depressive disorders.
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Charlson ME, Peterson JC, Syat BL, Briggs WM, Kline R, Dodd M, Murad V, Dionne W. Outcomes of community-based social service interventions in homebound elders. Int J Geriatr Psychiatry 2008; 23:427-32. [PMID: 17918183 DOI: 10.1002/gps.1898] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To document within-client change in function and quality of life over 6 months, and determine whether social service interventions, comorbidity, depressive symptoms, social support and stress are predictors of within-patient change. METHOD Assess homebound elderly referred for social services on depressive symptoms measured by the Geriatric Depression Scale (GDS), comorbidity with the Charlson Index, and stress and support with the Duke instrument. Function was measured by the Functional Autonomy Scale (FAS), measuring Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), mobility, communication and mental function. The SF-36 measured quality of life. RESULTS Among 56 new homebound clients with an average age of 82, 33% had depressive symptoms at baseline (>7 on the GDS). At baseline clients were at or below 25th percentile for five of eight domains of the SF-36, and mental and physical summary scores. Further at baseline, 90% had difficulties with mobility and IADLs; 61% had ADL limitations. At 6-month follow-up overall, 26% had depressive symptoms at follow-up. Greater comorbidity was associated with more depressive symptoms at both baseline and follow-up. By 6 months, 18% had deteriorated on the FAS, while 11% improved. More clients had changes in quality of life; regarding the physical component score, 13% had important deterioration, while 63% improved. Similarly, 33% declined on the mental component while 27% improved. CONCLUSION Among newly homebound elders, those with significant depressive symptoms are more likely to experience deterioration in function and quality of life over 6 months. However, those with more support showed significant improvement in the SF-36 mental component scale at 6 months.
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Affiliation(s)
- Mary E Charlson
- Center for Complementary and Integrative Medicine, Weill Cornell Medical College, New York, NY, USA.
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Mancuso CA, Wenderoth S, Westermann H, Choi TN, Briggs WM, Charlson ME. Patient-reported and physician-reported depressive conditions in relation to asthma severity and control. Chest 2008; 133:1142-8. [PMID: 18263683 DOI: 10.1378/chest.07-2243] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Depressive conditions in asthma patients have been described mostly from patient reports and less often from physician reports. While patient reports can encompass multiple symptoms, physician assessments can attribute symptoms to a mental health etiology. Our objectives were to identify associations between patient- and physician-reported depressive conditions and asthma severity and control. METHODS Patient-reported depressive symptoms were obtained using the Geriatric Depression Scale (GDS) [possible score 0 to 30; higher score indicates more depressive symptoms]. Patients were categorized as having a physician-reported depressive disorder if they had the following: a diagnosis of depression, depressive symptoms described in medical charts, or were prescribed antidepressants at doses used to treat depression. Patients also completed the Severity of Asthma Scale (SOA) [possible score 0 to 28; higher score indicates more severe] and the Asthma Control Questionnaire (ACQ) [possible score 0 to 6; higher score indicates worse control]. RESULTS Two hundred fifty-seven patients were included in this analysis (mean age, 42 years; 75% women). Mean SOA and ACQ (+/- SD) scores were 5.9 +/- 4.2 and 1.4 +/- 1.2, respectively; and mean GDS score was 6.3 +/- 6.4. After adjusting for age, sex, race, Latino ethnicity, education, medication adherence, body mass index, and smoking status, patient-reported depressive symptoms were associated with asthma severity (p = 0.007) and with asthma control (p = 0.0007). In contrast, physician-reported depressive disorders were associated with asthma severity (p = 0.04) but not with asthma control (p = 0.22) after adjusting for covariates. CONCLUSIONS Physician- and patient-reported depressive conditions were associated with asthma severity. In contrast, patient-reported depressive symptoms were more closely associated with asthma control than were physician-reported depressive disorders. Identifying associations between depressive conditions and asthma severity and control is necessary to concurrently treat these conditions in this population. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00195117.
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Affiliation(s)
- Carol A Mancuso
- Hospital for Special Surgery, 535 East Seventieth St, New York, NY 10021, USA.
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Rosenzweig JS, Van Deusen SK, Okpara O, Datillo PA, Briggs WM, Birkhahn RH. Authorship, collaboration, and predictors of extramural funding in the emergency medicine literature. Am J Emerg Med 2008; 26:5-9. [DOI: 10.1016/j.ajem.2007.02.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 02/08/2007] [Accepted: 02/09/2007] [Indexed: 10/22/2022] Open
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Hogle NJ, Briggs WM, Fowler DL. Documenting a learning curve and test-retest reliability of two tasks on a virtual reality training simulator in laparoscopic surgery. J Surg Educ 2007; 64:424-30. [PMID: 18063281 DOI: 10.1016/j.jsurg.2007.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 07/16/2007] [Accepted: 08/14/2007] [Indexed: 05/22/2023]
Abstract
BACKGROUND Virtual reality simulators are a component of the armamentarium for training surgical residents. No one knows exactly how to incorporate virtual reality simulators into a curriculum. The purpose of this study was to document and show the learning curve and test-retest reliability of 2 tasks on a virtual reality-training simulator (LapSim; Surgical Science, Göteborg, Sweden) in laparoscopic surgery. METHODS Twenty-nine medical students participated in 8 iterations of 7 virtual reality tasks ("camera navigation" (CN), "instrument navigation," "coordination," "grasping," "lifting and grasping" (LG), "cutting," and "clip applying") Learning curves for each outcome variable of the CN and LG tasks were generated. Using ANOVA, we evaluated the differences between each score from attempt number 7 to attempt number 8 to document test-retest reliability. RESULTS A plateau in the learning curve occurred within 8 sessions for CN misses, CN tissue damage, CN maximum damage, and LG maximum damage. Over the course of 8 sessions, a plateau in the learning curve was nearly reached for CN time, CN drift, CN path, CN angular path, and LG left and right path. The following variables had a downward trend to the mean learning curve over 8 sessions, but they did not reach a plateau: LG time, LG left and right miss, LG left and right angular path, and LG tissue damage. CONCLUSION Using the LapSim virtual reality simulator, we documented a learning curve and test-retest reliability for each outcome variable for CN and LG for rank novices. The modeling of the general learning curve is useful in designing training program. These results may be important in developing standards for technical evaluation in a surgical training curriculum.
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Affiliation(s)
- Nancy J Hogle
- College of Physicians and Surgeons, Department of Surgery, Columbia University, New York, New York, USA.
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Charlson ME, Peterson JC, Krieger KH, Hartman GS, Hollenberg JP, Briggs WM, Segal AZ, Parikh M, Thomas SJ, Donahue RG, Purcell MH, Pirraglia PA, Isom OW. Improvement of Outcomes after Coronary Artery Bypass II: A Randomized Trial Comparing Intraoperative High Versus Customized Mean Arterial Pressure. J Card Surg 2007; 22:465-72. [DOI: 10.1111/j.1540-8191.2007.00471.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mancuso CA, Choi TN, Westermann H, Briggs WM, Wenderoth S, Charlson ME. Measuring physical activity in asthma patients: two-minute walk test, repeated chair rise test, and self-reported energy expenditure. J Asthma 2007; 44:333-40. [PMID: 17530534 DOI: 10.1080/02770900701344413] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although prudent exercise is recommended for most patients with well-controlled asthma, many patients avoid exercise and physical activity because they are concerned about triggering asthma. In a sample of 258 asthma patients (mean age 42 years, 75% women), the objectives of this study were to assess the two-minute walk test and the repeated chair rise test and to compare results to self-reported physical activity recorded with the Paffenbarger Physical Activity and Exercise Index (PAEI). Patients walked a mean of 510 feet, required a mean of 14 seconds for the chair rise test, and reported a mean of 1,810 kilocalories per week from activities, mostly walking. In multivariable analysis, male sex, younger age, more education, lower body mass index, and better short-term asthma control, but not long-term asthma severity, were associated with better performance-based test results and more self-reported physical activity. Better short-term control also was associated with less breathing and leg exertion during both tests. Correlations between the PAEI and performance-based tests were approximately 0.38. Performance-based and self-reported measures provide information about various aspects of exercise capacity and can be used during routine clinical practice to assess physical activity in asthma patients.
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Affiliation(s)
- Carol A Mancuso
- Joan and Sanford I. Weill Medical College of Cornell University, New York, New York, USA.
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Charlson ME, Boutin-Foster C, Mancuso CA, Peterson JC, Ogedegbe G, Briggs WM, Robbins L, Isen AM, Allegrante JP. Randomized controlled trials of positive affect and self-affirmation to facilitate healthy behaviors in patients with cardiopulmonary diseases: rationale, trial design, and methods. Contemp Clin Trials 2007; 28:748-62. [PMID: 17459784 DOI: 10.1016/j.cct.2007.03.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 03/01/2007] [Accepted: 03/04/2007] [Indexed: 11/22/2022]
Abstract
Secondary prevention of adverse outcomes in patients with cardiopulmonary disease requires that patients become actively engaged in self-management efforts such as participation in physical activity or medication adherence. However, despite assiduous efforts to find strategies that help cardiovascular patients to adopt and maintain such behaviors, many studies of interventions designed to improve physical activity and adherence to medication have shown disappointing results. To this end, the Translational Behavioral Science Research Consortium was created by the National Heart, Lung, and Blood Institute to identify promising, but underutilized findings from basic behavioral science that might have potential application for translation to clinical populations where behavioral change has been refractory to standard intervention approaches. This paper describes the rationale and methods of a novel research project designed to test the efficacy of a behavioral intervention that combines constructs from two behavioral science theories (positive affect and self-affirmation) in order to help patients with coronary artery disease, asthma, and hypertension successfully change behaviors. The project consists of an intervention framed upon positive affect and self-affirmation and tested in three concurrent randomized controlled trials among three distinct populations. Each trial had a qualitative phase that served as a formative stage to inform the intervention; a pilot phase during which the feasibility of the intervention was tested and refined; and a randomized controlled phase conducted to investigate the effects of the interventions in these three patient groups.
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Affiliation(s)
- Mary E Charlson
- Center for Complementary and Integrative Medicine and Division of General Internal Medicine, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY 10021, USA.
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Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med 2006; 48:227-35. [PMID: 16934640 DOI: 10.1016/j.annemergmed.2006.01.008] [Citation(s) in RCA: 249] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 12/19/2005] [Accepted: 01/06/2006] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE Annually, 38 million people are evaluated for trauma, the leading cause of death in persons younger than 45 years. The primary objective is to assess whether using a protocol inclusive of point-of-care, limited ultrasonography (PLUS), compared to usual care (control), among patients presenting to the emergency department (ED) with suspected torso trauma decreased time to operative care. METHODS The study was a randomized controlled clinical trial conducted during a 6-month period at 2 Level I trauma centers. The intervention was PLUS conducted by verified clinician sonographers. The primary outcome measure was time from ED arrival to transfer to operative care; secondary outcomes included computed tomography (CT) use, length of stay, complications, and charges. Regression models controlled for confounders and analyzed physician-to-physician variability. All analyses were conducted on an intention-to-treat basis. Results are presented as mean, first-quartile, median, and third-quartile, with multiplicative change and 95% confidence intervals (CIs), or percentage with odds ratio and 95% CIs. RESULTS Four hundred forty-four patients with suspected torso trauma were eligible; 136 patients lacked consent, and attending physicians refused enrollment of 46 patients. Two hundred sixty-two patients were enrolled: 135 PLUS patients and 127 controls. There were no important differences between groups. Time to operative care was 64% (48, 76) less for PLUS compared to control patients. PLUS patients underwent fewer CTs (odds ratio 0.16) (0.07, 0.32), spent 27% (1, 46) fewer days in hospital, and had fewer complications (odds ratio 0.16) (0.07, 0.32), and charges were 35% (19, 48) less compared to control. CONCLUSION A PLUS-inclusive protocol significantly decreased time to operative care in patients with suspected torso trauma, with improved resource use and lower charges.
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Affiliation(s)
- Lawrence A Melniker
- Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY 11215-9008, USA.
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Milling T, Holden C, Melniker L, Briggs WM, Birkhahn R, Gaeta T. Randomized controlled trial of single-operator vs. two-operator ultrasound guidance for internal jugular central venous cannulation. Acad Emerg Med 2006; 13:245-7. [PMID: 16495416 DOI: 10.1197/j.aem.2005.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Use of ultrasound guidance for central line placement generally requires two operators: one to hold the transducer and the other to guide the needle. The authors propose a single-operator technique and compare it with the two-operator technique for placement of internal jugular central lines. METHODS This was a randomized clinical trial conducted from June to September 2004 in a U.S. urban teaching hospital. Enrollment packets were randomized to dynamic single operator (D1) and dynamic two operator (D2). The procedure was performed under ultrasound visualization in the transverse plane. The primary outcome measure was cannulation success. A complete Bayesian analysis using noninformative priors to estimate the probability of similarity of outcomes for D1 and D2 was performed. All variables are reported with 95% confidence intervals (CIs) where appropriate. RESULTS Forty-four patients were enrolled from the emergency department and intensive care unit. Twenty-three patients were randomized to D1, and 21 to D2. Cannulation success was 96% (95% CI = 85% to 100%) for D1 and 95% (95% CI = 83% to 100%) for D2. There was a 90% probability that the success rates of these two groups differed by less than 10% of each other. CONCLUSIONS This one-person technique appears to be equivalent to the standard two-person technique for successful ultrasound-guided internal jugular central venous catheterization with respect to overall success.
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Affiliation(s)
- Truman Milling
- Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY, USA.
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Milling T, Holden C, Melniker L, Briggs WM, Birkhahn R, Gaeta T. Randomized controlled trial of single-operator vs. two-operator ultrasound guidance for internal jugular central venous cannulation. Acad Emerg Med 2006. [PMID: 16495416 DOI: 10.1111/j.1553-2712.2006.tb01686.x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Use of ultrasound guidance for central line placement generally requires two operators: one to hold the transducer and the other to guide the needle. The authors propose a single-operator technique and compare it with the two-operator technique for placement of internal jugular central lines. METHODS This was a randomized clinical trial conducted from June to September 2004 in a U.S. urban teaching hospital. Enrollment packets were randomized to dynamic single operator (D1) and dynamic two operator (D2). The procedure was performed under ultrasound visualization in the transverse plane. The primary outcome measure was cannulation success. A complete Bayesian analysis using noninformative priors to estimate the probability of similarity of outcomes for D1 and D2 was performed. All variables are reported with 95% confidence intervals (CIs) where appropriate. RESULTS Forty-four patients were enrolled from the emergency department and intensive care unit. Twenty-three patients were randomized to D1, and 21 to D2. Cannulation success was 96% (95% CI = 85% to 100%) for D1 and 95% (95% CI = 83% to 100%) for D2. There was a 90% probability that the success rates of these two groups differed by less than 10% of each other. CONCLUSIONS This one-person technique appears to be equivalent to the standard two-person technique for successful ultrasound-guided internal jugular central venous catheterization with respect to overall success.
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Affiliation(s)
- Truman Milling
- Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY, USA.
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Milla F, Skubas N, Briggs WM, Girardi LN, Lee LY, Ko W, Tortolani AJ, Krieger KH, Isom OW, Mack CA. Epicardial beating heart cryoablation using a novel argon-based cryoclamp and linear probe. J Thorac Cardiovasc Surg 2006; 131:403-11. [PMID: 16434271 DOI: 10.1016/j.jtcvs.2005.10.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 10/18/2005] [Accepted: 10/28/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Epicardial, beating heart cryoablation for the treatment of atrial fibrillation may be limited by heat from intracardiac blood flow. We therefore evaluated the ability to create cryolesions using an argon-based cryoclamp device, which temporarily occludes blood flow and facilitates transmurality. METHODS Six mongrel dogs underwent sternotomy. A clamp employing a 10-cm argon-based linear cryoablation device was used epicardially to isolate the pulmonary veins and left atrial appendage. After clamping of lesions, the probe was removed from the cryoclamp device, and the remaining linear lesions, analogous to the Cox maze III, were performed. Pulmonary vein stenosis was evaluated with the use of magnetic resonance imaging. Left atrial function and pulmonary venous flow velocities were assessed with transesophageal echocardiography. Transmurality was confirmed both electrically and histologically. Animals were then put to death at 30 days. RESULTS All acute and chronic cryoclamp lesions produced conduction block. There was no change in right (RPV) or left pulmonary vein (LPV) diameter on the basis of magnetic resonance imaging at baseline and at planned death (RPV-1, 19.6 +/- 2.9 mm vs 16.9 +/- 2.8 mm, P = .22; RPV-2, 13.2 +/- 2.0 mm vs 11.8 +/- 1.6 mm, P = .22; and LPV, 12.2 +/- 2.4 mm vs 11.2 +/- 1.9 mm, P = .30). Left atrial function and pulmonary venous flow velocities were unchanged. Tissue sections determined transmurality in 93% of cryoclamp lesions and 84% of linear ablations performed with the 10-cm malleable probe. CONCLUSIONS Epicardial application of this cryoclamp device on the beating heart produced transmural lesions, which persisted 30 days. Linear epicardial cryoablation was not as effective as the cryoclamp device at producing consistent transmural lesions. This novel, versatile device may be useful in treating patients with atrial fibrillation on the beating heart without cardiopulmonary bypass.
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Affiliation(s)
- Federico Milla
- New York Presbyterian Hospital-Weill Cornell Medical Center, Department of Cardiothoracic Surgery, New York, NY, USA
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