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Duell CH, O'Sullivan DM, Bilinskaya A, Linder KE. Evaluation of Timing of Antimicrobial Surgical Prophylaxis on Rates of Surgical Site Infections. Surg Infect (Larchmt) 2024. [PMID: 38758048 DOI: 10.1089/sur.2024.010] [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] [Indexed: 05/18/2024] Open
Abstract
Background: Surgical site infections (SSIs) are common healthcare-associated infections, and national guidelines recommend that antimicrobial prophylaxis (AP) be administered 60 min prior to incision. However, there are limited data regarding the "most optimal" time for administration within the 60-min window. Patients and Methods: This was a multicenter, retrospective study of adult (≥18-year-old) patients that underwent an abdominal hysterectomy, colorectal surgery, or craniotomy and received AP within 60 min of incision. Incidence of SSI was compared between patients who received AP 0-30 versus 31-60 min of incision. In addition, a predefined subgroup analysis evaluated incidence of SSI for 15-min intervals within the 60-min timeframe. Results: Of the 277 patients included in the primary analysis, 233 (84.1%) and 44 (15.9%) received AP 0-30 min and 31-60 min prior to incision, respectively. SSIs were documented in 6.0% (14/233) versus 4.5% (2/44) of patients in the primary analysis (p = 0.703). In the secondary analysis, 137 (49.5%), 95 (34.3%), 34 (12.3%), and 11 (4.0%) patients received AP 0-15, 16-30, 31-45, and 46-60 min prior to incision, respectively. There was no difference in incidence of SSIs among the 15-min intervals (4.4% vs. 8.4% vs. 2.9% vs. 9.1%, p = 0.487). Of the 16 patients in this study that incurred a SSI, 5 patients had positive cultures, of which 3 contained bacteria that proved to be resistant to the antibiotic used for AP. Conclusions: The results of our analysis support current national guidelines. Future investigation of different intervals (e.g., AP 15-45 min prior to incision) may be beneficial on the basis of pharmacokinetics of routinely prescribed AP.
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Affiliation(s)
- Colin H Duell
- Department of Pharmacy Services, Hartford HealthCare, Hartford, Connecticut, USA
| | - David M O'Sullivan
- Department of Research Administration, Hartford HealthCare, Hartford, Connecticut, USA
| | - Anastasia Bilinskaya
- Department of Pharmacy Services, Hartford HealthCare, Hartford, Connecticut, USA
| | - Kristin E Linder
- Department of Pharmacy Services, Hartford HealthCare, Hartford, Connecticut, USA
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2
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Becker EC, Siddique O, O'Sullivan DM, Dar W, Einstein M, Morgan G, Emmanuel B, Sotil EU, Richardson E, Serrano OK. Disparities in Liver Transplantation for Nonalcoholic Steatohepatitis in Women. Transplantation 2024:00007890-990000000-00680. [PMID: 38419160 DOI: 10.1097/tp.0000000000004964] [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: 03/02/2024]
Abstract
BACKGROUND Nonalcoholic steatohepatitis (NASH) is the fastest-growing indication for liver transplantation (LT). Sex disparities among patients with cirrhosis on the LT waitlist are well known. We wanted to understand these disparities further in women with end-stage liver disease patients listed for NASH cirrhosis in a contemporary cohort. METHODS We used data from the Scientific Registry of Transplant Recipients to assess sex racial, and ethnic differences in NASH patients listed for LT. Adults transplanted from August 1997 to June 2021 were included. Inferential statistics were used to evaluate differences with univariate and multivariate comparisons, including competitive risk analysis. RESULTS During the study time period, we evaluated 12 844 LT for NASH cirrhosis. Women were transplanted at a lower rate (46.5% versus 53.5%; P < 0.001) and higher model for end-stage liver disease (MELD) (23.8 versus 22.6; P < 0.001) than men. Non-White women were transplanted at a higher MELD (26.1 versus 23.1; P < 0.001) than White women and non-White male patients (26.1 versus 24.8; P < 0.001). Graft and patient survivals were significantly different (P < 0.001) between non-White women and White women and men (White and non-White). CONCLUSIONS Evaluation of LT candidates in the United States demonstrates women with NASH cirrhosis have a higher MELD than men at LT. Additional disparities exist among non-White women with NASH as they have higher MELD and creatinine at LT compared with White women. After LT, non-White women have worse graft and patient survival compared with men or White women. These data indicate that non-White women with NASH are the most vulnerable on the LT waitlist.
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Affiliation(s)
- Erica C Becker
- Department of Internal Medicine, University of Connecticut Health, Farmington, CT
| | - Osama Siddique
- Department of Gastroenterology, Hartford Hospital, Hartford, CT
| | - David M O'Sullivan
- Department of Research Administration, Hartford HealthCare, Hartford, CT
| | - Wasim Dar
- Transplant Program, Hartford Hospital, Hartford, CT
- Department of Surgery, University of Connecticut Health, Farmington, CT
| | - Michael Einstein
- Department of Internal Medicine, University of Connecticut Health, Farmington, CT
- Transplant Program, Hartford Hospital, Hartford, CT
| | - Glyn Morgan
- Transplant Program, Hartford Hospital, Hartford, CT
- Department of Surgery, University of Connecticut Health, Farmington, CT
| | - Bishoy Emmanuel
- Transplant Program, Hartford Hospital, Hartford, CT
- Department of Surgery, University of Connecticut Health, Farmington, CT
| | - Eva U Sotil
- Department of Internal Medicine, University of Connecticut Health, Farmington, CT
- Transplant Program, Hartford Hospital, Hartford, CT
| | - Elizabeth Richardson
- Department of Internal Medicine, University of Connecticut Health, Farmington, CT
- Transplant Program, Hartford Hospital, Hartford, CT
| | - Oscar K Serrano
- Transplant Program, Hartford Hospital, Hartford, CT
- Department of Surgery, University of Connecticut Health, Farmington, CT
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3
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Sappenfield EC, Mellen C, Wilcox J, O'Hanlon DE, O'Sullivan DM, Tunitsky-Bitton E. The Impact of Vaginal Probiotics on Pessary Use: A Randomized Controlled Trial. Urogynecology (Phila) 2024; 30:50-58. [PMID: 37493229 DOI: 10.1097/spv.0000000000001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE Pessary-related adverse effects are common, and treatment options are limited. Probiotics may improve pessary-related adverse effects by altering the vaginal microenvironment. OBJECTIVE This study aimed to evaluate the effect of a vaginal probiotic suppository on the vaginal microenvironment among pessary users. STUDY DESIGN Women who used pessaries were randomized to vaginal probiotic suppository use versus without use. The intervention was a vaginal probiotic suppository and moisturizing vaginal gel. The vaginal microenvironment was assessed using Gram stain and Nugent's criteria at baseline and 3 months by a microbiologist blinded to group allocation. Symptoms and experience with use of the probiotic were assessed using questionnaires. The primary outcome was change in lactobacilli count on Nugent subscore at 3 months. RESULTS A total of 147 postmenopausal women were randomized (86 to the intervention arm and 61 to the control arm), and 124 (87.9%) presented for a 3-month follow-up. There was no difference between the arms in age, race, body mass index, and Charlson Comorbidity Index. A majority of participants had the pessary managed by the health care professional (intervention arm vs control arm, 46 [76.7%] vs 55 [68.8%]; P = 0.30). Composition of the vaginal microenvironment did not differ with or without probiotic treatment at 3 months. Bother from vaginal symptoms, including discharge, itching, and discomfort, did not differ between arms. Adverse effects from the intervention were minor, resolved with discontinuation, and occurred at 39.1%. CONCLUSION Vaginal probiotic suppository use did not affect the composition of the vaginal microenvironment, patient satisfaction, or vaginal symptoms after 3 months of use in pessary users.
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Affiliation(s)
- Elisabeth C Sappenfield
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
| | - Colleen Mellen
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
| | - Jennifer Wilcox
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
| | | | - David M O'Sullivan
- Department of Research Administration, Hartford HealthCare, Hartford, CT
| | - Elena Tunitsky-Bitton
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
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4
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O'Meara A, Abalyan V, O'Sullivan DM, Tunitsky-Bitton E. Clean-Catch Urine Specimen More Likely to Be Contaminated After Vaginal Surgery for Pelvic Organ Prolapse. Urogynecology (Phila) 2023; 29:953-958. [PMID: 37195817 DOI: 10.1097/spv.0000000000001366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
IMPORTANCE Accurate diagnosis of urinary tract infection after pelvic organ prolapse (POP) surgery is essential to postoperative care. OBJECTIVE Our aim was to determine the agreement between the urinalysis of a clean-catch versus a straight catheter urine specimen in women who underwent vaginal surgery for POP. STUDY DESIGN This was a cross-sectional study evaluating patients after vaginal surgery for POP. A clean-catch and straight catheter urine specimen were collected at routine postoperative appointments. Routine urinalyses and urine cultures were performed for all patients. A urine culture yielding mixed urogenital flora (which includes Lactobacillus species), coagulase-negative staphylococci, and Streptococcus species was considered a contaminated result. The agreement between the characteristics of urinalysis obtained via the clean catch versus the straight catheter at 3 weeks postoperatively was evaluated using weighted κ statistic. RESULTS Fifty-nine participants enrolled. The agreement between the characteristics of urinalysis obtained via the clean catch versus the straight catheter was poor (κ = 0.018). The urine culture was more likely to be contaminated from the clean-catch urine specimen than from the straight catheter urine specimen (53.7% vs 23.1%).The positive and negative predictive values of leukocyte esterase on clean catch were 22.6% and 100%, respectively. CONCLUSIONS Diagnosing urinary tract infection based on contaminated urinalyses may lead to antibiotic overuse and misdiagnosis of postoperative complications. Our results can help educate health care partners and discourage the use of clean-catch urine specimens when assessing women who have recently undergone vaginal surgery.
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Affiliation(s)
- Amanda O'Meara
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Hartford Hospital
| | - Victoria Abalyan
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Hartford Hospital
| | - David M O'Sullivan
- Department of Research Administration, Hartford HealthCare, Hartford, CT
| | - Elena Tunitsky-Bitton
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Hartford Hospital
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5
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Moallem N, Fiscus G, O'Sullivan DM, Perkins M, Scatola A, Parikh R. Assessing the optimal MAP target in pre-capillary PH patients with RV failure: A retrospective analysis. Pulm Circ 2023; 13:e12292. [PMID: 37817916 PMCID: PMC10560867 DOI: 10.1002/pul2.12292] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
Right ventricular failure (RVF) in pre-capillary pulmonary hypertension (PH) is associated with high morbidity and mortality. While mean arterial pressure (MAP) goals have been well established in critical care literature, the optimal MAP target for patients with RVF secondary to pre-capillary PH remains unknown. The objective of this study was to evaluate the difference in outcomes between patients who were managed with different MAP targets. We retrospectively analyzed records of 60 patients who were admitted to the intensive care unit for decompensated RVF secondary to pre-capillary PH. The records were stratified into two groups: 30 patients who were treated with a static MAP goal of either 65 or 70 mmHg (MAP65/70) and 30 patients who received a dynamic MAP goal (MAPCVP) determined by invasively obtained central venous pressure or right atrial pressure. The dynamic MAP group had a statistically significant decrease in in-hospital mortality and incidence of acute kidney injury compared to the static MAP cohort.
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Affiliation(s)
- Niala Moallem
- Department of Internal MedicineUniversity of ConnecticutFarmingtonConnecticutUSA
| | - Garrett Fiscus
- Department of Pulmonary and Critical Care FellowshipUniversity of ConnecticutFarmingtonConnecticutUSA
| | - David M. O'Sullivan
- Department of Research AdministrationHartford HealthCareHartfordConnecticutUSA
| | - Michael Perkins
- Division of Pulmonary, Critical Care and SleepHartford HospitalHartfordConnecticutUSA
| | - Andrew Scatola
- Division of Cardiology, Advanced Heart Failure and TransplantHartford HospitalHartfordConnecticutUSA
| | - Raj Parikh
- Division of Pulmonary, Critical Care and SleepHartford HospitalHartfordConnecticutUSA
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Parikh R, O'Sullivan DM, Farber HW. The PH-ILD Detection tool: External validation and use in patients with ILD. Pulm Circ 2023; 13:e12273. [PMID: 37564922 PMCID: PMC10410234 DOI: 10.1002/pul2.12273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023] Open
Abstract
Pulmonary hypertension (PH) results in increased morbidity and mortality in patients with interstitial lung disease (ILD). Early recognition of PH in this population is essential for planning diagnostic testing, initiating therapy, and evaluating for lung transplantation. The previously developed PH-ILD Detection tool has significant potential in the evaluation and treatment of ILD patients; the aim of this study was to validate the tool in an independent, multicenter cohort of patients. We conducted a retrospective review of prospectively collected data from 161 ILD patients. Patients were stratified into low- (n = 78, 48.4%), intermediate- (n = 54, 33.5%), and high-risk (n = 29, 18.0%) groups based on the score obtained with the tool. Intermediate- and high-risk patients underwent follow-up echocardiogram (TTE); 49.4% (n = 41) had an abnormal TTE suggestive of underlying PH. These patients underwent right heart catheterization; PH-ILD was diagnosed in 73.2% (n = 30) of these cases. The PH-ILD Detection tool has a sensitivity of 93.3%, specificity of 90.9%, and area-under-the-curve of 0.921 for diagnosing PH in ILD patients, validating the findings from the original study and establishing the tool as a fundamental resource for early recognition of PH in ILD patients.
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Affiliation(s)
- Raj Parikh
- Division of Pulmonary, Critical Care and Sleep, Hartford HospitalHartfordConnecticutUSA
| | - David M. O'Sullivan
- Department of Research AdministrationHartford HealthCareHartfordConnecticutUSA
| | - Harrison W. Farber
- Division of Pulmonary, Sleep and Critical Care Medicine, Tufts Medical CenterBostonMassachusettsUSA
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7
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Althoff AL, Ali MS, O'Sullivan DM, Dar W, Emmanuel B, Morgan G, Einstein M, Richardson E, Sotil E, Swales C, Sheiner PA, Serrano OK. Short- and Long-Term Outcomes for Ethnic Minorities in the United States After Liver Transplantation: Parsing the Hispanic Paradox. Transplant Proc 2022; 54:2263-2269. [DOI: 10.1016/j.transproceed.2022.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/03/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
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8
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Parikh R, Konstantinidis I, O'Sullivan DM, Farber HW. Pulmonary Hypertension in patients with Interstitial Lung Disease: a tool for early detection. Pulm Circ 2022; 12:e12141. [PMID: 36225536 PMCID: PMC9531548 DOI: 10.1002/pul2.12141] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/25/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension (PH) complicates the treatment of interstitial lung disease (ILD) patients resulting in poor functional status and worse outcomes. Early recognition of PH in ILD is important for initiating therapy and considering lung transplantation. However, no standard exists regarding which patients to screen for PH‐ILD or the optimal method to do so. The aim of this study was to create a risk assessment tool that could reliably predict PH in ILD patients. We developed a PH‐ILD Detection tool that incorporated history, exam, 6‐min walk distance, diffusion capacity for carbon monoxide, chest imaging, and cardiac biomarkers to create an eight‐component score. This tool was analyzed retrospectively in 154 ILD patients where each patient was given a score ranging from 0 to 12. The sensitivity (SN) and specificity (SP) of the PH‐ILD Detection tool and an area‐under‐the‐curve (AUC) were calculated. In this cohort, 74 patients (48.1%) had PH‐ILD. A score of ≥6 on the PH‐ILD Detection tool was associated with a diagnosis of PH‐ILD (SN: 86.5%; SP: 86.3%; area‐under‐the‐curve: 0.920, p < 0.001). The PH‐ILD Detection tool provides high SN and SP for detecting PH in ILD patients. With confirmation in larger cohorts, this tool could improve the diagnosis of PH in ILD and may suggest further testing with right heart catheterization and earlier intervention with inhaled treprostinil and/or lung transplant evaluation.
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Affiliation(s)
- R Parikh
- Division of Pulmonary, Critical Care and Sleep Hartford Hospital Hartford CT
| | - I Konstantinidis
- Department of Internal Medicine University of Connecticut Farmington CT
| | - DM O'Sullivan
- Department of Research Administration Hartford HealthCare Hartford CT
| | - HW Farber
- Division of Pulmonary, Sleep and Critical Care Medicine Tufts Medical Center Boston MA
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9
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Kumar M, Perucki W, Hiendlmayr B, Mazigh S, O'Sullivan DM, Fernandez AB. The Association of Serum Magnesium Levels and QT Interval with Neurological Outcomes After Targeted Temperature Management. Ther Hypothermia Temp Manag 2022; 12:210-214. [PMID: 35467975 DOI: 10.1089/ther.2021.0038] [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] [Indexed: 11/12/2022] Open
Abstract
Targeted temperature management (TTM) is associated with corrected QT (QTc) prolongation and decrease in serum magnesium (Mg) levels that may lead to recurrent ventricular arrhythmia and poor neurological outcomes. We aimed to evaluate the association between QTc interval and Mg levels during TTM with neurological outcomes. We reviewed the electrocardiograms of 366 patients who underwent TTM during the induction, maintenance, and rewarming phase after cardiac arrest. We reviewed the association of change in QTc interval, and Mg levels with neurological outcomes. In total, 71.3% of the patients had a significant increase in QTc interval defined as >60 ms or any QTc >500 ms during TTM. Poor neurological outcome was associated with persistent prolongation of QTc after rewarming (507 vs. 483 ms, p = 0.046) and higher Mg levels at presentation (2.08 ± 0.41 mg/dL, p = 0.014). Supplemental Mg did not have any significant change in their QTc. Patients with prolonged QTc during TTM should be promptly evaluated for QTc-prolonging factors given its association with worse neurological outcomes. The inverse correlation between Mg levels and poor neurological outcomes deserves further investigation.
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Affiliation(s)
- Manish Kumar
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - William Perucki
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
| | - Brett Hiendlmayr
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
| | - Silya Mazigh
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - David M O'Sullivan
- Department of Research, Research Administration, Hartford HealthCare, Hartford, Connecticut, USA
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10
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Nudy M, Xie R, O'Sullivan DM, Jiang X, Appt S, Register TC, Kaplan JR, Clarkson TB, Schnatz PF. Association between coronary artery vitamin D receptor expression and select systemic risks factors for coronary artery atherosclerosis. Climacteric 2021; 25:369-375. [PMID: 34694941 DOI: 10.1080/13697137.2021.1985992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study is to analyze the association between coronary artery vitamin D receptor (VDR) expression and systemic coronary artery atherosclerosis (CAA) risk factors. METHODS Female cynomolgus monkeys (n = 39) consumed atherogenic diets containing the women's equivalent of 1000 IU/day of vitamin D3. After 32 months consuming the diets, each monkey underwent surgical menopause. After 32 postmenopausal months, CAA and VDR expression were quantified in the left anterior descending coronary artery. Plasma 25OHD3, lipid profiles and serum monocyte chemotactic protein-1 (MCP-1) were measured. RESULTS In postmenopausal monkeys receiving atherogenic diets, serum MCP-1 was significantly elevated compared with baseline (482.2 ± 174.2 pg/ml vs. 349.1 ± 163.2 pg/ml, respectively; p < 0.001; d = 0.79) and at the start of menopause (363.4 ± 117.2 pg/ml; p < 0.001; d = 0.80). Coronary VDR expression was inversely correlated with serum MCP-1 (p = 0.042). Additionally, the change of postmenopausal MCP-1 (from baseline to necropsy) was significantly reduced in the group with higher, compared to below the median, VDR expression (p = 0.038). The combination of plasma 25OHD3 and total plasma cholesterol/high-density lipoprotein cholesterol was subsequently broken into low-risk, moderate-risk and high-risk groups; as the risk increased, the VDR quantity decreased (p = 0.04). CAA was not associated with various atherogenic diets. CONCLUSION Coronary artery VDR expression was inversely correlated with markers of CAA risk and inflammation, including MCP-1, suggesting that systemic and perhaps local inflammation in the artery may be associated with reduced arterial VDR expression.
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Affiliation(s)
- M Nudy
- Heart and Vascular Institute, Division of Cardiology, Penn State College of Medicine, Hershey Medical Center, Hershey, PA, USA
| | - R Xie
- Department of ObGyn, Reading Hospital, Reading, PA, USA
| | | | - X Jiang
- Department of ObGyn, Reading Hospital, Reading, PA, USA
| | - S Appt
- Department of Pathology/Comparative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - T C Register
- Department of Pathology/Comparative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - J R Kaplan
- Department of Pathology/Comparative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - T B Clarkson
- Department of Pathology/Comparative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - P F Schnatz
- Department of ObGyn, Reading Hospital, Reading, PA, USA.,Internal Medicine, Reading Hospital, Reading, PA, USA.,Department of ObGyn, Sidney Kimmel Medical College - Thomas Jefferson University, Philadelphia, PA, USA.,Internal Medicine, Sidney Kimmel Medical College - Thomas Jefferson University, Philadelphia, PA, USA
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11
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Abstract
BACKGROUND Para taekwondo has only recently been added to the Paralympic games scheduled to be held in 2021; however, there is limited research on the classification of the para taekwondo athletes. This study aimed to provide details on the impairments and disabilities of the para taekwondo players. The secondary objective was to investigate the relationship between some of the proposed factors and the athletes' rankings. METHODS The data of 556 para taekwondo athletes (119 females and 437 males), who had been classified over the past 5 years, were analyzed. RESULTS The K44 class was the most popular, and 61% of the classified athletes belonged to this class. Acute injury from trauma was the most frequent cause of impairment, and 62.3% of all impairments/disabilities occurred during 0-5 years of age. Approximately 28% of the athletes had <1 year of training prior to international competitions. One-way analysis of variance performed for the combined length of the upper limbs showed significant differences (F<inf>(3,311)</inf>=455.78, P<0.001) among the K41-K44 classes. There were weak correlations (ρ<0.1) between the ranking and the age of the disability/impairment onset, combined length of the upper limbs, and type of disability. CONCLUSIONS Continued data collection that provides insights into the impairment profiles of para taekwondo athletes is needed to improve the current classification system in order to enhance the safety and fairness.
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Affiliation(s)
- Angelo Davalli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,FIFA Italian Taekwondo Federation, Rome, Italy
| | - David M O'Sullivan
- Division of Sport Science, Pusan National University, Busan, South Korea -
| | - Stefano Bella
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Hee-Seong Jeong
- Department of Physical Education, Yonsei University, Seoul, South Korea.,International Olympic Committee Research Center Korea, Seoul, South Korea
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12
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Papasavas P, Olugbile S, Wu U, Robinson K, Roberts AL, O'Sullivan DM, McLaughlin T, Mather JF, Steinberg AC, Orlando R, Kumar A. Seroprevalence of SARS-CoV-2 antibodies, associated epidemiological factors and antibody kinetics among healthcare workers in Connecticut. J Hosp Infect 2021; 114:117-125. [PMID: 33930487 PMCID: PMC8076763 DOI: 10.1016/j.jhin.2021.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Healthcare workers (HCWs) are at the front line of the ongoing coronavirus 2019 (COVID-19) pandemic. Comprehensive evaluation of the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) among HCWs in a large healthcare system could help to identify the impact of epidemiological factors and the presence of symptoms on the immune response to the infection over time. AIM To determine the seroprevalence of SARS-CoV-2-specific antibodies among HCWs, identify associated epidemiological factors and study antibody kinetics. METHODS A longitudinal evaluation of the seroprevalence and epidemiology of SARS-CoV-2-specific antibodies was undertaken in approximately 30,000 HCWs in the largest healthcare system in Connecticut, USA. FINDINGS At baseline, the prevalence of SARS-CoV-2 antibody among 6863 HCWs was 6.3% [95% confidence interval (CI) 5.7-6.9%], and was highest among patient care support (16.7%), medical assistants (9.1%) and nurses (8.2%), and lower for physicians (3.8%) and advanced practice providers (4.5%). Seroprevalence was significantly higher among African Americans [odds ratio (OR) 3.26 compared with Caucasians, 95% CI 1.77-5.99], in participants with at least one symptom of COVID-19 (OR 3.00, 95% CI 1.92-4.68), and in those reporting prior quarantine (OR 3.83, 95% CI 2.57-5.70). No symptoms were reported in 24% of seropositive participants. Among the 47% of participants who returned for a follow-up serological test, the seroreversion rate was 39.5% and the seroconversion rate was 2.2%. The incidence of re-infection in the seropositive group was zero. CONCLUSION Although there is a decline in the immunoglobulin G antibody signal over time, 60.5% of seropositive HCWs had maintained their seroconversion status after a median of 5.5 months.
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Affiliation(s)
- P Papasavas
- Department of Surgery, Hartford Hospital, Hartford, CT, USA.
| | - S Olugbile
- Cancer Institute, Hartford HealthCare, Hartford, CT, USA
| | - U Wu
- Administration, Hartford HealthCare, Hartford, CT, USA
| | - K Robinson
- Department of Emergency Medicine, Hartford Hospital, Hartford, CT, USA
| | - A L Roberts
- Department of Clinical Laboratory Services: Microbiology, Hartford HealthCare, Hartford, CT, USA
| | | | - T McLaughlin
- Department of Surgery, Hartford Hospital, Hartford, CT, USA
| | - J F Mather
- Hartford Healthcare Research Program, Hartford, CT, USA
| | - A C Steinberg
- Department of Medical Affairs, Hartford HealthCare, Hartford, CT, USA
| | - R Orlando
- Department of Academic Affairs, Hartford HealthCare, Hartford, CT, USA
| | - A Kumar
- Clinical Affairs, Hartford HealthCare, Hartford, CT, USA
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Marti K, Rochon C, O'Sullivan DM, Ye X, Ebcioglu Z, Kainkaryam PP, Kuzaro H, Morgan G, Serrano OK, Singh J, Tremaglio J, Kutzler HL. Evaluation of a multimodal analgesic regimen on outcomes following laparoscopic living donor nephrectomy. Clin Transplant 2021; 35:e14311. [PMID: 33829561 DOI: 10.1111/ctr.14311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
Postoperative pain is a significant source of morbidity in patients undergoing living donor nephrectomy (LDN) and a deterrent for candidates. We implemented a standardized multimodal analgesic regimen, which consists of pharmacist-led pre-procedure pain management education, a combination transversus abdominis plane and rectus sheath block performed by the regional anesthesia team, scheduled acetaminophen and gabapentin, and as-needed opioids. This single-center retrospective study evaluated outcomes between patients undergoing LDN who received a multimodal analgesic regimen and a historical cohort. The multimodal cohort had a significantly shorter length of stay (LOS) (days, mean ± SD: 1.8 ± 0.7 vs. 2.6 ± 0.8; p < .001) and a greater proportion who were discharged on postoperative day (POD) 1 (38.6% vs. 1.5%; p < .001). The total morphine milligram equivalents (MME) that patients received during hospitalization were significantly less in the multimodal cohort on POD 0-2. The outpatient MME prescribed through POD 60 was also significantly less in the multimodal cohort (median [IQR]; 180 [150-188] vs. 225 [150-300]; p < .001). The mean patient-reported pain score (PRPS) was significantly lower in the multimodal cohort on POD 0-2. The maximum PRPS was significantly lower on POD 0 (mean ± SD: 7 ± 2 vs. 8 ± 1, respectively; p = .02). This study suggests that our multimodal regimen significantly reduces LOS, PRPS, and opioid requirements and has the potential to improve the donation experience.
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Affiliation(s)
- Kristen Marti
- Department of Pharmacy Services, Hartford Hospital, Hartford, CT, USA
| | - Caroline Rochon
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | - David M O'Sullivan
- Department of Research Administration, Hartford HealthCare, Hartford, CT, USA
| | - Xiaoyi Ye
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | - Zeynep Ebcioglu
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | | | - Hillary Kuzaro
- Department of Pharmacy Services, Hartford Hospital, Hartford, CT, USA.,Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | - Glyn Morgan
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | - Oscar K Serrano
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | - Joseph Singh
- Department of Transplant, Hartford Hospital, Hartford, CT, USA
| | | | - Heather L Kutzler
- Department of Pharmacy Services, Hartford Hospital, Hartford, CT, USA.,Department of Transplant, Hartford Hospital, Hartford, CT, USA
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14
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Stamps H, Linder K, O'Sullivan DM, Serrano OK, Rochon C, Ebcioglu Z, Singh J, Ye X, Tremaglio J, Sheiner P, Cheema F, Kutzler HL. Evaluation of cytomegalovirus prophylaxis in low and intermediate risk kidney transplant recipients receiving lymphocyte-depleting induction. Transpl Infect Dis 2021; 23:e13573. [PMID: 33527728 DOI: 10.1111/tid.13573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/22/2020] [Accepted: 01/17/2021] [Indexed: 11/28/2022]
Abstract
Cytomegalovirus (CMV) is a significant cause of morbidity in kidney transplant recipients (KTR). Historically at our institution, KTR with low and intermediate CMV risk received 6 months of valganciclovir if they received lymphocyte depleting induction therapy. This study evaluates choice and duration of CMV prophylaxis based on donor (D) and recipient (R) CMV serostatus and the incidence of post-transplant CMV viremia in low (D-/R-) and intermediate (R+) risk KTR receiving lymphocyte-depleting induction therapy. A protocol utilizing valacyclovir for 3 months for D-/R- and valganciclovir for 3 months for R+ was evaluated. Adult D-/R- and R+ KTR receiving anti-thymocyte globulin, rabbit or alemtuzumab induction from 8/20/2016 to 9/30/2018 were evaluated through 1 year post-transplant. Patients were excluded if their CMV serostatus was D+/R-, received a multi-organ transplant, or received basiliximab. Seventy-seven subjects met the inclusion criteria: 25 D-/R- (4 historic group, 21 experimental group) and 52 R+ (31 historic, 21 experimental). No D-/R- patients experienced CMV viremia. Among the R+ historic and experimental groups, there was no significant difference in viremia incidence (35.5% vs 52.4%; P = .573). Of these cases, the peak viral load was similar between the groups (median [IQR], 67 [<200-444] vs <50 [<50-217]; P = .711), and there was no difference in the incidence of CMV syndrome (16.1% vs 14.3%; P = 1.000) or CMV related hospitalization (12.9% vs 14.3%; P = 1.000). No patient experienced tissue invasive disease. These results suggest limiting valganciclovir exposure may be possible in low and intermediate risk KTR receiving lymphocyte-depleting induction therapy with no apparent impact on CMV-related outcomes.
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Affiliation(s)
- Hillary Stamps
- Department of Pharmacy, Hartford Hospital, Hartford, CT, USA
| | - Kristin Linder
- Department of Pharmacy, Hartford Hospital, Hartford, CT, USA
| | - David M O'Sullivan
- Department of Research Administration, Hartford Healthcare, Hartford, CT, USA
| | - Oscar K Serrano
- Department of Transplant and Comprehensive Liver Center, Hartford Hospital, Hartford, CT, USA
| | - Caroline Rochon
- Department of Transplant and Comprehensive Liver Center, Hartford Hospital, Hartford, CT, USA
| | - Zeynep Ebcioglu
- Department of Transplant and Comprehensive Liver Center, Hartford Hospital, Hartford, CT, USA
| | - Joseph Singh
- Department of Transplant and Comprehensive Liver Center, Hartford Hospital, Hartford, CT, USA
| | - Xiaoyi Ye
- Department of Transplant and Comprehensive Liver Center, Hartford Hospital, Hartford, CT, USA
| | - Joseph Tremaglio
- Department of Transplant and Comprehensive Liver Center, Hartford Hospital, Hartford, CT, USA
| | - Patricia Sheiner
- Department of Transplant and Comprehensive Liver Center, Hartford Hospital, Hartford, CT, USA
| | - Faiqa Cheema
- Department of Transplant and Comprehensive Liver Center, Hartford Hospital, Hartford, CT, USA
| | - Heather L Kutzler
- Department of Pharmacy, Hartford Hospital, Hartford, CT, USA.,Department of Transplant and Comprehensive Liver Center, Hartford Hospital, Hartford, CT, USA
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15
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Young KP, Kolcz DL, O'Sullivan DM, Ferrand J, Fried J, Robinson K. Health Care Workers' Mental Health and Quality of Life During COVID-19: Results From a Mid-Pandemic, National Survey. Psychiatr Serv 2021; 72:122-128. [PMID: 33267652 DOI: 10.1176/appi.ps.202000424] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [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: 11/30/2022]
Abstract
OBJECTIVE The authors sought to quantify the rates of psychological distress among health care workers (HCWs) during the COVID-19 pandemic and to identify job-related and personal risk and protective factors. METHODS From April 1 to April 28, 2020, the authors conducted a national survey advertised via e-mail lists, social media, and direct e-mail. Participants were self-selecting, U.S.-based volunteers. Scores on the Patient Health Questionnaire-9, General Anxiety Disorder-7, Primary Care Posttraumatic Stress Disorder Screen, and Alcohol Use Disorders Identification Test-C were used. The relationships between personal resilience and risk factors, work culture and stressors and supports, and COVID-19-related events were examined. RESULTS Of 1,685 participants (76% female, 88% White), 31% (404 of 1,311) endorsed mild anxiety, and 33% (427 of 1,311) clinically meaningful anxiety; 29% (393 of 1,341) reported mild depressive symptoms, and 17% (233 of 1,341) moderate to severe depressive symptoms; 5% (64 of 1,326) endorsed suicidal ideation; and 14% (184 of 1,300) screened positive for posttraumatic stress disorder. Pediatric HCWs reported greater anxiety than did others. HCWs' mental health history increased risk for anxiety (odds ratio [OR]=2.78, 95% confidence interval [CI]=2.09-3.70) and depression (OR=3.49, 95% CI=2.47-4.94), as did barriers to working, which were associated with moderate to severe anxiety (OR=2.50, 95% CI=1.80-3.48) and moderate depressive symptoms (OR=2.15, 95% CI=1.45-3.21) (p<0.001 for all comparisons). CONCLUSIONS Nearly half of the HCWs reported serious psychiatric symptoms, including suicidal ideation, during the COVID-19 pandemic. Perceived workplace culture and supports contributed to symptom severity, as did personal factors.
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Affiliation(s)
- Kevin P Young
- Psychological Testing Service (Young), Department of Neuropsychology (Kolcz), and Department of Health Psychology (Ferrand), Hartford Hospital's Institute of Living, Hartford, Connecticut; Department of Psychiatry (Young) and Department of Trauma and Emergency Medicine (Robinson), University of Connecticut School of Medicine, Farmington; Department of Research Administration, Hartford HealthCare, Hartford (O'Sullivan); Emergency Department, Midstate Medical Center, Meriden, Connecticut (Fried); Department of Emergency Medicine, Hartford Hospital, Hartford (Robinson)
| | - Diana L Kolcz
- Psychological Testing Service (Young), Department of Neuropsychology (Kolcz), and Department of Health Psychology (Ferrand), Hartford Hospital's Institute of Living, Hartford, Connecticut; Department of Psychiatry (Young) and Department of Trauma and Emergency Medicine (Robinson), University of Connecticut School of Medicine, Farmington; Department of Research Administration, Hartford HealthCare, Hartford (O'Sullivan); Emergency Department, Midstate Medical Center, Meriden, Connecticut (Fried); Department of Emergency Medicine, Hartford Hospital, Hartford (Robinson)
| | - David M O'Sullivan
- Psychological Testing Service (Young), Department of Neuropsychology (Kolcz), and Department of Health Psychology (Ferrand), Hartford Hospital's Institute of Living, Hartford, Connecticut; Department of Psychiatry (Young) and Department of Trauma and Emergency Medicine (Robinson), University of Connecticut School of Medicine, Farmington; Department of Research Administration, Hartford HealthCare, Hartford (O'Sullivan); Emergency Department, Midstate Medical Center, Meriden, Connecticut (Fried); Department of Emergency Medicine, Hartford Hospital, Hartford (Robinson)
| | - Jennifer Ferrand
- Psychological Testing Service (Young), Department of Neuropsychology (Kolcz), and Department of Health Psychology (Ferrand), Hartford Hospital's Institute of Living, Hartford, Connecticut; Department of Psychiatry (Young) and Department of Trauma and Emergency Medicine (Robinson), University of Connecticut School of Medicine, Farmington; Department of Research Administration, Hartford HealthCare, Hartford (O'Sullivan); Emergency Department, Midstate Medical Center, Meriden, Connecticut (Fried); Department of Emergency Medicine, Hartford Hospital, Hartford (Robinson)
| | - Jeremy Fried
- Psychological Testing Service (Young), Department of Neuropsychology (Kolcz), and Department of Health Psychology (Ferrand), Hartford Hospital's Institute of Living, Hartford, Connecticut; Department of Psychiatry (Young) and Department of Trauma and Emergency Medicine (Robinson), University of Connecticut School of Medicine, Farmington; Department of Research Administration, Hartford HealthCare, Hartford (O'Sullivan); Emergency Department, Midstate Medical Center, Meriden, Connecticut (Fried); Department of Emergency Medicine, Hartford Hospital, Hartford (Robinson)
| | - Kenneth Robinson
- Psychological Testing Service (Young), Department of Neuropsychology (Kolcz), and Department of Health Psychology (Ferrand), Hartford Hospital's Institute of Living, Hartford, Connecticut; Department of Psychiatry (Young) and Department of Trauma and Emergency Medicine (Robinson), University of Connecticut School of Medicine, Farmington; Department of Research Administration, Hartford HealthCare, Hartford (O'Sullivan); Emergency Department, Midstate Medical Center, Meriden, Connecticut (Fried); Department of Emergency Medicine, Hartford Hospital, Hartford (Robinson)
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16
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Conner CM, Perucki WH, Gabriel A, O'Sullivan DM, Fernandez AB. Heart Rate and Neurological Outcomes in Patients Undergoing Targeted Temperature Management. J Intensive Care Med 2020; 36:1392-1397. [PMID: 33380239 DOI: 10.1177/0885066620982502] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is a paucity of data evaluating the impact of heart rate (HR) during Targeted Temperature Management (TTM) and neurologic outcomes. Current resuscitation guidelines do not specify a HR goal during TTM. We sought to determine the relationship between HR and neurologic outcomes in a single-center registry dataset. METHODS We retrospectively studied 432 consecutive patients who completed TTM (33°C) after cardiac arrest from 2008 to 2017. We evaluated the relationship between neurologic outcomes and HR during TTM. Pittsburgh Cerebral Performance Categories (CPC) at discharge were used to determine neurological recovery. Statistical analysis included chi square, Student's t-test and Mann-Whitney U. A logistic regression model was created to evaluate the strength of contribution of selected variables on the outcome of interest. RESULTS Approximately 94,000 HR data points from 432 patients were retrospectively analyzed; the mean HR was 82.17 bpm over the duration of TTM. Favorable neurological outcomes were seen in 160 (37%) patients. The mean HR in the patients with a favorable outcome was lower than the mean HR of those with an unfavorable outcome (79.98 bpm vs 85.67 bpm p < 0.001). Patients with an average HR of 60-91 bpm were 2.4 times more likely to have a favorable neurological outcome compared to than HR's < 60 or > 91 (odds ratio [OR] = 2.36, 95% confidence interval [CI] 1.61-3.46, p < 0.001). Specifically, mean HR's in the 73-82 bpm range had the greatest rate of favorable outcomes (OR 3.56, 95% CI 1.95-6.50), p < 0.001. Administration of epinephrine, a history of diabetes mellitus and hypertension all were associated with worse neurological outcomes independent of HR. CONCLUSION During TTM, mean HRs between 60-91 showed a positive association with favorable outcomes. It is unclear whether a specific HR should be targeted during TTM or if heart rates between 60-91 bpm might be a sign of less neurological damage.
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Affiliation(s)
- Chad M Conner
- University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Andre Gabriel
- University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Antonio B Fernandez
- University of Connecticut School of Medicine, Farmington, CT, USA.,Division of Cardiology, Hartford Hospital, Hartford, CT, USA
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17
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Ali MI, Cunningham A, O'Sullivan DM, Kutzler HL, Rochon C, Reginald Morgan G, Ann Sheiner P, Serrano OK. Outcomes for Hispanics after Liver Transplantation are Comparable to Non-Hispanic Whites, Despite a Greater Burden of Disease: Parsing the Hispanic Paradox. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Ramaseshan AS, O'Sullivan DM, Steinberg AC, Tunitsky-Bitton E. A comprehensive model for pain management in patients undergoing pelvic reconstructive surgery: a prospective clinical practice study. Am J Obstet Gynecol 2020; 223:262.e1-262.e8. [PMID: 32413429 DOI: 10.1016/j.ajog.2020.05.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/30/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative opioid prescription patterns play a key role in driving the opioid epidemic. A comprehensive system toward pain management in surgical patients is necessary to minimize overall opioid consumption. OBJECTIVE This study aimed to evaluate the efficacy of a pain management model in patients undergoing pelvic reconstructive surgery by measuring postdischarge narcotic use in morphine milligram equivalents. STUDY DESIGN This is a prospective clinical practice study that included women undergoing inpatient pelvic reconstructive surgery from December 2018 to June 2019 with overnight stay after surgery. As a routine protocol, all the patients followed an enhanced recovery after surgery protocol that included a preoperative multimodal pain regimen. Brief Pain Inventory surveys were collected preoperatively and on postoperative day 1. Brief pain inventory and activities assessment scale scores were collected at postoperative week 1 and postoperative weeks 4-6 after surgery. Patients were discharged with 15 tablets of an oral narcotic using an electronic prescription for controlled substances software platform, which is mandated in the state of Connecticut for all controlled substances, prescriptions, and refills. Patients were called at postoperative week 1 and postoperative weeks 4-6 to answer questions regarding their pain, the number of remaining narcotic tablets, and patient satisfaction regarding pain management. Patient electronic medical records and the Connecticut Prescription Monitoring and Reporting System were reviewed to determine whether patients received narcotic refills. Primary outcome was postdischarge narcotic use measured in morphine milligram equivalents. Secondary outcomes evaluated refill rate, brief pain inventory and activities assessment scale scores, and patient satisfaction with pain management. Descriptive statistics were described as mean and standard deviation and median and interquartile range. Bivariate comparisons used Spearman's rho (ρ) with α=0.05. RESULTS A total 113 patients were enrolled; the median (interquartile range) morphine milligram equivalent prescribed (including refills) was 112.5 (112.5-112.5). The median postdischarge narcotic use was 24.0 (0-82.5) morphine milligram equivalent, which is equivalent to fewer than 4 oxycodone (5 mg) tablets. About 75% of our participants required fewer than 11 oxycodone tablets. The median unused morphine milligram equivalent was 90.0 (45-112.5). 81.4% (92/113), and 83.2% (94/113) of patients at postoperative week 1 and postoperative weeks 4-6, respectively, reported being satisfied or extremely satisfied with their postdischarge pain control. About 88.5% (100/113) of patients felt that the number of opioids they were discharged with was sufficient for their pain needs at the postoperative 1 and postoperative weeks 4-6 time points. At postoperative weeks 4-6, 19.5% of patients said that they filled the narcotic prescription but did not use any of the pills. The overall refill rate was 10.6% (12/113). All patients who needed a refill described the refill process as easy. In-hospital narcotic use was not predictive of postdischarge narcotic use (ρ0.065, P=.495). Patients reported median brief pain inventory scores for "average pain" of 0 (no pain) at postoperative week 1 and postoperative weeks 4-6; however, the scores did not clinically correlate with postdischarge narcotic use. Activities assessment scale scores were not correlated with postdischarge narcotic use. CONCLUSION Most patients after pelvic reconstructive surgery used fewer than 11 oxycodone (5 mg) tablets, averaging less than 4 tablets, with a third of patients not requiring any opioids. Pain and activities scores did not correlate with narcotic use. A minimal number of opioids can be prescribed because the secure electronic prescribing system allows for convenient electronic refill if required. Our practical and comprehensive pre- and postoperative protocol for pain management minimizes opioid consumption in addition to maximizing patient satisfaction.
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Affiliation(s)
- Aparna S Ramaseshan
- Division of Female Pelvic Medicine and Reconstructive Surgery, Hartford Hospital, Hartford, CT.
| | - David M O'Sullivan
- Department of Research Administration, Hartford Healthcare, Hartford, CT
| | - Adam C Steinberg
- Division of Female Pelvic Medicine and Reconstructive Surgery, Hartford Hospital, Hartford, CT
| | - Elena Tunitsky-Bitton
- Division of Female Pelvic Medicine and Reconstructive Surgery, Hartford Hospital, Hartford, CT
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19
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Abstract
OBJECTIVE To evaluate the influence of pessary visit intervals on development of vaginal epithelial abnormalities. METHODS We conducted a randomized, noninferiority trial of office-based pessary care. Eligible participants were adult women wearing a ring, Gellhorn, or incontinence dish pessary to treat pelvic organ prolapse or incontinence or both. Patients were randomized 1:1 to routine pessary care (office visits every 12 weeks, "routine" arm) or to extended pessary care (office visits every 24 weeks, "extended" arm). The primary study outcome was rate of vaginal epithelial abnormalities (epithelial break or erosion) at the final study visit (48 weeks). The predetermined noninferiority margin was 7.5%. RESULTS From January 2015 through June 2017, inclusive, 448 patients were screened and 130 were randomized, 64 to the routine arm and 66 to the extended arm. Baseline characteristics of the study arms were similar with the exception of pessary type, with ring pessary more common in the routine arm and Gellhorn pessary more common in the extended arm (P=.02). The rate of epithelial abnormalities at the final study visit (48 weeks) was 7.4% in the routine arm and 1.7% in the extended arm (difference, -5.7 percentage points; 95% CI -7.4 to -4), which met the criterion for noninferiority. Rates of all types of epithelial abnormalities did not differ between arms at any time point. Increasing duration of pessary use (P=.003) and history of prior epithelial abnormalities were associated with development of epithelial abnormalities (P=.01). Other than epithelial abnormalities, no adverse events related to pessary use occurred in either arm. CONCLUSION In women who receive office-based pessary care and are using a ring, Gellhorn, or incontinence dish pessary, routine follow-up every 24 weeks is noninferior to every 12 weeks based on incidence of vaginal epithelial abnormalities. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02371083.
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Affiliation(s)
- Katie Propst
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, Hartford Hospital, and the Department of Research Administration, Hartford Healthcare, Hartford, Connecticut
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20
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Zeiner AL, Burak MA, O'Sullivan DM, Laskey D. Effect of a Law Requiring Prescription Drug Monitoring Program Use on Emergency Department Opioid Prescribing: A Single-Center Analysis. J Pharm Pract 2020; 34:774-779. [PMID: 32295459 DOI: 10.1177/0897190020918096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare opioid prescribing behavior of emergency medicine providers following the enactment of Connecticut Public Act (PA) 15-198 at a large academic tertiary medical center. METHODS This study is a single-center pre and postlaw retrospective cohort of ED patients discharged with opioid prescriptions. Patients discharged from January 1, 2015, to June 30, 2015, were analyzed as the prelaw cohort, and patients discharged from January 1, 2016, to June 30, 2016, were analyzed as the postlaw cohort. The primary outcome was the cumulative dose of solid dosage forms of opioids per prescription, calculated in morphine milligram equivalents (MME). RESULTS A total of 10,307 prescriptions included in the final analysis. A statistically significant decrease in the primary outcome was seen in the postlaw cohort compared with the prelaw cohort, respectively (75 MME [interquartile range, IQR: 60-100) vs 80 MME [IQR: 75-150]; P < .001). The postlaw cohort also saw 1289 (22.2%) fewer opioid prescriptions, primarily driven by a reduction in the number of schedule II opioids prescribed. In a posthoc analysis, the primary outcome remained statistically significant even when opioid prescriptions were only included if their prebuilt settings were unchanged between pre and postlaw cohorts, respectively (85.1%; 95.6 MME (±56.0); n = 5041 vs 86.7 MME (±39.6); n = 3713; P < .001). CONCLUSIONS The passage of PA 15-198 was associated with a decrease in the cumulative dose of opioids per prescription of solid dosage form products. This drop was precipitated by a transition from using opioids in schedule II to opioids in schedule IV and a modest decrease in prescribed opioid quantity.
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Affiliation(s)
- Abigail L Zeiner
- Department of Pharmacy Services, Hartford Hospital, CT, USA.,University of Connecticut, School of Pharmacy, Storrs, CT, USA
| | - Michelle A Burak
- Department of Pharmacy Services, Hartford Hospital, CT, USA.,University of Connecticut, School of Pharmacy, Storrs, CT, USA
| | | | - Dayne Laskey
- Department of Pharmacy Services, Hartford Hospital, CT, USA.,University of Saint Joseph, School of Pharmacy, Hartford, CT, USA
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21
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Tong K, Nolan W, O'Sullivan DM, Sheiner P, Kutzler HL. Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation. Pharmacotherapy 2019; 39:975-982. [PMID: 31446626 DOI: 10.1002/phar.2322] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE Nonopioid strategies to optimize pain management in patients after liver transplantation remain underexplored. The purpose of this study was to evaluate whether the use of a multimodal pain management (MPM) order set would reduce postoperative opioid use in adult patients after liver transplantation. DESIGN Retrospective pre- and post-order set implementation study. SETTING Large academic tertiary care hospital. PATIENTS Thirty-one adults who underwent liver transplantation were included; of these, 18 received provider-managed pain regimens (pre-MPM group: August 20, 2016-January 17, 2018), and 13 received the MPM order set (post-MPM group: January 18-July 31, 2018) after implementation of the order set on January 18, 2018. MEASUREMENTS AND MAIN RESULTS The MPM order set included standardized receipt of acetaminophen 650 mg every 6 hours, gabapentin 300 mg every 8 hours (adjusted for renal function), and opioids for breakthrough pain. Patients managed with the MPM order set received, on average, 30.6 fewer opioid morphine milligram equivalents per day after final extubation than patients who did not receive MPM (median 16, interquartile range [IQR] 4.5-45.6 vs median 46.6, IQR 30.1-75.2; Mann-Whitney U test, p=0.031). Although patients in the post-MPM group had significantly worse renal function at baseline, no other statistically significant differences in baseline characteristics, pain scores, or prescribed outpatient opioids were noted between groups. Patients in the pre-MPM group had a shorter intensive care unit and overall length of stay; however, patients in the post-MPM group may have had more complex postoperative courses contributing to these differences. CONCLUSION Implementation of the MPM order set significantly reduced postoperative opioid use in liver transplant recipients. Our results provide a compelling rationale to further investigate the use of a non-opioid-centered strategy to optimize pain management in patients recovering from liver transplantation, a population vulnerable to the risks of opioid use such as opioid use disorder, increased susceptibility to adverse effects, and poor allograft and survival outcomes.
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Affiliation(s)
- Kimhouy Tong
- Department of Pharmacy Services, Hartford Hospital, Hartford, Connecticut
| | - William Nolan
- Department of Pharmacy Services, Hartford Hospital, Hartford, Connecticut
| | - David M O'Sullivan
- Department of Research Administration, Hartford HealthCare, Hartford, Connecticut
| | - Patricia Sheiner
- Department of Transplant, Hartford Hospital, Hartford, Connecticut
| | - Heather L Kutzler
- Department of Pharmacy Services, Hartford Hospital, Hartford, Connecticut.,Department of Transplant, Hartford Hospital, Hartford, Connecticut
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22
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Kumar A, Tandon V, O'Sullivan DM, Cronin E, Gluck J, Kluger J. ICD shocks in LVAD patients are not associated with increased subsequent mortality risk. J Interv Card Electrophysiol 2019; 56:341-348. [PMID: 31506872 DOI: 10.1007/s10840-019-00619-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/31/2019] [Accepted: 08/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) shocks are associated with increased mortality risk in heart failure patients. Whether ICD shocks are associated with mortality in continuous flow LVAD (CF-LVAD) patients is unknown. We studied the relationship of ICD shocks and ventricular arrhythmias (VAs) to morbidity and mortality in CF-LVAD-supported patients in our institution. METHODS Single-center, retrospective study of prospectively collected ICD and LVAD databases. We analyzed data on VA which received ICD therapy in patients who underwent CF-LVAD implantation at Hartford Hospital between 2008 and 2018. RESULTS A total of 157 patients were studied. During a median follow-up of 10 months (interquartile range 5-20 months), 48 patients (30.6%) experienced post-LVAD sustained VA. Thirty patients (19.1%) had appropriate shocks for VA and 5 patients (3.1%) had inappropriate shocks. Shocks for any arrhythmia were not associated with an increased risk of death (OR 0.836, 95% CI 0.224-3.115, p = 0.789). Neither post-LVAD VA nor the rate of VA was associated with an increased mortality risk (OR 0.662 [0.329-1.334], p = 0.248; OR 1.001 [0.989-1.014], p = 0.817, respectively). Cox multivariate regression analysis revealed pre-LVAD VA as a significant predictor of VA post LVAD implantation (OR 3.284 [1.584-6.808], p = 0.001). Symptoms with VA occurred in 22 (45.8%) patients, ranging from palpitations to near syncope/syncope. None of the variables including the rate of VA was associated with death or symptoms. CONCLUSIONS VAs are common in CF-LVAD patients and occur with higher frequency in those with pre-LVAD VA and frequently cause symptoms. Neither VA nor ICD shocks are associated with mortality risk.
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Affiliation(s)
- Aswini Kumar
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA. .,Department of Medicine, University of Connecticut, Farmington, CT, USA.
| | - Varun Tandon
- Department of Medicine, University of Connecticut, Farmington, CT, USA
| | - David M O'Sullivan
- Department of Research Administration, Hartford HealthCare, Hartford, CT, USA
| | - Edmond Cronin
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| | - Jason Gluck
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| | - Jeffrey Kluger
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
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Bartels CB, Ditrio L, Grow DR, O'Sullivan DM, Benadiva CA, Engmann L, Nulsen JC. The window is wide: flexible timing for vitrified–warmed embryo transfer in natural cycles. Reprod Biomed Online 2019; 39:241-248. [DOI: 10.1016/j.rbmo.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/08/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
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Propst K, O'Sullivan DM, Ulrich A, Tunitsky-Bitton E. Informed Consent Education in Obstetrics and Gynecology: A Survey Study. J Surg Educ 2019; 76:1146-1152. [PMID: 30611700 DOI: 10.1016/j.jsurg.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/21/2018] [Accepted: 12/09/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The practice of obstetrics and gynecology poses specific ethical challenges for informed consent (IC). Data regarding resident confidence with the IC process are lacking. Our objective was to evaluate obstetrics and gynecology residents' education, experience, and confidence related to IC. DESIGN This was a cross-sectional survey of obstetrics and gynecology residents. Descriptive analyses were performed using mean and standard deviation or frequency expressed as a percentage. The results were analyzed for statistical significance using chi-square or Fisher's exact tests for categorical variables and Student t or Mann-Whitney U tests, as appropriate, for continuous variables; all results yielding p < 0.05 were deemed statistically significant. SETTING Electronic survey. RESULTS Two hundred eighty-one trainees completed the survey. The majority of participants were female (84.3%) and from an academic training program (65.1%). Two hundred seventy-seven trainees (98.6%) reported that they had obtained IC for operating room procedures; the majority had first done this in the first postgraduate year (PGY) (n = 258, 91.8%). Trainees most commonly obtain IC for resident and general gynecology attending cases. Most trainees primarily learn how to obtain IC via observation of their coresidents and attendings. Nearly 90% of trainees have obtained IC for a procedure for which they were unsure of all the risks. One hundred seventy-three trainees (61.6%) reported that they would like to have more training in IC. Increasing PGY was significantly associated with increasing confidence in obtaining IC for gynecologic, obstetric, and office procedures (all p < 0.01). There were no differences based on PGY in frequency of reviewing who will perform the surgical procedure (p = 0.75), how trainees will be involved in the procedure (p = 0.35), review of alternative treatments (p = 0.91), or in documentation of the IC process (p = 0.16). CONCLUSIONS Based on the findings of this survey study, education related to the IC process is warranted and curriculum development should be the focus of future study.
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Affiliation(s)
- Katie Propst
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, Hartford Hospital, Hartford, Connecticut.
| | | | - Amanda Ulrich
- Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut
| | - Elena Tunitsky-Bitton
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, Hartford Hospital, Hartford, Connecticut
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Elsaid O, O'Sullivan DM, Zweibel S, Cronin EM. Total laser cycles-a measure of transvenous lead extraction difficulty. J Interv Card Electrophysiol 2018; 53:383-389. [PMID: 30117011 DOI: 10.1007/s10840-018-0422-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several variables have been identified as predictors for difficult or complicated transvenous lead extraction (TLE), including age and number of implanted leads, as well as patient's age; however, a standard measure of TLE difficulty has not been described. OBJECTIVE Total laser cycles (TLCs) delivered during laser-assisted TLE is an objective variable that could reflect the difficulty of TLE. This study investigated whether TLC is correlated with known predictors of difficult TLE. METHODS In a retrospective study of TLE procedures using the laser sheath, we analyzed TLC delivered and compared it to established predictors of procedural failure and complications. RESULTS Of 166 patients undergoing TLE, the laser sheath (SLS II or Glidelight, Spectranetics Inc.,) was used as the primary extraction sheath in 130 patients, and 100 patients had complete TLC data available. The mean age of the oldest lead (AOL) was 7.1 ± 3.2 years with a median of 6.91 (interquartile range [IQR] 0.48-16.69) years, and 1.6 ± 0.7 leads (range, 1-4) were extracted per procedure. Two thirds of procedures involved ICD leads. Clinical success was 99%, with one patient (1%) experiencing a major complication. Median TLC delivered was 1165 (IQR, 567-2062; range, 49-9522). TLC was positively correlated with AOL (r = 0.227, p = 0.023), and the combined age of leads was extracted (r = 0.307, p = 0.002). TLC was also positively correlated with number of leads extracted per procedure (ρ = 0.227, p = 0.024). There was a non-significant negative trend towards correlation between TLC and patient's age (r = -0.112, p = 0.268). CONCLUSION TLC showed significant correlation with known predictors of difficulty during TLE using the laser sheath. TLC is an objective method to report the difficulty of TLE and could usefully be reported in future series of laser lead extractions.
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Affiliation(s)
- Ossama Elsaid
- Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA.
| | | | - Steven Zweibel
- Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Edmond M Cronin
- Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
- University of Connecticut School of Medicine, Farmington, CT, USA
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Jiang X, Asmaro R, O'Sullivan DM, Modi J, Budnik E, Schnatz PF. Depression may be a risk factor for coronary heart disease in midlife women <65 years: A 9-year prospective cohort study. Int J Cardiol 2018; 271:8-12. [PMID: 29880298 DOI: 10.1016/j.ijcard.2018.05.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/26/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Depression has been suggested as a risk factor for coronary heart disease (CHD). However, whether the risk may be affected by age is unknown. We seek to assess the difference in long-term CHD risk between younger (<65) and older (≥65) women with depressive symptoms. METHODS Between June and August 2004, 1995 women presenting for routine mammography were enrolled to the primary study on breast arterial calcification. In 2005 (year 2), each woman completed a validated depression screening questionnaire. A similar questionnaire was mailed to each participant at year 4, 5, and 10 to obtain follow-up data (demographic and CHD risk factors) and record any change in CHD status. RESULTS Of 1084 women who returned surveys at year 10, 998 had no history of CHD and answered depression screening questions at year 2 as well as questions about CHD events at year 10. Of 185 out of 998 (18.5%) who had positive depression screening at year 2, 24 (13.0%) developed ≥1 CHD events by year 10, which is significantly higher than the incidence of 6.5% (53/813) in control group (p < 0.001). With CHD risk factors including age adjusted in a logistic regression model, depression was the only significant predictive factor for CHD in women aged <65 (OR = 6.56, 95% CI 1.07-40.09, p = 0.042). However, in women aged ≥65, age was the only significant predictive factor for CHD. CONCLUSION A history of depression may increase the risk of CHD over 9 years of follow-up, and more prominently in midlife women aged <65 years.
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Affiliation(s)
- Xuezhi Jiang
- Department of ObGyn, The Reading Hospital of Tower Health, Reading, PA, United States; Departments of ObGyn, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States.
| | - Ragad Asmaro
- Drexel College of Medicine, Depart of Internal Medicine, Philadelphia, PA, United States
| | - David M O'Sullivan
- Department of ObGyn, The Reading Hospital of Tower Health, Reading, PA, United States
| | - Jaymin Modi
- The Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States
| | - Elizabeth Budnik
- The Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States
| | - Peter F Schnatz
- Department of ObGyn, The Reading Hospital of Tower Health, Reading, PA, United States; Internal Medicine, The Reading Hospital of Tower Health, Reading, PA, United States; Departments of ObGyn, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States; Internal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
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Perucki WH, Hiendlmayr B, O'Sullivan DM, Gunaseelan AC, Fayas F, Fernandez AB. Magnesium Levels and Neurologic Outcomes in Patients Undergoing Therapeutic Hypothermia After Cardiac Arrest. Ther Hypothermia Temp Manag 2018; 8:14-17. [DOI: 10.1089/ther.2017.0016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- William H. Perucki
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Brett Hiendlmayr
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | | | | | - Farruk Fayas
- Aureus University School of Medicine, Noord, Aruba
| | - Antonio B. Fernandez
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
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Theze SA, O'Sullivan DM, O'Sullivan ED. Conversion of renal abstracts to papers: Published or perished? Nephrology (Carlton) 2018; 23:193-194. [PMID: 29346844 DOI: 10.1111/nep.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - E D O'Sullivan
- Department of Renal Medicine, Royal Infirmary or Edinburgh, UK
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Reagan KML, O'Sullivan DM, Gannon R, Steinberg AC. Decreasing postoperative narcotics in reconstructive pelvic surgery: a randomized controlled trial. Am J Obstet Gynecol 2017; 217:325.e1-325.e10. [PMID: 28551445 DOI: 10.1016/j.ajog.2017.05.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Postoperative pain control is crucial to any successful recovery plan. Many currently used medication regimens are narcotic-focused. OBJECTIVE The objective of our study was to evaluate the efficacy of a multimodal pain regimen after pelvic reconstructive surgery. STUDY DESIGN The primary outcome measure was narcotic use. Secondary outcomes included pain, nausea, and constipation. Patients were randomized to either usual care postoperative treatment or multimodal pain regimen. Usual care included no specific preoperative or intraoperative medications, and postoperative narcotics with ibuprofen. Multimodal pain regimen included preoperative and postoperative celecoxib, gabapentin, intraoperative and postoperative intravenous and oral acetaminophen and ibuprofen, and narcotics as needed. All narcotics were converted to milligram equivalents of oral morphine for standardization according to Centers for Disease Control and Prevention guidelines where conversion factors for oral hydrocodone = 1, oral oxycodone = 1.5, and oral hydromorphone = 4. Patients were given the validated Brief Pain Inventory survey preoperatively (baseline), at postoperative day 1, and 1 week postoperatively. At 1 week, bowel function and narcotics usage was assessed. RESULTS Seventy patients were randomized to the usual care arm and 68 to the multimodal pain regimen arm. Patients in the multimodal pain regimen arm used significantly fewer intravenous narcotics in the operating room (90.7 ± 39.1 mg vs 104.6 ± 33.5 mg; P = .026) and while in the hospital (10.8 ± 15.1 mg vs 31.2 ± 29.6 mg; P < .001) and were more likely to use 0 oral narcotics after discharge to home (34.8% of patients vs 10.6%; P = .001). Of the patients who did use oral narcotics after discharge to home, there was no difference in amount used between groups (121.3 ± 103.7 mg in the multimodal pain regimen arm vs 153.0 ± 113.8 mg in the usual care arm; P = .139). Total narcotic usage (operating room + hospital + home) was significantly less in the multimodal pain regimen arm of the study (195.5 ± 147.2 mg vs 304.0 ± 162.1 mg; P < .001). There were no significant differences in pain scores between the 2 arms of the study on either postoperative time point. There were no significant differences in antiemetic use while in hospital, consistency of first bowel movement, length of stay, or number of telephone calls to nurses in first 3 weeks postoperatively. CONCLUSION A multimodal pain regimen in pelvic reconstructive surgery was found to decrease postoperative opioid requirements, while providing equivalent pain control.
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Affiliation(s)
| | | | - Richard Gannon
- Department of Pharmacy Services, Hartford Hospital, Hartford, CT
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Abstract
OBJECTIVE The purpose of this study was to monitor head impact magnitude and characteristics, such as impact location and frequency, at high school taekwondo sparring sessions. METHODS Eight male high school taekwondo athletes participated in this study. The head impact characteristics were recorded by X-Patch, a wireless accelerometer and gyroscope, during 6 taekwondo sparring sessions. The outcome measures were the peak linear acceleration ( g = 9.81 msec2), peak rotational acceleration, rotational velocity, and Head Injury Criterion. RESULTS A total of 689 impacts occurred over 6 sessions involving the 8 athletes. There was an average of 24 impacts per 100 minutes, and there were significant differences in the frequency of impacts among both the sessions and individual athletes. In order of frequency, the most commonly hit locations were the side (38.2%), back (35.7%), and front (23.8%) of the head. CONCLUSIONS The data indicate that there is a relatively high number of head impacts experienced by taekwondo athletes during sparring practice. According to the rotational acceleration predicting impact severity published in previous research, 17.1% of the impacts were deemed to be a moderate and 15.5% were deemed to be severe.
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Affiliation(s)
- David M O'Sullivan
- Department of Sports Science, Pusan National University, Busan, Republic of Korea; and
| | - Gabriel P Fife
- Department of Health and Human Performance, Texas State University, San Marcos, Texas
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Propst K, Butler H, O'Sullivan DM, Tunitsky Bitton E. Peripheral Tibial Nerve Stimulation for Overactive Bladder Syndrome: Treatment Success and Patient Satisfaction. Conn Med 2017; 81:209-213. [PMID: 29714405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the success rate and patient satisfaction ofperipheral tibial nerve stimulation (PTNS) therapy. METHOD Retrospective cohort study assessing PTNS treatment success and patient satisfaction. RESULTS Data from 34 women were included. On average, patients were 70.2 (± 12) years of age, had a BMI of 29.9 (± 8.9) kg/M², and traveled 11.2 (± 12.3) miles to receive weekly PTNS treatments. Overall, 22 patients (64.7%) were satisfied, four (11.8%) unsatisfied, and eight (23.5%) undecided. Those who were satisfied completed an average of 10.9 treatments (± 2.4), those who were unsatisfied completed an average of 9.5 treatments (± 2.6), and those left undecided completed an average of 7.2 treatments (± 4.3). The fourth treatment visit was the most likely to predict whether a patient would be satisfied or unsatisfied by the 12th treatment. CONCLUSION Overall the success of the PTNS therapy was 64.7%, consistent with previous studies. Most patients note improvement after the fourth treatment.
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Ross AL, O'Sullivan DM, Drescher MJ, Krawczynski MA. Comparison of Weight-Based Dose vs. Standard Dose Diltiazem in Patients with Atrial Fibrillation Presenting to the Emergency Department. J Emerg Med 2016. [PMID: 27452987 DOI: 10.1016/j.jemermed.2016.05.036.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite evidence-based recommended weight-based (WB) dosing of diltiazem for the initial treatment of atrial fibrillation (AF) with rapid ventricular response (RVR), many providers utilize lower initial doses of diltiazem. OBJECTIVE We sought to determine whether a low, standard dose of diltiazem is noninferior to WB diltiazem as an initial bolus dose in the treatment of AF with RVR. METHODS This retrospective review included patients who presented to the emergency department (ED) of an urban, academic tertiary medical center experiencing AF with RVR from November 2010 to August 2014. Adult patients were categorized by the dose of diltiazem received; 10 mg standard dose or 0.2-0.3 mg/kg WB dose. The primary outcome of successful treatment was defined as a composite of the following parameters 15 min after the initial bolus dose: heart rate (HR) < 100 beats/min, reduction of HR ≥ 20%, or a conversion to normal sinus rhythm. RESULTS Four hundred and fifty-six patients who received diltiazem were included for study evaluation (standard dose: n = 255 patients, WB: n = 201 patients). Baseline characteristics, medical history, and medication use before ED presentation were similar between the groups. Significant differences at baseline between the groups included weight and HR at presentation. The primary outcome of successful treatment was attained in 60.8% of the standard dose patients and 68.7% of the WB patients (p = 0.082). CONCLUSIONS In patients presenting to the ED, we found that standard dose diltiazem was noninferior to WB dosing in the initial treatment of AF with RVR.
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Affiliation(s)
- Adam L Ross
- Department of Pharmacy Services, Hartford, Connecticut
| | - David M O'Sullivan
- Department of Research Administration, Hartford Hospital, Hartford, Connecticut
| | - Michael J Drescher
- Department of Emergency Medicine, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut
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Lingenfelter BM, Jiang X, Schnatz PF, O'Sullivan DM, Minassian SS, Forstein DA. CREOG In-Training Examination Results: Contemporary Use to Predict ABOG Written Examination Outcomes. J Grad Med Educ 2016; 8:353-7. [PMID: 27413437 PMCID: PMC4936852 DOI: 10.4300/jgme-d-15-00408.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The in-training examination (ITE) offers formative assessments of residents' developing medical knowledge. Identification of an ITE performance level associated with success on the specialty board examination allows identification of "at risk" residents. OBJECTIVE This study sought to identify a threshold score for obstetrics and gynecology residents' performance on the Council on Resident Education in Obstetrics and Gynecology (CREOG) ITE that predicts successful performance on the American Board of Obstetrics and Gynecology (ABOG) written examination. METHODS We analyzed ITE and ABOG results of 80 residents who completed 4 years of CREOG ITEs at 2 institutions between 2002 and 2012. We assessed the level of performance associated with successful performance on the ABOG written examination. RESULTS Data analyzed included scores for 71 of 80 residents (89%), with an overall pass rate of 82%. A postgraduate year (PGY) 4 score of 200 on the CREOG ITE or twice in any of the PGY training years was associated with a 100% ABOG pass rate. Scoring ≥ 205 in any PGY also was associated with a 100% pass rate. Residents who did not attain a score of 200 had a 35% to 45% chance of failing the ABOG written examination, depending on the PGY of the ITE performance. CONCLUSIONS Our findings suggest that a CREOG ITE score of at least 200 twice, or as a PGY-4, offers assurance of successful performance on the ABOG examination. Scores lower than this threshold may be used to identify "at risk" residents for added learning and provide program elements in need of improvement.
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Affiliation(s)
- Brandon M. Lingenfelter
- Corresponding author: Peter F. Schnatz, DO, Reading Health System, Department of Obstetrics and Gynecology, 6th Avenue and Spruce Street, Reading, PA 19611, 484.628.8827,
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Duvall WL, Rai M, Ahlberg AW, O'Sullivan DM, Henzlova MJ. A multi-center assessment of the temporal trends in myocardial perfusion imaging. J Nucl Cardiol 2015; 22:539-51. [PMID: 25652080 DOI: 10.1007/s12350-014-0051-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recent literature suggests that the frequency of abnormal SPECT myocardial perfusion imaging (MPI) has decreased over the past two decades despite an increase in the prevalence of many cardiac risk factors. This study examined the trends in the prevalence of obstructive coronary artery disease (CAD) by abnormal and ischemic MPI and invasive angiography. METHODS We analyzed all patients who underwent stress MPI or invasive angiography at two academic centers between January 1996 and December 2012, for their demographic data and study results. RESULTS A total of 108,654 MPI studies were performed. Over time, the percentage of patients with hypertension, hyperlipidemia, diabetes, and a history of smoking increased. There was a decline in the prevalence of abnormal MPI studies in all patients as well as in those with and without known CAD (from 47.2%, 71.8%, and 31.4% in 1996 to 33.9%, 64.8%, and 18.8% in 2012, respectively, all P < .0001). Similarly, there was a decline in the prevalence of ischemic MPI studies in all patients as well as in those with and without known CAD. A total of 142,924 invasive angiograms were performed. There was a decline in the prevalence of one-vessel and multi-vessel coronary disease (from 29.1% and 53.6% in 1996 to 22.4% and 35.9% in 2012, respectively, all P < .0001). CONCLUSIONS There has been a temporal decline in the prevalence of abnormal and ischemic MPI studies as well as the frequency and extent of obstructive CAD on angiography. However, this decline was not to the same extent as previously reported, and the overall 34% abnormal MPI rate, with 19% in patients with no known CAD and 65% in patients with known CAD, remains a clinically relevant percentage of patients tested.
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Affiliation(s)
- W Lane Duvall
- Division of Cardiology, Henry Low Heart Center, Hartford Hospital, 80 Seymour Streeet, Hartford, CT, 06102, USA,
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Brazell HD, O'Sullivan DM, Steinberg AC. Do Patients With Pelvic Organ Prolapse Have an Increased Frequency of Asymptomatic Microscopic Hematuria? Urology 2014; 83:1236-8. [DOI: 10.1016/j.urology.2014.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/04/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
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Woo JH, Ko JY, Choi EY, Her JG, O'Sullivan DM. Development and evaluation of a novel taekwondo chest protector to improve mobility when performing axe kicks. Biol Sport 2014; 30:51-5. [PMID: 24744466 PMCID: PMC3944553 DOI: 10.5604/20831862.1029822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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] [Accepted: 09/28/2012] [Indexed: 11/13/2022] Open
Abstract
The axe kick, in Olympic style taekwondo, has been identified as the most popular scoring technique aimed to the head during full contact competition. The first purpose of this study was to identify and investigate design issues with the current World Taekwondo Federation approved chest protector. A secondary purpose was to develop a novel chest protector addressing the identified design issues and to conduct a biomechanical analysis. Fifteen male elite Taekwondo players were selected to perform three different styles of the axe kick, i.e., front, in-out, and out-in axe kick five times each for a total of 45 kicks. Two-way repeated measures ANOVA showed significant differences between the novel and existing chest protector conditions for vertical height of the toe, downward kicking foot speed, hip flexion angle and ipsilateral shoulder flexion extension range of motion (ROM) (p < 0.05). There were no significant differences between the control condition (no chest protector) and the novel chest protector condition for these variables (p > 0.05). These results indicate that the novel chest protector interferes less with both the lower and upper limbs during the performance of the axe kick and provides a more natural, free-moving alternative to the current equipment used.
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Affiliation(s)
- J H Woo
- Department of Rehabilitation Therapy, Hallym University, Korea
| | - J Y Ko
- Department of Rehabilitation Medicine, CHA University, CHA Bundang Medical, Rep. of Korea
| | - E Y Choi
- Department of Rehabilitation Therapy, Hallym University, Korea
| | - J G Her
- Graduate School of Medical & Therapy Science, Hallym University, Korea
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Brazell HD, O'Sullivan DM, Lasala CA. Trends in sacral colpopexy for the management of apical prolapse. Conn Med 2014; 78:153-157. [PMID: 24772832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate trends in surgical approach for sacral colpopexy since the advent of robotic technology for gynecologic procedures. STUDY DESIGN Women who underwent surgery for uterovaginal prolapse, cystocele, and/orvaginalvault prolapse were included in this study. The number of patients undergoing a vaginal approach for prolapse was compared to the number of patients receiving sacral colpopexy. Descriptive statistics comprised means and standard deviations, while categorical data were reported as frequencies. Inferential statistics comprised Student's t-test for assessing two-group differences between means ofcontinuous, normally distributed data and chi-squared tests for comparisons of equality of distribution between categorical variables. RESULTS Patients undergoing sacral colpopexy were younger than their vaginal surgery counterparts (P< 0.001). When stage ofprolapsewas dichotomized, among those with stage 1-2 prolapse, a greater percentage of patients received colpopexy in favor of vaginal surgery in 2010 than in 2007 (P=0.001). CONCLUSION There is an increasing trend towards robotic-assisted sacralcolpopexyforthe management of apical prolapse.
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Brazell HD, O'Sullivan DM, Tulikangas PK. Socioeconomic status and race as predictors of treatment-seeking behavior for pelvic organ prolapse. Am J Obstet Gynecol 2013; 209:476.e1-5. [PMID: 23673228 DOI: 10.1016/j.ajog.2013.05.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/27/2013] [Accepted: 05/10/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to evaluate the prevalence of pelvic organ prolapse (POP) among a diverse group of women and to determine if race/ethnicity and/or socioeconomic status (SES) are factors in treatment-seeking behavior. STUDY DESIGN All data were collected from the National Institutes of Health-supported Boston Area Community Health Survey. SES was calculated by a 2-factor index that combined household income with years of education. Inferential statistics comprised 1-way analysis of variance, with a post hoc Scheffé test performed to evaluate whether there were differences between individual groups. A χ(2) test was used to evaluate whether distributions were equal among the various questions by race/ethnicity and SES category. RESULTS A total of 3205 women were included in the analysis. Hispanic ethnicity and younger age were associated with POP (P < .002 and P < .001, respectively) as well as with seeking treatment for prolapse (P = .007 and P < .001, respectively). These factors were also associated with subsequent surgical repair (P = .027 and P = .019, respectively). A regression model showed that women were 4.9% more likely to seek treatment for every year younger they were, across the range of age. Although women of a higher SES were more likely to have POP, SES was neither associated with a higher likelihood of seeking treatment nor with the surgical management of prolapse. CONCLUSION Hispanic ethnicity and younger age were associated with seeking treatment for POP. Hispanics were more likely than whites or blacks to proceed with surgical management. There was no correlation of SES with any of the above factors.
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Affiliation(s)
- Hema D Brazell
- Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
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Suozzi BA, Galffy A, O'Sullivan DM, Tulikangas PK. Advanced pelvic organ prolapse and routine health screening. Conn Med 2013; 77:595-598. [PMID: 24367842] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate whether patients with advanced pelvic-organ prolapse (POP) were less likely than controls to obtain screening Papanicolaou (Pap) test, mammography, and colonoscopy. STUDY DESIGN Records were reviewed from 7/2/2010 through 4/22/2011. We identified patients with advanced POP, defined as prolapse > or = 4 cm beyond the hymenal ring, and made age- and parity-matched controls from patients whose prolapse was <4 cm. Compliance for screening of cervical, breast and colon cancers was compared between the two groups. RESULTS Of 933 records, we identified 51 patients with advanced POP and 51 controls. Neither Pap test nor colonoscopy screening differed between the groups (McNemar chi2, P=1.00; McNemar chi2, P=1.00). Mammogram screening did not differ statistically; however, there was a trend towards neglecting screening in the advanced POP group (McNemar chi2, P=0.057). CONCLUSION Patients with POP > or = 4 cm beyond the hymenal ring were equally as likely to obtain routine health screening as age- and parity-matched controls whose POP measured <4 cm.
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Affiliation(s)
- Brent A Suozzi
- Division of Urogynecology, Hartford Hospital, Hartford, USA.
| | - Andrew Galffy
- Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, USA
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Brazell HD, O'Sullivan DM, Lasala CA. Does the impact of urinary incontinence on quality of life differ based on age? Int Urogynecol J 2013; 24:2077-80. [PMID: 24013484 DOI: 10.1007/s00192-012-2005-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/12/2012] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study was to evaluate if the impact of urinary incontinence (UI) on quality of life (QOL) differs between women based on age. METHODS A retrospective review of patients presenting for the management of UI was performed. Patients with UI and their corresponding degree of bother were identified by their responses to validated questionnaires. Distributions of comorbidities and types of UI were presented as frequencies and compared between age cohorts with a chi-square test. Mean scale scores were assessed for normality and a one-way analysis of variance with a post hoc Scheffé's test was used to compare the scores. RESULTS Of 765 patients meeting inclusion criteria, 22.4 % were <45, 28.9 % were 45-55, and 48.8 % were >55 years of age. Women older than 55 were significantly more likely to have urge UI and mixed UI than their counterparts (p < 0.001). Women <45 and 45-55 were more negatively impacted in their ability to perform physical activities compared to women >55 (p = 0.004), whereas women >55 were significantly less likely to feel frustrated by their incontinence than women <45 (p = 0.022). However, there was no significant difference in overall impact of incontinence among groups (p = 0.585). CONCLUSIONS UI equally impacts the functional and psychological QOL in women regardless of age. UI in women <55 results in a greater negative impact on level of physical activity, whereas women <45 are significantly more frustrated.
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Affiliation(s)
- Hema D Brazell
- Department of Obstetrics and Gynecology, Division of Urogynecology, Hartford Hospital, 85 Seymour Street, Suite 525, Hartford, CT, 06106, USA,
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Schnatz PF, Whitehurst SK, O'Sullivan DM. Sexual dysfunction, depression, and anxiety among patients of an inner-city menopause clinic. J Womens Health (Larchmt) 2013; 19:1843-9. [PMID: 20677995 DOI: 10.1089/jwh.2009.1800] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The objective of this study was to identify the prevalence of female sexual dysfunction (FSD) in a sample comprising women of mostly Hispanic descent and low socioeconomic status (SES). METHODS Demographic data and symptoms related to sexuality were analyzed from 102 women who consecutively came to the Women's Life Center at Hartford Hospital (2004-2008). FSD was defined as decreased sexual desire, dyspareunia, or vaginal dryness; depression as one positive response to a validated three-question screening instrument; and anxiety as a positive response to whether the patient experiences anxiety sometimes or often. RESULTS The cohort was 52.9 ± 6.8 years of age (mean ± standard deviation [SD]) and 80.0% Hispanic, and 47.8% were unemployed. The majority (92.8%) earned < $25,000, and most (95.8%) did not have a college degree. The prevalence of FSD was 75.6%. The prevalence of depression was 80.9% vs. 52.8% (p = 0.01) and that of anxiety was 76.6% vs. 45.7% (p = 0.01) among women with vs. without a decrease in sexual desire. The prevalence of depression was 83.3% vs. 55.9% (p = 0.03) and that of anxiety was 76.7% vs. 52.9% (p = 0.07) among women who reported dyspareunia vs. those who did not. Problems sleeping was the only variable associated with a statistically higher likelihood of FSD (odds ratio [OR] 5.57, 95% confidence interval [CI] 1.22-25.33, p = 0.03). No significant differences were seen when comparing FSD between Hispanics and non-Hispanics. CONCLUSIONS This sample of predominantly Hispanic women of low SES had a high prevalence of FSD. These data also suggest that poor sleep is significantly associated with FSD and that women of low SES with FSD may have a significantly higher prevalence of depression and anxiety.
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Affiliation(s)
- Peter F Schnatz
- Department of Obstetrics/Gynecology, The Reading Hospital and Medical Center, Reading, Pennsylvania 19612-6052, USA.
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Schnatz PF, Nudy M, O'Sullivan DM, Jiang X, Cline JM, Kaplan JR, Clarkson TB, Appt SE. Coronary artery vitamin D receptor expression and plasma concentrations of 25-hydroxyvitamin D: their association with atherosclerosis. Menopause 2012; 19:967-73. [PMID: 22617336 PMCID: PMC3427720 DOI: 10.1097/gme.0b013e31824cfa8f] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to analyze coronary artery vitamin D receptor (VDR) expression, the plasma concentrations of 25-hydroxyvitamin D3 (25OHD3), and their relationship with coronary artery atherosclerosis. METHODS Premenopausal cynomolgus monkeys were fed atherogenic diets containing the equivalent of 1,000 IU/day of vitamin D3. Protein was derived from casein-lactalbumin (C/L, n = 10), soy protein isolate (soy, n = 10), or a combination (n = 19). After 32 months of consuming the diets, each monkey underwent surgical menopause. After 32 postmenopausal months, coronary atherosclerosis was measured in the left circumflex (LCX) artery and left anterior descending (LAD) artery. VDR expression was determined for the LAD, and 25OHD3 concentrations were assessed. RESULTS Both the cross-sectional area of atherosclerotic plaques (in square millimeters) and plaque thickness (in millimeters) in the LCX as well as the LAD arteries were analyzed in these monkeys. Those with higher plasma vitamin D3 concentrations and higher VDR were compared with those with higher plasma 25OHD3 concentrations and lower VDR. Significantly smaller plaque sizes were noted with higher plasma 25OHD3 concentrations and higher VDR. For the LCX artery, there was also a significantly lower plaque size (both plaque thickness and cross-sectional area) in those with higher quantities of VDR and lower 25OHD3 concentrations versus those with lower quantities of VDR and higher plasma concentrations of 25OHD3 (P = 0.009 and P = 0.040, respectively). CONCLUSIONS Cynomolgus monkeys with higher quantities of VDR have significantly less atherosclerosis than do those with lower quantities of VDR and higher plasma 25OHD3 concentrations. If these findings translate to human beings, it might explain why some individuals with higher plasma concentrations of 25OHD3 have more coronary artery atherosclerosis.
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Affiliation(s)
- Peter F Schnatz
- Department of Obstetrics and Gynecology, The Reading Hospital and Medical Center; Reading, PA 19612-6052, USA.
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Fife GP, O'Sullivan DM, Pieter W, Cook DP, Kaminski TW. Effects of Olympic-style taekwondo kicks on an instrumented head-form and resultant injury measures. Br J Sports Med 2012; 47:1161-5. [PMID: 22930694 DOI: 10.1136/bjsports-2012-090979] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The objective of this study was to assess the effect of taekwondo kicks and peak foot velocity (FVEL) on resultant head linear acceleration (RLA), head injury criterion (HIC15) and head velocity (HVEL). METHODS Each subject (n=12) randomly performed five repetitions of the turning kick (TK), clench axe kick (CA), front leg axe kick, jump back kick (JB) and jump spinning hook kick (JH) at the average standing head height for competitors in their weight division. A Hybrid II Crash Test Dummy head was fitted with a protective taekwondo helmet and instrumented with a triaxial accelerometer and fixed to a height-adjustable frame. Resultant head linear acceleration, HVEL, FVEL data were captured and processed using Qualysis Track Manager. RESULTS The TK (130.11 ± 51.67 g) produced a higher RLA than the CA (54.95 ± 20.08 g, p<0.001, d=1.84) and a higher HIC15 than the JH (672.74 ± 540.89 vs 300.19 ± 144.35, p<0.001, ES=0.97). There was no difference in HVEL of the TK (4.73 ± 1.67 m/s) and that of the JB (4.43 ± 0.78 m/s; p=0.977, ES<0.01). CONCLUSIONS The TK is of concern because it is the most common technique and cause of concussion in taekwondo. Future studies should aim to understand rotational accelerations of the head.
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Affiliation(s)
- Gabriel P Fife
- Department of Physical Education, Yonsei University, Seoul, Republic of Korea
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Schnatz PF, Marakovits KA, O'Sullivan DM, Ethun K, Clarkson TB, Appt SE. Response to an adequate dietary intake of vitamin D3 modulates the effect of estrogen therapy on bone density. J Womens Health (Larchmt) 2012; 21:858-64. [PMID: 22691032 DOI: 10.1089/jwh.2011.3244] [Citation(s) in RCA: 9] [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] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION This study analyzed associations between plasma vitamin D(3) (25OHD(3)) and bone mineral density (BMD) and whether the effects of conjugated equine estrogens (CEE) on BMD are modulated by 25OHD(3). METHODS Fifty cynomolgus monkeys were fed a diet containing 25OHD(3) (providing a woman's equivalent of 1000 IU/day of 25OHD3). The monkeys underwent bilateral oophorectomy and were randomized to either CEE (equivalent of 0.45 mg/day) (n=25) or placebo (n=25) and continued receiving the same diet. 25OHD(3) and BMD were measured at randomization and after 6 months. BMD also was measured after 20 months (equivalent to 6 human years). Associations between 25OHD(3) and BMD were subsequently analyzed. RESULTS Baseline 25OHD(3) plasma concentrations varied from 26 to 95 ng/mL (mean±standard deviation [SD] 54 ± 15 ng/mL). Higher plasma concentrations of 25OHD(3) were associated with a significantly increased BMD. Monkeys on both CEE and placebo had increased BMD over 20 months; however, the increase was not significantly different (0.034 g/cm(2) vs. 0.020 g/cm(2), respectively; p=0.064). The 20-month BMD increased significantly with CEE treatment in those with higher vs. lower 25OHD(3) concentrations (p=0.027). The percent change in BMD over 20 months also increased significantly with CEE treatment in those with higher vs. lower 25OHD(3) concentrations (p=0.018). A higher 25OHD(3) concentration had no significant effect on BMD in those receiving placebo. CONCLUSIONS Monkeys fed a diet containing 1000 IU/day equivalent of 25OHD(3) have a wide range of plasma 25OHD(3) concentrations. Those receiving CEE with higher 25OHD(3) concentrations had higher BMDs, suggesting 25OHD(3) and CEE have synergistic effects on BMD.
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Affiliation(s)
- Peter F Schnatz
- Department of Obstetrics and Gynecology, The Reading Hospital and Medical Center, Reading, Pennsylvania 19612-6052, USA.
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Collins SA, Tulikangas PK, O'Sullivan DM. Effect of surgical approach on physical activity and pain control after sacral colpopexy. Am J Obstet Gynecol 2012; 206:438.e1-6. [PMID: 22397901 DOI: 10.1016/j.ajog.2012.01.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/10/2012] [Accepted: 01/31/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to compare recovery of activity and pain control after robotic (ROB) vs abdominal (ABD) sacral colpopexy. STUDY DESIGN Women undergoing ROB and ABD sacral colpopexy wore accelerometers for 7 days preoperatively and the first 10 days postoperatively. They completed postoperative pain diaries and Short Form-36 questionnaires before and after surgery. RESULTS At 5 days postoperatively, none of the 14 subjects in the ABD group and 4 of 28 (14.3%) in the ROB group achieved 50% total baseline activity counts (P = .283). At 10 days, 5 of 14 (35.7%) in the ABD group and 8 of 26 (30.8%) in the ROB group (P = .972) achieved 50%. Postoperative pain was similar in both groups. Short Form-36 vitality scores were lower (P = .017) after surgery in the ABD group, but not in the ROB group. CONCLUSION Women undergoing ROB vs ABD sacral colpopexy do not recover physical activity faster, and pain control is not improved.
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Affiliation(s)
- Sarah A Collins
- Division of Urogynecology, Department of Obstetrics and Gynecology, Hartford Hospital, University of Connecticut Health Center, Hartford, CT, USA
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Schnatz PF, Nudy M, O'Sullivan DM, Jiang X, Cline JM, Kaplan JR, Clarkson TB, Appt SE. The quantification of vitamin D receptors in coronary arteries and their association with atherosclerosis. Maturitas 2012; 73:143-7. [PMID: 22542390 DOI: 10.1016/j.maturitas.2012.03.014] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/22/2012] [Accepted: 03/24/2012] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The activated vitamin D receptor (VDR) may have an important role in vascular health. The objective of this study was to determine whether there is an association between the expression of VDRs in coronary arteries and the extent of diet-induced atherosclerosis. METHODS Utilizing a cohort of 39 postmenopausal female cynomolgus monkeys with varying stages of atherosclerosis, histologic sections of the left anterior descending artery (LAD) were analyzed for plaque cross-sectional area, plaque thickness, and VDR quantity using immunohistochemical H-score analysis. The quantities of VDRs were analyzed as a continuous variable and were divided at the median intimal H-score into high vs. low groupings. RESULTS In the LAD, a significant negative correlation was observed between the quantity of VDR and plaque size (both cross-sectional area [p<0.001] and plaque thickness [p<0.001]). Monkeys in the low VDR group had a significantly greater cross-sectional plaque area (1.2mm(2)) and greater plaque thickness (0.3mm) than those in the high VDR group (0.4mm(2), p=0.005; 0.1mm, p=0.003, respectively). CONCLUSIONS Lower concentrations of VDRs in a main coronary artery were associated with greater atherosclerotic plaque size in postmenopausal female monkeys. Given that coronary artery atherosclerosis is a major cause of coronary heart disease in postmenopausal women, further research to ascertain the relationship between VDRs and atherosclerosis is warranted.
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Affiliation(s)
- Peter F Schnatz
- Department of ObGyn, The Reading Hospital and Medical Center, Reading, PA 19612-6052, United States.
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Ahlberg AW, Kazi FA, Azemi T, Katten DM, O'Sullivan DM, Papaioannou GI, Danias PG, Heller GV. Usefulness of stress gated technetium-99m single photon emission computed tomographic myocardial perfusion imaging for the prediction of cardiac death in patients with moderate to severe left ventricular systolic dysfunction and suspected coronary artery disease. Am J Cardiol 2012; 109:26-30. [PMID: 21943938 DOI: 10.1016/j.amjcard.2011.07.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 11/25/2022]
Abstract
Although stress gated technetium-99m single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) is useful in differentiating ischemic from nonischemic cardiomyopathy, its prognostic usefulness in this patient population is not well understood. Consecutive unique patients with suspected coronary artery disease who, for clinical indications, underwent technetium-99m rest and stress MPI demonstrating ejection fractions ≤40% by gated SPECT imaging were retrospectively identified. In addition to prescan variables, previously defined cutoffs for gated SPECT parameters using visual and standard 17-segment semiquantitative scoring were applied and related to the occurrence of cardiac death up to 5 years after MPI. Of the 475 patients fulfilling criteria for study inclusion, follow-up was complete in 444 (93%) over 3.7 ± 1.6 years. Of 393 patients without subsequent early (≤60 days) coronary revascularization, cardiac death occurred in 64 (16%). The summed stress score, an MPI measure of the extent and severity of coronary artery disease that also accounts for the ischemic burden, was the gated SPECT parameter most related to cardiac death with Kaplan-Meier 5-year cardiac death-free survival of 85.6% and 67.3% in patients with summed stress scores ≤8 and >8, respectively (p <0.001). In multivariate Cox regression analysis, a summed stress score >8 independently contributed to cardiac death (adjusted hazard ratio 2.20, 95% confidence interval 1.34 to 3.61), and its addition to the model significantly increased the global chi-square value over prescan variables (from 32.46 to 41.67, p = 0.002). In conclusion, stress MPI data from gated technetium-99m SPECT scans are useful for the prediction of cardiac death in patients with moderate to severe left ventricular systolic dysfunction in whom there is suspicion of underlying coronary artery disease.
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Felding-Habermann B, O'Sullivan DM, Lorger M, MacDermed D, Fernandez-Santidrian A, Steele JB, Telli ML, Jeffrey SS, Murray S, Torkamani A, Cunliffe H, Vaughn SV. PD03-07: Breast Cancer Heterogeneity and Treatment Resistance: Clues from Metaplastic Tumors. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-pd03-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
At late stage, nearly all breast cancers are heterogeneous and refractory to treatment, like metaplastic breast cancer is at an early stage. These rare carcinomas are highly aggressive and de-differentiated. They are enriched for mesenchymal and stem cell features and essentially fail current therapies. As metaplastic tumors provide a time-compressed picture of breast cancer progression early on, understanding these tumors will yield insight into mechanisms that drive breast cancer into advanced stages and treatment resistance.
To investigate a genetic basis for heterogeneity in metaplastic breast cancer, we established a progression model comprising three cell lines. The cell lines were derived from a primary tumor, a local recurrence and a pleural effusion of a 40-year old patient. The primary tumor was a stage III invasive metaplastic, triple negative, inflammatory breast cancer, resected after neoadjuvant chemotherapy (capecitabine and taxotere, then adriamycin and one cycle of bevacizumab). The local recurrence, biopsied seven months post mastectomy, developed after the patient received adjuvant carboplatin and gemcitabine for 3 cycles and then radiation to the chest wall. At this time, the patient had lung metastases and was treated with taxol and bevacizumab yielding a mixed response. Local invasive growth continued and a malignant pleural effusion developed four months later. Analyzing the genetic and molecular characteristics of this progression model in vitro, its tumorigenicity and metastasis in vivo, and interrogating lead findings in a growing collection of metaplastic tumors helps us to dissect the genetic heterogeneity in breast cancer, and potentially to identify the cell types that drive disease progression and treatment resistance. Our gene expression analyses and genomic evaluations identified epithelial to mesenchymal transition (EMT) as a key characteristic in the progression and treatment resistance of this cancer. Major changes in cytoskeletal genes, chemokines and their receptors, amplification of drug transporter proteins, metalloproteinases and matrix proteins seen with increasing motility and invasiveness along with recruitment of host inflammatory responses in the in vivo model, loss of chromosomal regions harboring known and putative tumor suppressors, and deletions of genes encoding proteins for metabolic inactivation of sex hormones in the breast tissue, along with specific loss of clusters of desmosomal genes are guiding our understanding of metaplastic breast cancer progression. The results provide insight into the development, the extremely invasive nature, and treatment resistance of these tumors. Our collaborative network of clinicians, pathologists, translational genomic researchers and bioinformatics specialists will enable us to identify and prioritize genetic events as disease drivers, prognostic biomarkers of disease progression, and determinants of treatment resistance. Our goal is to identify molecular and functional targets for effective therapy and evaluate them in the clinic. Lessons learned from metaplastic breast cancer will improve our understanding of breast cancer progression in general, and could translate into effective treatments for advanced breast cancer where current standard of care is failing.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD03-07.
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Affiliation(s)
- B Felding-Habermann
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
| | - DM O'Sullivan
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
| | - M Lorger
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
| | - D MacDermed
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
| | - A Fernandez-Santidrian
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
| | - JB Steele
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
| | - ML Telli
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
| | - SS Jeffrey
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
| | - S Murray
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
| | - A Torkamani
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
| | - H Cunliffe
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
| | - SV Vaughn
- 1The Scripps Research Institute, La Jolla, CA; Scripps Clinic, La Jolla, CA; Stanford University, Stanford, CA; Translational Genomics Research Institute, Phoenix, AZ
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Borer SM, Kokkirala A, O'Sullivan DM, Silverman DI. Systolic Strain Abnormalities to Predict Hospital Readmission in Patients With Heart Failure and Normal Ejection Fraction. Cardiol Res 2011; 2:274-281. [PMID: 28352395 PMCID: PMC5358255 DOI: 10.4021/cr104w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2011] [Indexed: 11/23/2022] Open
Abstract
Background Despite intensive investigation, the pathogenesis of heart failure with normal ejection fraction (HFNEF) remains unclear. We hypothesized that subtle abnormalities of systolic function might play a role, and that abnormal systolic strain and strain rate would provide a marker for adverse outcomes. Methods Patients of new CHF and left ventricular ejection fraction > 50% were included. Exclusion criteria were recent myocardial infarction, severe valvular heart disease, severe left ventricular hypertrophy (septum >1.8 cm), or a technically insufficient echocardiogram. Average peak systolic strain and strain rate were measured using an off-line grey scale imaging technique. Systolic strain and strain rate for readmitted patients were compared with those who remained readmission-free. Results One hundred consecutive patients with a 1st admission for HFNEF from January 1, 2004 through December 31, 2007, inclusive, were analyzed. Fifty two patients were readmitted with a primary diagnosis of heart failure. Systolic strain and strain rates were reduced in both study groups compared to controls. However, systolic strain did not differ significantly between the two groups (-11.7% for those readmitted compared with -12.9% for those free from readmission, P = 0.198) and systolic strain rates also were similar (-1.05 s-1 versus -1.09 s-1, P = 0.545). E/e’ was significantly higher in readmitted patients compared with those who remained free from readmission (14.5 versus 11.0, P = 0.013). E/e’ (OR 1.189, 95% CI 1.026-1.378; P = 0.021) was found to be an independent predictor for HFNEF readmission. Conclusions Among patients with new onset HFNEF, SS and SR rates are reduced compared with patients free of HFNEF, but do not predict hospital readmission. Elevated E/e’ is a predictor of readmission in these patients.
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Affiliation(s)
- Steven M Borer
- Henry Low Heart Center, Hartford Hospital, Hartford, CT, USA
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