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Kyei KA, Daniels J, Broni R, Anim-Sampong S, Kitson-Mills D, Amoabeng KA, Odey Tackie JN, Obeng-Mensah T, Anoa Scott PA, Owusu AB. The sexuality of women with cervical cancer undergoing definitive radiotherapy in Ghana. Radiography (Lond) 2024; 30:332-339. [PMID: 38128249 DOI: 10.1016/j.radi.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The purpose of this study was to assess the sexuality of cervical cancer patients undergoing radiotherapy at a major cancer treatment center in Ghana. This is an area of interest as globally; cervical cancer kills approximately 342,000 people per annum with an estimated number of 604,000 new cases in 2020. Acknowledging the World Health Organization's definition of sexual health as a state of physical, mental and social well-being in relation to sexuality, this paper sheds light on how these dimensions affect the quality of life of cervical cancer patients. METHODS This was a longitudinal study, which assessed the impact of radiotherapy on the sexuality of both premenopausal and postmenopausal cervical cancer patients presenting for primary treatment with chemoradiation from April to July, 2021 at a major cancer treatment centre in Ghana. The Female Sexual Function Index and Body Image Scale questionnaires were respectively used to evaluate the sexual functions scores among the cervical cancer patients, and to assess the impact of the treatment on their body image. MATLAB software was used for data analysis. RESULTS Most of the cervical cancer patients sampled were postmenopausal (57 %). About 79 % premenopausal and 96 % postmenopausal cervical cancer patients were sexually inactive during radiotherapy (day 15). Also, 48 % premenopausal and 24 % postmenopausal patients were very dissatisfied with their bodies at the onset of treatment. The frequency of orgasm in cervical cancer patients declined after treatment causing a deterioration in their sexual function. The patients' sexuality was influenced by age and menopausal status. The decreased sexual desire of the patients resulted in emotional distancing from their partners, which invariably induced changes in their partners' level of sexual interest. This study established significant differences between premenopausal and postmenopausal cervical cancer patients who were generally very dissatisfied with their sexual relationships with their partners on day 1 (p = 0.02) and on day 15 (p = 0.00) of treatment. CONCLUSION The majority of patients who presented for treatment for cervical cancer in this study were postmenopausal. Their interest in sexual activity was more influenced by their menopausal status than their antineoplastic treatment. This study indicates that cervical cancer patients are more likely to develop sexual health problems which could substantially worsen over the course of their treatment and beyond. IMPLICATION FOR PRACTICE The study will contribute within the oncology team by assisting personnel in putting in place measures that will guide the treatment of cervical cancer patients and improve quality of care.
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Affiliation(s)
- K A Kyei
- Dept. of Radiography, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana; National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - J Daniels
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana.
| | - R Broni
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - S Anim-Sampong
- Dept. of Radiography, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana
| | - D Kitson-Mills
- Dept. of Radiography, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana; National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - K A Amoabeng
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - J N Odey Tackie
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - T Obeng-Mensah
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - P A Anoa Scott
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - A-B Owusu
- University of Ghana Medical Centre, Legon, Ghana
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Sanchez J, Woods C, Zagrodzky J, Nazari J, Singleton MJ, Schricker A, Ruppert A, Brumback B, Jenny B, Athill C, Joseph C, Shah D, Upadhyay G, Kulstad E, Cogan J, Leyton-Mange J, Cooper J, Tamirisa K, Omotoye S, Timilsina S, Perez-Verdia A, Kaplan A, Patel A, Ro A, Corsello A, Kolli A, Greet B, Willms D, Burkland D, Castillo D, Zahwe F, Nayak H, Daniels J, MacGregor J, Sackett M, Kutayli WM, Barakat M, Percell R, Akrivakis S, Hao SC, Liu T, Panico A, Ramireddy A, Dewland T, Gerstenfeld EP, Lanes DB, Sze E, Francisco G, Silva J, McHugh J, Sung K, Feldman L, Serafini N, Kawasaki R, Hongo R, Kuk R, Hayward R, Park S, Vu A, Henry C, Bailey S, Mickelsen S, Taneja T, Fisher W, Metzl M. Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2023; 9:2558-2570. [PMID: 37737773 DOI: 10.1016/j.jacep.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed. OBJECTIVES The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling. METHODS This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. RESULTS A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals. In the time frames before adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In the preadoption cohort, a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates for procedures using LET monitoring. In the postadoption cohort, no AEFs were found in the prespecified sites, yielding an AEF rate of 0% (P < 0.0001). CONCLUSIONS Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate.
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Affiliation(s)
| | | | | | - Jose Nazari
- NorthShore University Health System, Evanston, Illinois, USA
| | | | - Amir Schricker
- Mills-Peninsula Medical Center, Burlingame, California, USA
| | | | | | | | | | | | - Dipak Shah
- Ascension Michigan, Detroit, Michigan, USA
| | | | - Erik Kulstad
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - John Cogan
- Memorial Healthcare System, Hollywood, Florida, USA
| | | | - Julie Cooper
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | | | | | - Apoor Patel
- Houston Methodist Hospital, Houston, Texas, USA
| | - Alex Ro
- NorthShore University Health System, Evanston, Illinois, USA
| | | | | | - Brian Greet
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Danya Willms
- Sharp Memorial Hospital, San Diego, California, USA
| | | | | | | | - Hemal Nayak
- University of Texas, San Antonio, Texas, USA
| | - James Daniels
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Matthew Sackett
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | | | | | | | | | - Steven C Hao
- Sutter Pacific Medical Foundation, San Francisco, California, USA
| | - Taylor Liu
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | | | | | - Thomas Dewland
- University of California-San Fransisco, San Fransico, California, USA
| | | | | | - Edward Sze
- MaineHealth Cardiology, Portland, Maine, USA
| | | | - Jose Silva
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | - Julia McHugh
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | - Kai Sung
- Tri-City Cardiology, Mesa, Arizona, USA
| | - Leon Feldman
- Eisenhower Medical Center, Rancho Mirage, California, USA
| | | | - Raymond Kawasaki
- Northwest Community Healthcare, Arlington Heights, Illinois, USA
| | - Richard Hongo
- California Pacific Medical Center, San Francisco, California, USA
| | - Richard Kuk
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | - Robert Hayward
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | - Shirley Park
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | - Andrew Vu
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | | | - Shane Bailey
- LoneStar Heart and Vascular, New Braunfels, Texas, USA
| | | | - Taresh Taneja
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | - Westby Fisher
- NorthShore University Health System, Evanston, Illinois, USA
| | - Mark Metzl
- NorthShore University Health System, Evanston, Illinois, USA
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Das S, Friedrich NA, Daniels J, Galvan GC, Gong J, Posadas E, Aronson W, Freedland SJ. Relative search popularity of five advanced prostate cancer medications using Google Trends. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00716-9. [PMID: 37679603 PMCID: PMC11019934 DOI: 10.1038/s41391-023-00716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/27/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND There are many FDA-approved drugs for advanced prostate cancer (PC), yet public interest in these drugs is not well understood. We compared public interest and state-level predictors of interest in five common oral adjunctive hormonal therapies. METHODS Google Trends™ was queried for: "Enzalutamide", "Abiraterone Acetate", "Bicalutamide", "Apalutamide", and "Darolutamide" in the United States from January 2004 to November 2022. Data are presented as relative search index (RSI) by month. RSI ranges from 0 to 100 with 100 being peak popularity, 50 being half of the peak popularity, and 0 representing insufficient data to be determined. RESULTS Several drugs abruptly increased in popularity following FDA approval including abiraterone, enzalutamide, and apalutamide. All drugs decreased in popularity from January 2020 to July 2020, corresponding with the COVID-19 pandemic. In the most recent 5 years, enzalutamide and abiraterone were the most common searched drugs, with bicalutamide a close 3rd place. States that did not expand Medicaid were significantly more likely to have bicalutamide as the top search drug vs. states that expanded Medicaid (p = 0.012). Across all states with data (n = 39), higher bicalutamide RSIs were significantly associated with lower household income (r = 0.385, p = 0.02) and greater percent of uninsured adults (r = 0.426, p = 0.007). This is the first study using Google Trends to compare advanced PC drugs by search popularity. CONCLUSIONS Despite the emergence of more effective medications, bicalutamide remains relatively popular, particularly in states with lower household income, more uninsured adults, or those that did not expand Medicaid, possibly due to its lower cost.
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Affiliation(s)
- Sanjay Das
- Department of Urology, University of California - Los Angeles, Los Angeles, CA, USA.
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Durham Veterans Affairs Health Care System, Department of Surgery, Durham, NC, USA.
| | - Nadine A Friedrich
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James Daniels
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - G Cecilia Galvan
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jun Gong
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edwin Posadas
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - William Aronson
- Department of Urology, University of California - Los Angeles, Los Angeles, CA, USA
- Greater Los Angeles Veterans Affairs, Los Angeles, CA, USA
| | - Stephen J Freedland
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Durham Veterans Affairs Health Care System, Department of Surgery, Durham, NC, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Lomas S, Minton Z, Daniels J. Systematic review of the effectiveness of remifentanil in term breech pregnancies undergoing external cephalic version. Int J Obstet Anesth 2023; 54:103649. [PMID: 36989876 DOI: 10.1016/j.ijoa.2023.103649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND External cephalic version (ECV) is a moderately painful procedure used to turn a fetus from a non-vertex to cephalic position. This systematic review and meta-analysis compared intravenous remifentanil with other analgesia or no analgesia or placebo on the success rate and associated pain of ECV. METHODS Systematic searches for randomised controlled trials using remifentanil during ECV for non-cephalic term singleton pregnancies were conducted in EMBASE, MEDLINE and Cochrane Library to October 2021. The primary outcomes were successful ECV and maternal pain; secondary outcomes included mode of delivery and adverse effects. The Cochrane Risk of Bias tool was used and meta-analysis undertaken if there were ≥2 comparable studies. RESULTS Four trials were identified, three placebo-controlled and one vs no analgesia, totalling 482 participants. Comparisons against nitrous oxide or neuraxial anaesthesia were not analysed. Two studies had a low overall risk of bias, and two had some concern for bias. Remifentanil compared with placebo increased the success of ECV by 43% (risk ratio [RR] 1.43; 95% confidence interval [CI] 1.14 to 1.78). Pain scores (0-10) were lower (mean difference -1.97; 95% CI -2.49 to -1.46) whilst there was no impact on caesarean delivery rate (RR 0.97; 95% CI 0.81 to 1.17). Adverse events were rare, with fetal bradycardia observed less often with remifentanil than placebo. CONCLUSIONS Remifentanil increases the procedural success of ECV and reduces pain compared with placebo. Trials were at low risk of bias and contained a sufficient number of participants to have reasonable confidence in this finding.
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Schwamm LH, Kamel H, Granger CB, Piccini JP, Katz JM, Sethi PP, Sidorov EV, Kasner SE, Silverman SB, Merriam TT, Franco N, Ziegler PD, Bernstein RA, Abi-Samra F, Acosta I, Al Balushi A, Al-Awwad A, Alimohammad R, Alkahalifah M, Allred J, Alsorogi M, Arias V, Aroor S, Arora R, Asdaghi N, Asi K, Assar M, Badhwar N, Banchs J, Bansal S, Barrett C, Beaver B, Beldner S, Belt G, Bernabei M, Bernard M, Bhatt N, Black J, Bledsoe D, Bonaguidi H, Bonyak K, Boyd C, Cajavilca C, Caprio F, Carter J, Chancellor B, Chang C, Chaudhary G, Chaudhary S, Cheung P, Ching M, Chinitz L, Chiu D, Chokhawala H, Choudhuri I, Choudry S, Clayton S, Cross J, Cucchiara B, Culpepper A, Daniels J, Dash S, Del Brutto V, Deline C, Delpirou Nouh C, Deo R, Dhamoon M, Dillon G, Donsky A, Doshi A, Downey A, Dukkipati S, Epstein L, Etherton M, Fara M, Fayad PB, Felberg R, Flaster M, Frankel D, Furer S, Gadhia R, Gadient P, Garabelli P, Gibson D, Glotzer T, Goltz D, Gordon D, Graner S, Graybeal D, Grimes MR, Guerrero W, Hanna J, Hao Q, Hasabnis S, Hasan R, Heist EK, Horowitz D, Hourihane JM, Hussein H, Ishida K, Ismail H, Jadonath R, Jamal S, Jamnadas P, Jia J, Johnson M, Jung R, Kalafut M, Kalia J, Kandel A, Kasner S, Katz L, Katz J, Kaur G, Kearney M, Khatib S, Kim S, Kim C, Kipta J, Koch S, Koruth J, Kreger H, Krueger K, Kurian C, LaFranchise E, Lambrakos L, Langan MN, Lee R, Libman R, Lillemoe K, Logan W, Lord A, Lubitz S, Luciano J, Lynch J, Maccaro PC, Magadan A, Magun R, Malik M, Malik A, Manda S, Marulanda-Londono E, Matos Diaz I, Mattera B, McCall-Brown A, Mcclelland N, Meisel K, Memon Z, Mendelson S, Mendoza I, Merriam T, Messe S, Miles WM, Miller M, Mir O, Mitrani R, Morin D, Morris K, Moussavi M, Mowla A, Moye S, Mullen M, Mullins S, Neisen K, Nguyen C, Niazi I, Olson N, Olsovsky G, Ortiz G, Ostrander M, Pakala A, Parker B, Parker M, Passman R, Patel A, Patel A, Pickett RA(D, Polin G, Radoslovich G, Ramano J, Rami T, Ramirez D, Rasmussen J, Ray B, Reddy V, Reddy R, Reeves R, Regenhardt R, Rempe D, Rogers P, Rogers J, Rowe S, Rowley C, Ruff I, Sackett M, Sajjad R, Salem R, Saltzman M, Santangeli P, Saucedo S, Sawyer R, Schaller R, Seeger S, Sethi P, Shang T, Sharma J, Sharma R, Sheinart K, Shukla G, Shultz J, Sidorov E, Silverman S, Simonson J, Singh D, Skalabrin E, Sloane K, Smith M, Smith W, Soik D, Stavrakis S, Stein L, Steinberg JS, Sur N, Switzer D, Talpur N, Tansy A, Tempro K, Thavapalan V, Thomas A, Thomas K, Torres J, Torres L, Tuhrim S, Uddin P, Vidal G, Viswanathan A, Volpi J, Ward K, Weinberger J, Whang W, Wilder M, Willner J, Wright P, Yuan Q, Zhang C, Zhu D, Zide K, Zimmerman J, Zweifler R. Predictors of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease: A Prespecified Secondary Analysis of the STROKE AF Randomized Clinical Trial. JAMA Neurol 2023; 80:99-103. [PMID: 36374508 PMCID: PMC9664367 DOI: 10.1001/jamaneurol.2022.4038] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Importance The Stroke of Known Cause and Underlying Atrial Fibrillation (STROKE AF) trial found that approximately 1 in 8 patients with recent ischemic stroke attributed to large- or small-vessel disease had poststroke atrial fibrillation (AF) detected by an insertable cardiac monitor (ICM) at 12 months. Identifying predictors of AF could be useful when considering an ICM in routine poststroke clinical care. Objective To determine the association between commonly assessed risk factors and poststroke detection of new AF in the STROKE AF cohort monitored by ICM. Design, Setting, and Participants This was a prespecified analysis of a randomized (1:1) clinical trial that enrolled patients between April 1, 2016, and July 12, 2019, with primary follow-up through 2020 and mean (SD) duration of 11.0 (3.0) months. Eligible patients were selected from 33 clinical research sites in the US. Patients had an index stroke attributed to large- or small-vessel disease and were 60 years or older or aged 50 to 59 years with at least 1 additional stroke risk factor. A total of 496 patients were enrolled, and 492 were randomly assigned to study groups (3 did not meet inclusion criteria, and 1 withdrew consent). Patients in the ICM group had the index stroke within 10 days before insertion. Data were analyzed from October 8, 2021, to January 28, 2022. Interventions ICM monitoring vs site-specific usual care (short-duration external cardiac monitoring). Main Outcomes and Measures The ICM device automatically detects AF episodes 2 or more minutes in length; episodes were adjudicated by an expert committee. Cox regression multivariable modeling included all parameters identified in the univariate analysis having P values <.10. AF detection rates were calculated using Kaplan-Meier survival estimates. Results The analysis included the 242 participants randomly assigned to the ICM group in the STROKE AF study. Among 242 patients monitored with ICM, 27 developed AF (mean [SD] age, 66.6 [9.3] years; 144 men [60.0%]; 96 [40.0%] women). Two patients had missing baseline data and exited the study early. Univariate predictors of AF detection included age (per 1-year increments: hazard ratio [HR], 1.05; 95% CI, 1.01-1.09; P = .02), CHA2DS2-VASc score (per point: HR, 1.54; 95% CI, 1.15-2.06; P = .004), chronic obstructive pulmonary disease (HR, 2.49; 95% CI, 0.86-7.20; P = .09), congestive heart failure (CHF; with preserved or reduced ejection fraction: HR, 6.64; 95% CI, 2.29-19.24; P < .001), left atrial enlargement (LAE; HR, 3.63; 95% CI, 1.55-8.47; P = .003), QRS duration (HR, 1.02; 95% CI, 1.00-1.04; P = .04), and kidney dysfunction (HR, 3.58; 95% CI, 1.35-9.46; P = .01). In multivariable modeling (n = 197), only CHF (HR, 5.06; 95% CI, 1.45-17.64; P = .05) and LAE (HR, 3.32; 1.34-8.19; P = .009) remained significant predictors of AF. At 12 months, patients with CHF and/or LAE (40 of 142 patients) had an AF detection rate of 23.4% vs 5.0% for patients with neither (HR, 5.1; 95% CI, 2.0-12.8; P < .001). Conclusions and Relevance Among patients with ischemic stroke attributed to large- or small-vessel disease, CHF and LAE were associated with a significantly increased risk of poststroke AF detection. These patients may benefit most from the use of ICMs as part of a secondary stroke prevention strategy. However, the study was not powered for clinical predictors of AF, and therefore, other clinical characteristics may not have reached statistical significance. Trial Registration ClinicalTrials.gov Identifier: NCT02700945.
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Affiliation(s)
- Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York, New York,Deputy Editor, JAMA Neurology
| | - Christopher B. Granger
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jonathan P. Piccini
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey M. Katz
- Department of Neurology and Radiology, North Shore University Hospital, Manhasset, New York
| | - Pramod P. Sethi
- Guilford Neurology Associates, Moses H. Cone Hospital, Greensboro, North Carolina
| | - Evgeny V. Sidorov
- Department of Neurology, The University of Oklahoma Health Sciences Center, Oklahoma City
| | - Scott E. Kasner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Noreli Franco
- Clinical Department, Medtronic, Minneapolis, Minnesota
| | | | - Richard A. Bernstein
- Davee Department of Neurology, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
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Joseph C, Cooper J, Sikka R, Zagrodzky J, Turer RW, McDonald SA, Kulstad E, Daniels J. Improved hospital discharge and cost savings with esophageal cooling during left atrial ablation. J Med Econ 2023; 26:158-167. [PMID: 36537305 DOI: 10.1080/13696998.2022.2160596] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Left atrial ablation to obtain pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) is a technologically intensive procedure utilizing innovative and continually improving technology. Changes in the technology utilized for PVI can in turn lead to changes in procedure costs. Because of the proximity of the esophagus to the posterior wall of the left atrium, various technologies have been utilized to protect against thermal injury during ablation. The impact on hospital costs during PVI ablation from utilization of different technologies for esophageal protection during ablation has not previously been evaluated. OBJECTIVE To compare the costs of active esophageal cooling to luminal esophageal temperature (LET) monitoring during left atrial ablation. METHODS We performed a time-driven activity-based costing (TDABC) analysis to determine costs for PVI procedures. Published data and literature review were utilized to determine differences in procedure time and same-day discharge rates using different esophageal protection technologies and to determine the cost impacts of same-day discharge versus overnight hospitalization after PVI procedures. The total costs were then compared between cases using active esophageal cooling to those using LET monitoring. RESULTS The effect of implementing active esophageal cooling was associated with up to a 24.7% reduction in mean total procedure time, and an 18% increase in same-day discharge rate. TDABC analysis identified a $681 reduction in procedure costs associated with the use of active esophageal cooling after including the cost of the esophageal cooling device. Factoring in the 18% increase in same-day discharge resulted in an increased cost savings of $2,135 per procedure. CONCLUSIONS The use of active esophageal cooling is associated with significant cost-savings when compared to traditional LET monitoring, even after accounting for the additional cost of the cooling device. These savings originate from a per-patient procedural time savings and a per-population improvement in same-day discharge rate.
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Affiliation(s)
| | - Julie Cooper
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rishi Sikka
- Policy and Practice, Brown University School of Public Health, Providence, RI, USA
- Lifeforce Capital, San Francisco, CA, USA
| | - Jason Zagrodzky
- Texas Cardiac Arrhythmia Institute, St. David's South Austin Medical Center, Austin, TX, USA
| | - Robert W Turer
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Daniels
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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de Vos L, Mazinyo E, Bezuidenhout D, Ngcelwane N, Mandell DS, Schriger SH, Daniels J, Medina-Marino A. Reasons for missed opportunities to screen and test for TB in healthcare facilities. Public Health Action 2022; 12:171-173. [PMID: 36561902 PMCID: PMC9716824 DOI: 10.5588/pha.22.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/27/2022] [Indexed: 12/03/2022] Open
Abstract
Missed opportunities for TB screening and/or passive testing in clinics continues to contribute to the number of missed cases. To understand reasons for these missed opportunities, we conducted focus group discussions with clinic-based nurses. Nurses described low indices of suspicion, prioritization of seemingly more urgent ailments and clinic operational challenges as barriers to TB screening and testing. To improve TB screening and testing in clinics, standard patients should be used to identify real-time factors that impact nurses' clinical decision-making and engage in real-time feedback and discussion with nurses to help optimize opportunities for TB screening and testing.
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Affiliation(s)
- L de Vos
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - E Mazinyo
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - D Bezuidenhout
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - N Ngcelwane
- Department of Health, Buffalo City Metro Health District, Eastern Cape Province, South Africa
| | - D S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S H Schriger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J Daniels
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - A Medina-Marino
- Research Unit, Foundation for Professional Development, East London, South Africa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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8
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Cooper J, Joseph C, Zagrodzky J, Woods C, Metzl M, Turer RW, McDonald SA, Kulstad E, Daniels J. Active esophageal cooling during radiofrequency ablation of the left atrium: data review and update. Expert Rev Med Devices 2022; 19:949-957. [PMID: 36413154 PMCID: PMC9839561 DOI: 10.1080/17434440.2022.2150930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Radiofrequency (RF) ablation of the left atrium of the heart is increasingly used to treat atrial fibrillation (AF). Unfortunately, inadvertent thermal injury to the esophagus can occur during this procedure, potentially creating an atrioesophageal fistula (AEF) which is 80% fatal. The ensoETM (Attune Medical, Chicago, IL), is an esophageal cooling device that has been shown to reduce thermal injury to the esophagus during RF ablation. AREAS COVERED This review summarizes growing evidence related to active esophageal cooling during RF ablation for the treatment of AF. The review presents data demonstrating improved outcomes related to patient safety and procedural efficiency and suggests directions for future research. EXPERT OPINION The use of active esophageal cooling during RF ablation reduces esophageal injury, reduces or eliminates fluoroscopy requirements, reduces procedure duration and post-operative pain, and increases long-term freedom from arrhythmia. These effects in turn increase patient same-day discharge rates, decrease operator cognitive load, and reduce cost. These findings are likely to further accelerate the adoption of active esophageal cooling.
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Affiliation(s)
- Julie Cooper
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | | | - Jason Zagrodzky
- Texas Cardiac Arrhythmia Institute, St. David’s South Austin Medical Center, Austin, TX 78704
| | | | - Mark Metzl
- NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL 60201
| | - Robert W. Turer
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | | | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - James Daniels
- University of Texas Southwestern Medical Center, Dallas, TX 75390
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10
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Mercado Montoya M, Gomez Bustamante T, Berjano E, Hernandez Arango P, Mickelsen S, Schieber J, Kulstad E, Daniels J. An analysis of the influence of atrial wall thickness on the protective effects of proactive esophageal cooling during high-power short-duration radiofrequency ablation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The use of proactive esophageal cooling using a dedicated cooling device during radiofrequency (RF) left atrial ablation has increased, with endoscopic studies showing reductions in esophageal lesions using medium power ablation settings. With no atrioesophageal fistula yet identified using esophageal cooling, and clinical practice increasingly shifting to high-power short-duration (HPSD) ablation, additional data on the protective potential of this technique in HPSD ablation may help guide RF ablation strategies. In particular, a better understanding of the effects of anatomical variations in myocardial thickness on cooling efficacy is warranted.
Purpose
We sought to evaluate the influence of atrial wall thickness on the protective effects of proactive esophageal cooling during HPSD ablation.
Methods
Using a computer model of the left atrium and esophagus, we analyzed the esophageal damage that occurs under two HPSD ablation conditions (50 W for 10 s and 90 W for 4 s) with and without proactive esophageal cooling while varying atrial wall thickness. Injury to the esophagus was quantified using the Arrhenius equation as well as by determining the percentage of tissue reaching a 50°C lethal isotherm. Atrial thickness was varied between 0.6 mm to 2.0 mm. Esophageal cooling was set to the recommended 4°C coolant temperature.
Results
Using 50 W power settings in control (non-cooled) conditions, esophageal lesion transmurality ranged from 75% to 82% as calculated by the Arrhenius equation, with decreased transmurality seen as atrial wall thickness increased. With the addition of proactive cooling, lesion transmurality decreased to less than 43% in the thinnest atrial wall sections, and to less than 25% in the thickest atrial wall sections. Using 90 W power settings, control conditions showed esophageal lesion transmurality ranging from 52% to 63%, with the greatest damage seen in the middle-range atrial thicknesses (1 and 1.5 mm). Active esophageal cooling reduced this esophageal injury to less than 12% transmurality through the esophagus in all anatomic scenarios.
Conclusions
Modeling suggests that the use of proactive esophageal cooling significantly reduces esophageal lesion transmurality under HPSD ablation conditions across a range of typical atrial wall thicknesses, including in very thin myocardium, where the risk of esophageal injury is greatest.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Attune
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Affiliation(s)
| | | | - E Berjano
- Universitat Politècnica de València, Department of Electronic Engineering , Valencia , Spain
| | | | - S Mickelsen
- University of Iowa, Electrophysiology , Iowa City , United States of America
| | - J Schieber
- Illinois Institute of Technology, Chemical Engineering , Chicago , United States of America
| | - E Kulstad
- University of Texas Southwestern Medical School, Emergency Medicine , Dallas , United States of America
| | - J Daniels
- University of Texas Southwestern Medical Center, Electrophysiology , Dallas , United States of America
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Cooper J, Joseph C, Xiong T, Brar D, Kostov V, Kulstad E, Daniels J. Patient age, gender, and early outcome after PVI atrial ablation: analysis of a large regional database. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Demographics such as patient age and gender have been inconsistently found to be associated with outcome after ablation to achieve pulmonary vein isolation (PVI). A database created by the Dallas-Fort Worth Hospital Council (DFWHC) includes a collaboration of 90 member hospitals in North Texas reporting data on procedures, diagnoses, and discharges. All patients in this system can be followed longitudinally via unique identification number. The availability of this large, regional database offers opportunities to better characterize trends.
Objective
Characterize the association between age, gender, and 60-day outcome in patients receiving PVI over a 7-year time span.
Methods
Using the DFWHC database, all PVI procedures performed from January 2013 to December 2019 were identified. Follow up visits for this cohort of patients were then obtained, and outcomes recorded. Early mortalities (occurring less than 60 days from PVI), mean age and patient gender were determined for each of the groups and compared.
Results
A total of 11,880 unique PVI procedures were performed over this 7 year timeframe. Mean patient age was 64±10 years, with 66% male and 34% female. A total of 130 mortalities at any time after PVI occurred (1.1%), with 19 (0.16%) occurring within 60 days of the procedure. In multivariate analysis, the risk of 60-day mortality increased with year of procedure (OR 1.07, 95% CI 0.85 to 1.4) and female gender (OR 1.43, 95% CI 0.57 to 3.6), and decreased with age (OR 0.99, 95% CI 0.95 to 1.03); however no variable demonstrated statistically significant association with outcome.
Conclusions
Although trends towards increasing mortality over time and in female patients were seen, the total number of events remained low, and no statistically significant associations between age, gender, and early mortality were identified in this large regional database.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Cooper
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - C Joseph
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - T Xiong
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - D Brar
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - V Kostov
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - E Kulstad
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - J Daniels
- University of Texas Southwestern Medical Center , Dallas , United States of America
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Tyeku N, Apolisi I, Daniels J, Beko B, Memani B, Cengani L, Fatshe S, Gumede N, Joseph K, Mathee S, Furin J, Maugans C, Cox H, Reuter A. Pediatric delamanid treatment for children with rifampicin-resistant TB. Int J Tuberc Lung Dis 2022; 26:986-988. [PMID: 36163672 PMCID: PMC9524514 DOI: 10.5588/ijtld.22.0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- N Tyeku
- Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
| | - I Apolisi
- Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
| | - J Daniels
- Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
| | - B Beko
- Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
| | - B Memani
- Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
| | - L Cengani
- Department of Health, Province of the Western Cape, Cape Town, South Africa
| | - S Fatshe
- Department of Health, Province of the Western Cape, Cape Town, South Africa
| | - N Gumede
- Department of Health, Province of the Western Cape, Cape Town, South Africa
| | - K Joseph
- Department of Health, City of Cape Town, Cape Town, South Africa
| | - S Mathee
- Department of Health, Province of the Western Cape, Cape Town, South Africa
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - C Maugans
- The Sentinel Project on Pediatric Drug Resistant Tuberculosis, Boston, MA, USA
| | - H Cox
- Institute of Infectious Diseases and Molecular Medicine, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - A Reuter
- Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
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13
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Joseph C, Cooper J, Turer RW, McDonald SA, Kulstad EB, Daniels J. Reduced Procedure Time and Variability with Active Esophageal Cooling During Radiofrequency Ablation for Atrial Fibrillation. J Vis Exp 2022. [PMID: 36094261 DOI: 10.3791/64417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Various methods are utilized during radiofrequency (RF) pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) to protect the esophagus from inadvertent thermal injury. Active esophageal cooling is increasingly being used over traditional luminal esophageal temperature (LET) monitoring, and each approach may influence procedure times and the variability around those times. The objective of this study is to measure the effects on procedure time and variability in procedure time of two different esophageal protection strategies utilizing advanced informatics techniques to facilitate data extraction. Trained clinical informaticists first performed a contextual inquiry in the catheterization laboratory to determine laboratory workflows and observe the documentation of procedural data within the electronic health record (EHR). These EHR data structures were then identified in the electronic health record reporting database, facilitating data extraction from the EHR. A manual chart review using a REDCap database created for the study was then performed to identify additional data elements, including the type of esophageal protection used. Procedure duration was then compared using summary statistics and standard measures of dispersion. A total of 164 patients underwent radiofrequency PVI over the study timeframe; 63 patients (38%) were treated with LET monitoring, and 101 patients (62%) were treated with active esophageal cooling. The mean procedure time was 176 min (SD of 52 min) in the LET monitoring group compared to 156 min (SD of 40 min) in the esophageal cooling group (P = 0.012). Thus, active esophageal cooling during PVI is associated with reduced procedure time and reduced variation in procedure time when compared to traditional LET monitoring.
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Affiliation(s)
- Christopher Joseph
- Department of Emergency Medicine, University of Texas Southwestern Medical Center
| | - Julie Cooper
- Department of Internal Medicine, University of Texas Southwestern Medical Center
| | - Robert W Turer
- Department of Emergency Medicine and Clinical Informatics Center, University of Texas Southwestern Medical Center
| | - Samuel A McDonald
- Department of Emergency Medicine and Clinical Informatics Center, University of Texas Southwestern Medical Center
| | | | - James Daniels
- Department of Electrophysiology, University of Texas Southwestern Medical Center
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14
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Nazareth D, Sumner C, Daniels J, Mathews J, Hyde G, Walshaw M. Managing an adult CF population in the COVID-19 pandemic-1 year on. QJM 2022; 115:521-524. [PMID: 34432060 PMCID: PMC8499742 DOI: 10.1093/qjmed/hcab228] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/19/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The advent of the COVID-19 pandemic in 2020 required an alteration in the routine care of people with CF (pwCF), deemed to be extremely vulnerable. AIM We wished to report the alterations in clinical practice, including the introduction of remote video-assisted clinics, made to manage the adult pwCF attending our large centre. METHODS We studied clinical records over a period of 2 years (March 2019 to February 2021) by comparing 19th March to 20th February (Y1) with 20th March to 21st February (Y2). RESULTS We have shown out of hospital Multi Disciplinary Team (MDT) support increased and a greater proportion of IV therapy was administered at home. The VAC model of care increased clinical activity while reducing clinic non-attendance rates, suggesting more individuals engage with their carers. CONCLUSIONS This new model of care has allowed greater engagement with pwCF.
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Affiliation(s)
- D Nazareth
- Address correspondence to Dilip Nazareth, Adult CF Unit, Liverpool Heart and Chest Hospital NHS Trust, Thomas Drive, Liverpool L14 3PE, UK.
| | - C Sumner
- From the Adult CF Unit, Liverpool Heart and Chest Hospital NHS Trust, Thomas Drive, University of Liverpool, Liverpool L14 3PE, UK
| | - J Daniels
- From the Adult CF Unit, Liverpool Heart and Chest Hospital NHS Trust, Thomas Drive, University of Liverpool, Liverpool L14 3PE, UK
| | - J Mathews
- Division of Medicine, Liverpool Heart and Chest Hospital NHS Trust, Thomas Drive, Liverpool L14 3PE, UK
| | - G Hyde
- Digital Systems Team, Liverpool Heart and Chest Hospital NHS Trust, Thomas Drive, Liverpool L14 3PE, UK
| | - M Walshaw
- From the Adult CF Unit, Liverpool Heart and Chest Hospital NHS Trust, Thomas Drive, University of Liverpool, Liverpool L14 3PE, UK
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15
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Memani B, Beko B, Dumile N, Mohr-Holland E, Daniels J, Sibanda B, Damse Z, Scott V, von der Heyden E, Pfaff C, Reuter A, Furin J. Causes of loss to follow-up from drug-resistant TB treatment in Khayelitsha, South Africa. Public Health Action 2022; 12:55-57. [PMID: 35734003 PMCID: PMC9176197 DOI: 10.5588/pha.21.0083] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/22/2022] [Indexed: 01/24/2023] Open
Abstract
Patients initiated on drug-resistant TB(DR-TB) treatment in 2019 in Khayelitsha, South Africa, with a loss to follow-up outcome were evaluated to better understand reasons for loss to follow-up and to determine if any had returned to care. Of a total of 187 patients, 28 (15%) were lost to follow-up (LTFU), 24 (86%) of whom were traced: 20/24 (83%) were found when they re-presented to facilities and 8/28 (29%) were linked back to DR-TB care. People with DR-TB continue to seek care even after being LTFU; thus better coordination between different components of the healthcare system are required to re-engage with these patients. Interventions to mitigate the socio-economic challenges of people on DR-TB treatment are needed. Many people who were LTFU and symptomatic were willing to re-engage with DR-TB care, which highlights the importance of for compassionate interventions to welcome them back.
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Affiliation(s)
- B. Memani
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - B. Beko
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - N. Dumile
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - E. Mohr-Holland
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
, MSF Southern Africa Medical Unit, Cape Town, South Africa
| | - J. Daniels
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - B. Sibanda
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - Z. Damse
- City of Cape Town Department of Health, Eastern Area, Cape Town, South Africa
| | - V. Scott
- City of Cape Town Department of Health, Eastern Area, Cape Town, South Africa
| | | | - C. Pfaff
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - A. Reuter
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - J. Furin
- Harvard Medical School, Boston, MA, USA
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Kulstad E, Mercado-Montoya M, Gomez-Bustamante T, Berjano E, Mickelsen S, Daniels J, Hernandez-Arango P, Schieber J. Influence of tissue thickness on thermal latency during high-power short-duration radiofrequency ablation with proactive esophageal cooling. Europace 2022. [DOI: 10.1093/europace/euac053.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Thermal latency, or delayed heating, is increasingly recognized as an important factor in the formation of both intentional and unintentional lesions during radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF). High-power short-duration (HPSD) ablation appears to have greater thermal latency than low or medium power ablation. Proactive esophageal cooling (PEC) has been shown to reduce esophageal lesion formation under a variety of conditions by directly reducing the effects of thermal latency, but the influence of anatomic dimensions on the protective efficacy of cooling during HPSD ablation has not been investigated.
Purpose
Determine the impact of changes in pericardial tissue thickness on thermal latency in order to quantify the protective efficacy of PEC across a range of anatomic dimensions.
Methods
We created a mathematical model of the left atrium undergoing HPSD ablation, both with and without a PEC device in place, using a range of pericardial tissue thicknesses (0.5, 0.75, and 1 mm). HPSD ablation was set at 50 W for 10 s, or 90 W for 4 s. We then examined the temperature dynamics at a range of thickness, focusing on the layer of mostly fatty tissue between the atrial and esophageal walls by varying the thickness of this layer while quantifying the degree of esophageal damage using the Arrhenius equation to determine the fraction of damage after peak heating has occurred.
Results
Under control conditions, the growth of lesions from RF ablation at both 50 W and 90 W was found to continue for greater than 10 seconds beyond the cessation of RF energy application. Esophageal lesion formation ranged from 71% to 96% transmurality after 50 W ablation for 10 s, and from 50% to 72% transmurality after 90 W ablation for 4 s. With PEC in place, esophageal lesion transmurality was markedly reduced, with a maximum transmurality ranging from 12% to 32% with 50 W ablation, and from 2% to 20% with 90 W ablation (Figure). Increasing thickness of pericardial tissue (with simulations of 0.5, 0.75, and 1 mm) resulted in decreasing esophageal lesion transmurality (67%, 74%, and 83% at 50 W power, and 72%, 82%, and 96% at 90 W power, respectively, with the 0.5, 0.75, and 1 mm simulations).
Conclusions
Thermal latency with HPSD ablation contributes to lesion growth and can cause esophageal injury. Proactive esophageal cooling counteracts this effect across a range of pericardial tissue thicknesses, and reduces esophageal lesion transmurality by an average of 79%.
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Affiliation(s)
- E Kulstad
- University of Texas Southwestern Medical School, Emergency Medicine, Dallas, United States of America
| | | | | | - E Berjano
- Universitat Politecnica de Valencia, Valencia, Spain
| | - S Mickelsen
- University of Iowa, Iowa City, United States of America
| | - J Daniels
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | | | - J Schieber
- Illinois Institute of Technology, Chicago, United States of America
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Mohr-Holland E, Daniels J, Reuter A, Rodriguez CA, Mitnick C, Kock Y, Cox V, Furin J, Cox H. Early mortality during rifampicin-resistant TB treatment. Int J Tuberc Lung Dis 2022; 26:150-157. [PMID: 35086627 PMCID: PMC8802559 DOI: 10.5588/ijtld.21.0494] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND: Data suggest that treatment with newer TB drugs (linezolid [LZD], bedaquiline [BDQ] and delamanid [DLM]), used in Khayelitsha, South Africa, since 2012, reduces mortality due to rifampicin-resistant TB (RR-TB).METHODS: This was a retrospective cohort study to assess 6-month mortality among RR-TB patients diagnosed between 2008 and 2019.RESULTS: By 6 months, 236/2,008 (12%) patients died; 12% (78/651) among those diagnosed in 2008-2011, and respectively 8% (49/619) and 15% (109/738) with and without LZD/BDQ/DLM in 2012-2019. Multivariable analysis showed a small, non-significant mortality reduction with LZD/BDQ/DLM use compared to the 2008-2011 period (aOR 0.79, 95% CI 0.5-1.2). Inpatient treatment initiation (aOR 3.2, 95% CI 2.4-4.4), fluoroquinolone (FQ) resistance (aOR 2.7, 95% CI 1.8-4.2) and female sex (aOR 1.5, 95% CI 1.1-2.0) were also associated with mortality. When restricted to 2012-2019, use of LZD/BDQ/DLM was associated with lower mortality (aOR 0.58, 95% CI 0.39-0.87).CONCLUSIONS: While LZD/BDQ/DLM reduced 6-month mortality between 2012 and 2019, there was no significant effect overall. These findings may be due to initially restricted LZD/BDQ/DLM use for those with high-level resistance or treatment failure. Additional contributors include increased treatment initiation among individuals who would have otherwise died before treatment due to universal drug susceptibility testing from 2012, an effect that also likely contributed to higher mortality among females (survival through to care-seeking).
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Affiliation(s)
- E Mohr-Holland
- Khayelitsha Project, Médecins Sans Frontières (MSF), Cape Town, South Africa, Southern Africa Medical Unit, MSF, Cape Town, South Africa
| | - J Daniels
- Khayelitsha Project, Médecins Sans Frontières (MSF), Cape Town, South Africa
| | - A Reuter
- Khayelitsha Project, Médecins Sans Frontières (MSF), Cape Town, South Africa
| | - C A Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - C Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Y Kock
- National Department of Health, Pretoria, South Africa
| | - V Cox
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - H Cox
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape Town, South Africa, Institute for Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa
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18
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Carey K, Alban T, Daniels J, Stocks A, Kaider A. 328: What COVID taught us—Collaboration in pursuit of expanded paid leave. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01752-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Alkhateb R, Prajapati V, Daniels J, Greebon L. RhD negative women transfused RhD positive blood: Alloimmunization prophylaxis protocol and experiences. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Preventing allomiunization from D-mismatched transfusions, i.e., transfusion RhD positive (RhD+) red blood cells (RBC) to an RhD negative (RhD–) individual, is not well established. We describe our hospital protocol and experiences managing RhD– young women who received emergency release D-mismatched transfusions.
Methods/Case Report
The pathologists evaluate all patients who received D-mismatched blood transfusions. The inclusion criteria for alloimmunization prophylaxis protocol include: RhD– females; <50 years old; No current or historical Anti-D; and received ≥1 unit of RhD+ blood.
The prophylaxis protocol depends on the RBC volume (RBCV) transfused. Patients who receive RBCV <20% of their total blood volume (TBV) are eligible to receive high dose RhIg, calculated based on the volume transfused. Those who received RBCV ≥20% of TBV would be eligible for red cell exchange (RBCX) followed by RhIg.
Results (if a Case Study enter NA)
Since 2016, four eligible patients received RhIg prophylaxis protocol and none met the criteria for RBCX. All the patients started the prophylaxis protocol within 24 hours of transfusion and completed it within 72 hours. One patient developed post treatment hemolysis and significant drop in hemoglobin requiring blood transfusion. Passive anti-D post treatment was confirmed in three patients, and one had passive anti C. Three of the four patients had follow up antibody screens >6 months post treatment that were negative for RhD alloimmunization.
Conclusion
Our therapeutic plan, the first well established protocol, involves identifying eligible patients based on set criteria and protocols. Our experience demonstrates that this protocol is effective in reducing/preventing RhD alloimmunization.
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Affiliation(s)
- R Alkhateb
- Pathology, University of Texas San Antonio, San Antonio, Texas, UNITED STATES
| | - V Prajapati
- Pathology, University of Texas San Antonio, San Antonio, Texas, UNITED STATES
| | - J Daniels
- Pathology, University of Texas San Antonio, San Antonio, Texas, UNITED STATES
| | - L Greebon
- Pathology, University of Texas San Antonio, San Antonio, Texas, UNITED STATES
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Turner T, Daniels J, Belloso A. 977 The Role of Telephone Triage in Head and Neck Cancer Care in a Teaching Hospital. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
NHS England sets standards to ensure prompt specialist review, diagnosis, and treatment of cancer. Patients with suspected cancer should receive specialist review within 14 days of referral, diagnosis by day 28 and first treatment by day 62. To reduce transmission during the SARS-CoV-2 pandemic, the NHS recommended telephone triage as the first specialist appointment. The effect of telephone triage on head and neck cancer timeframes in an NHS teaching hospital was assessed.
Method
Four head and neck cancer telephone triage clinics during July 2020 were selected at random. Clinical correspondence and the electronic patient records were reviewed for each patient and cancer pathway timeframes were analysed.
Results
31 patients were referred for telephone triage and 100% received specialist review within 14 days. Subsequently 17 (55%) patients were investigated, 12 (71%) of which received a diagnosis within 28 days. 4 patients received a cancer diagnosis, but none received first treatment within 62 days. 24 (77%) patients were seen in a face-to-face clinic after telephone triage on average 7 days after telephone triage.
Conclusions
In this sample, telephone triage allowed safe initial specialist review by meeting the 14-day standard. However, the 28-day diagnosis and 62-day treatment standards were not adhered to. Telephone triage does not largely reduce overall patient contact, with 77% of patients subsequently reviewed in a patient-facing setting. The addition of telephone triage delayed first clinical examination by a specialist by an average of 7 days, which may be a contributing factor to the delays seen in diagnosis and treatment.
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Affiliation(s)
- T Turner
- East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
| | - J Daniels
- East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
| | - A Belloso
- East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
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21
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Reuling E, Naves D, Daniels J, Dickhoff C, Kortman P, Plaisier P, Thunnissen E, Radonic T. FP14.03 Diagnostic Accuracy in Central Pulmonary Carcinoid tumors is Dependent of Biopsy Size. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Reuling E, Naves D, Thunnissen E, Kortman P, Broeckaert M, Plaisier P, Dickhoff C, Daniels J, Radonic T. P66.04 A Multimodal Biomarker Predicts Dissemination of Bronchial Carcinoid. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Latta L, Figueiredo FC, Ashery-Padan R, Collinson JM, Daniels J, Ferrari S, Szentmáry N, Solá S, Shalom-Feuerstein R, Lako M, Xapelli S, Aberdam D, Lagali N. Pathophysiology of aniridia-associated keratopathy: Developmental aspects and unanswered questions. Ocul Surf 2021; 22:245-266. [PMID: 34520870 DOI: 10.1016/j.jtos.2021.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 04/10/2021] [Revised: 07/19/2021] [Accepted: 09/08/2021] [Indexed: 12/13/2022]
Abstract
Aniridia, a rare congenital disease, is often characterized by a progressive, pronounced limbal insufficiency and ocular surface pathology termed aniridia-associated keratopathy (AAK). Due to the characteristics of AAK and its bilateral nature, clinical management is challenging and complicated by the multiple coexisting ocular and systemic morbidities in aniridia. Although it is primarily assumed that AAK originates from a congenital limbal stem cell deficiency, in recent years AAK and its pathogenesis has been questioned in the light of new evidence and a refined understanding of ocular development and the biology of limbal stem cells (LSCs) and their niche. Here, by consolidating and comparing the latest clinical and preclinical evidence, we discuss key unanswered questions regarding ocular developmental aspects crucial to AAK. We also highlight hypotheses on the potential role of LSCs and the ocular surface microenvironment in AAK. The insights thus gained lead to a greater appreciation for the role of developmental and cellular processes in the emergence of AAK. They also highlight areas for future research to enable a deeper understanding of aniridia, and thereby the potential to develop new treatments for this rare but blinding ocular surface disease.
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Affiliation(s)
- L Latta
- Dr. Rolf. M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg, Saar, Germany; Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar, Germany.
| | - F C Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - R Ashery-Padan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - J M Collinson
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Institute of Medical Sciences, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom
| | - J Daniels
- Cells for Sight, UCL Institute of Ophthalmology, University College London, London, EC1V 9EL, UK
| | - S Ferrari
- The Veneto Eye Bank Foundation, Venice, Italy
| | - N Szentmáry
- Dr. Rolf. M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg, Saar, Germany
| | - S Solá
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - R Shalom-Feuerstein
- Department of Genetics and Developmental Biology, The Rappaport Faculty of Medicine and Research Institute, Technion - Israel Institute of Technology, Haifa, Israel
| | - M Lako
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - S Xapelli
- Instituto Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - D Aberdam
- Centre de Recherche des Cordeliers, INSERM U1138, Team 17, France; Université de Paris, 75006, Paris, France.
| | - N Lagali
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway.
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Mohr-Holland E, Hacking D, Daniels J, Scott V, Mudaly V, Furin J, Pfaff C, Reuter A. Diagnosis patterns for rifampicin-resistant TB after onset of COVID-19. Int J Tuberc Lung Dis 2021; 25:772-775. [PMID: 34802503 PMCID: PMC8412107 DOI: 10.5588/ijtld.21.0340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/11/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- E Mohr-Holland
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa, MSF Southern Africa Medical Unit, Cape Town, South Africa
| | - D Hacking
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - J Daniels
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - V Scott
- City of Cape Town Department of Health, Eastern Area, Cape Town, South Africa
| | - V Mudaly
- Provincial Government of the Western Cape, Cape Town, South Africa
| | - J Furin
- Harvard Medical School, Boston, MA, USA
| | - C Pfaff
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - A Reuter
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
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25
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Hui J, Jeong DH, Daniels J. Using Point Of Care Ultrasound To Evaluate A Curious Case Of Back Pain In A Hockey Player. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764056.74505.ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Silverthorne C, Daniels J, Thompson M, Robson J, Ndosi M, Swales C, Wilkins K, Dures E. POS1472-HPR CLINICIANS’ PERSPECTIVES ON PSYCHOLOGICAL DISTRESS AND MEETING PATIENTS’ SUPPORT NEEDS IN RHEUMATOLOGY CARE SETTINGS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:People with inflammatory rheumatic diseases (IRDs) face challenges that include fluctuations in pain, fatigue and flares of disease activity, complex medical regimens, and decisions about when to seek clinical help with symptoms [1,2]. Evidence suggests levels of anxiety and depression are higher in people with IRDs compared to the general population [3]. Rheumatology teams report that psychologically distressed patients can have additional support needs and require more time. Patients’ concerns include health-related anxiety and difficulty accepting the diagnosis. This group can have poor outcomes and poor adherence to treatments. However, little is currently known about optimal ways to meet these patients’ support needs.Objectives:To understand rheumatology clinicians’ perspectives on psychological distress in care settings with the long-term aim to develop a proposed model/pathway of support.Methods:Telephone interviews were conducted with members of UK rheumatology teams who have clinical experience with patients experiencing distress. The semi-structured interviews explored both ‘what happens now’ (current clinical practice) and ‘what should happen’ (acceptable models of future psychological support provision). The semi-structured format provided flexibility to probe more deeply and develop new lines of enquiry based on participants’ responses.Results:Fourteen interviews were conducted with rheumatology clinicians including 2 consultants, 4 nurses, 1 physiotherapist, 4 occupational therapists, 2 clinical psychologists and 1 podiatrist. Inductive thematic analysis was used to analyse the data. Two main themes represent the data (Table 1).Table 1.Main ThemeSub-themes1. ‘No one shoe fits all’ – the many manifestations of distress in patients.‘I pick up on distress as increased emotion…tearfulness and sadness I suppose, but also frustration, anger...A lot of helplessness comments’1. ‘Distress can be quite emotive and quite obvious, but then it can also hide away’2. ‘They’re [patients] trying to manage their own conditions, but they’re also trying to manage life’2. ‘If Rheumatology could be interwoven with psychological principles’ – the need to attend to the psychological impact of IRDs, alongside the physical impact.‘The physical and mental health side of things are so closely linked because one affects the other…after a while they [patients] don’t really know what’s affecting what’1. ‘Prioritising physical health…sometimes the stress gets not thought about’2. ‘Make best use of everyone in the team to work with patients who are struggling’3. ‘For the psychological side of things we don’t measure anything about that at all’Conclusion:Distress can be obvious or hidden and cause issues for both patient and clinician. It can lead to poor engagement with care provision. Clinicians differ in their perceptions of distress and in their thresholds for dealing with distress and have described the inconsistency of support offered for distressed patients. They described the powerful link between physical and mental distress, the vicious cycle that can develop, and the benefits of incorporating a psychological approach to treatment. This study suggests psychological support should be embedded within the team as it is felt there is a need for speciality understanding and for patients’ emotional wellbeing to consistently be given equal priority to their physical wellbeing.References:[1]Gettings L. Psychological well-being in rheumatoid arthritis: a review of the literature. Musculoskeletal care 2010;8(2):99-106. doi: 10.1002/msc.171 [published Online First: 2010/03/17][2]Homer D. Addressing psychological and social issues of rheumatoid arthritis within the consultation: a case report. Musculoskeletal care 2005;3(1):54-9. doi: 10.1002/msc.26 [published Online First: 2006/10/17][3]Isik A, Koca SS, Ozturk A, et al. Anxiety and depression in patients with rheumatoid arthritis. Clinical rheumatology 2007;26(6):872-8. doi: 10.1007/s10067-006-0407-y [published Online First: 2006/08/31]Disclosure of Interests:None declared
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27
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Rana D, Wu O, Cheed V, Middleton LJ, Moss J, Lumsden MA, McKinnon W, Daniels J, Sirkeci F, Manyonda I, Belli AM, McPherson K. Uterine artery embolisation or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: a cost-utility analysis of the FEMME trial. BJOG 2021; 128:1793-1802. [PMID: 34053154 DOI: 10.1111/1471-0528.16781] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the cost-effectiveness of uterine artery embolisation (UAE) and myomectomy for women with symptomatic uterine fibroids wishing to avoid hysterectomy. DESIGN Economic evaluation alongside the FEMME randomised controlled trial. SETTING 29 UK hospitals. POPULATION Premenopausal women who had symptomatic uterine fibroids amenable to UAE or myomectomy wishing to avoid hysterectomy. 254 women were randomised to UAE (127) and myomectomy (127). METHODS A within-trial cost-utility analysis was conducted from the perspective of the UK NHS. MAIN OUTCOME MEASURES Quality-adjusted life years (QALYs) measured using the EuroQoL EQ-5D-3L, combined with costs to estimate cost-effectiveness over 2 and 4 years of follow-up. RESULTS Over a 2-year time horizon, UAE was associated with higher mean costs (difference £645; 95% CI -1381 to 2580) and lower QALYs (difference -0.09; 95% CI -0.11 to -0.04) when compared with myomectomy. Similar results were observed over the 4-year time horizon. Thus, UAE was dominated by myomectomy. Results of the sensitivity analyses were consistent with the base case results for both years. Over 2 years, UAE was associated with higher costs (difference £456; 95% CI -1823 to 3164) and lower QALYs (difference -0.06; 95% CI -0.11 to -0.02). CONCLUSIONS Myomectomy is a cost-effective option for the treatment of uterine fibroids. The differences in costs and QALYs are small. Women should be fully informed and have the option to choose between the two procedures.
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Affiliation(s)
- D Rana
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - O Wu
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - V Cheed
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - L J Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - J Moss
- School of Medicine, University of Glasgow, Glasgow, UK
| | - M-A Lumsden
- School of Medicine, University of Glasgow, Glasgow, UK
| | - W McKinnon
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - J Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - F Sirkeci
- Department of Obstetrics and Gynaecology, Whipps Cross Hospital, London, UK
| | - I Manyonda
- Department of Gynaecology, St George's Hospital and Medical School, London, UK
| | - A-M Belli
- Department of Radiology, St George's Hospital and Medical School, London, UK
| | - K McPherson
- Department of Primary Care, University of Oxford, Oxford, UK
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Sun A, Bennett A, Patel N, Daniels J, Kaza V, Joglar J, Wu R, Link M. PREDICTORS OF LATE POST LUNG TRANSPLANT ATRIAL FIBRILLATION AND ORGANIZED ATRIAL TACHYCARDIA DIFFER. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01728-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mohr-Holland E, Daniels J, Douglas-Jones B, Mema N, Scott V, Trivino-Duran L, Pfaff C, Furin J, Isaakidis P. A positive COVID-19 test is associated with high mortality in RR-TB-HIV patients. Int J Tuberc Lung Dis 2021; 25:409-412. [PMID: 33977912 PMCID: PMC8091908 DOI: 10.5588/ijtld.21.0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- E Mohr-Holland
- Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa, MSF Southern Africa Medical Unit, Observatory, Cape Town, South Africa
| | - J Daniels
- Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa
| | - B Douglas-Jones
- Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa
| | - N Mema
- Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa
| | - V Scott
- City of Cape Town Health Department, Khayelitsha, Cape Town, South Africa
| | - L Trivino-Duran
- Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa
| | - C Pfaff
- Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa
| | - J Furin
- Harvard Medical School, Boston, MA, USA
| | - P Isaakidis
- MSF Southern Africa Medical Unit, Observatory, Cape Town, South Africa
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30
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Daniels J, Kulstad E. Further mechanistic evidence against luminal esophageal temperature monitoring? J Cardiovasc Electrophysiol 2021; 32:1787-1788. [PMID: 33811712 DOI: 10.1111/jce.15018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 12/20/2022]
Affiliation(s)
- James Daniels
- Department of Internal Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Erik Kulstad
- Department of Emergency Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas, USA
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Leow HW, Koscielniak M, Williams L, Saunders PTK, Daniels J, Doust AM, Jones MC, Ferguson GD, Bagger Y, Horne AW, Whitaker LHR. Dichloroacetate as a possible treatment for endometriosis-associated pain: a single-arm open-label exploratory clinical trial (EPiC). Pilot Feasibility Stud 2021; 7:67. [PMID: 33712086 PMCID: PMC7953373 DOI: 10.1186/s40814-021-00797-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 02/15/2021] [Indexed: 01/31/2023] Open
Abstract
Background Endometriosis (where endometrial-like tissue is found outside the uterus) affects ~ 176 million women worldwide and can lead to debilitating pelvic pain. There is an unmet need for new medical treatment options for endometriosis. Pelvic peritoneal mesothelial cells of women with endometriosis exhibit detrimental metabolic reprogramming that creates an environment favouring the formation and survival of endometriosis lesions. We have generated powerful preclinical proof-of-concept data to show that it is possible to correct this metabolic phenotype using dichloroacetate (DCA), a non-hormonal compound previously used to treat rare metabolic disorders in children. We plan a single-arm, open-label, single site exploratory clinical trial to inform the design of a future randomised controlled trial (RCT) to determine the efficacy of DCA for the treatment of endometriosis-associated pain. Methods We will recruit 30 women with endometriosis-associated pain over a 6-month period. All participants will receive approximately 6.25 mg/kg oral DCA capsules twice daily for 6 weeks, with a dose increase to approximately 12.5 mg/kg twice daily for a further 6 weeks if their pain has not been adequately controlled on this dose regime and side-effects are acceptable. If pain is adequately controlled with minimal side-effects, the lower dose will be continued for a further 6 weeks. The primary objective is to determine whether it is possible to achieve acceptable recruitment and retention rates within the defined exclusion and inclusion criteria. Secondary objectives are to determine the acceptability of the trial to participants, including the proposed methods of recruitment, treatment, follow-up frequency and number of questionnaires. The recruitment rate will be determined by the proportion of patients recruited from the pool of eligible women. The retention rate will be determined by the proportion of participants who attended the final trial visit. Discussion This is a feasibility study to explore effectiveness and acceptability of the proposed field methodology (recruitment, retention, study processes and compliance with treatment). The results will be used to inform the design of a future RCT. Trial registration ClinicalTrials.gov, NCT04046081 Registered 6 August 2019
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Affiliation(s)
- H W Leow
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - M Koscielniak
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - L Williams
- Usher Institute, NINE Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | - P T K Saunders
- Centre for Inflammation Research, Queen's Medical Research Institue, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - J Daniels
- Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - A M Doust
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - M-C Jones
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - G D Ferguson
- Reproductive Medicine and Maternal Health, Ferring Research Institute, San Diego, CA, 92121, USA
| | - Y Bagger
- Reproductive Medicine and Maternal Health, Ferring Research Institute, San Diego, CA, 92121, USA
| | - A W Horne
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - L H R Whitaker
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
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Haig-Ferguson A, Cooper K, Cartwright E, Loades M, Daniels J. Practitioner review: health anxiety in children and young people in the context of the COVID-19 pandemic. Behav Cogn Psychother 2021; 49:129-143. [PMID: 32829718 PMCID: PMC7503041 DOI: 10.1017/s1352465820000636] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
Health-related fear is a normal and common response in the face of the global pandemic of COVID-19. Children and young people are frequently being exposed to messages about the threat to health, including from the media and authorities. Whilst for most, their anxiety will be proportionate to the threat, for some, existing pre-occupation with physical symptoms and illness will become more problematic. There is a growing body of evidence that health anxiety may occur in childhood, however much of the literature is taken from research using adult samples. This practitioner review aims to give an overview of the assessment and treatment of health-related worries in children and young people in the context of the COVID-19 pandemic. This review is based on the limited existing evidence in this population and the more substantial evidence base for treating health anxiety in adults. We consider the adaptations needed to ensure such interventions are developmentally appropriate.
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Affiliation(s)
| | - K. Cooper
- Department of Psychology, University of Bath, Bath, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - E. Cartwright
- Department of Psychology, University of Bath, Bath, UK
| | - M.E. Loades
- Department of Psychology, University of Bath, Bath, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - J. Daniels
- Department of Psychology, University of Bath, Bath, UK
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Ronden M, Bahce I, Hashemi S, Paul M, De Haan P, Becker A, Spoelstra F, Dahele M, Dickhoff C, Tiemessen M, Van Diepen D, Tarasevych S, Looysen E, Van Den Brink KM, Haasbeek N, Daniels J, Van Laren M, Roeleveld R, Alberts B, De Fraiture D, Veltman J, Verbakel W, Senan S. P18.02 Factors Influencing Multi-Disciplinary Tumor Board Recommendations in Stage III Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Han H, Williams R, Hingle S, Klamen DL, Rull GM, Clark T, Daniels J. Medical Students' Progress in Detecting and Interpreting Visual and Auditory Clinical Findings. Teach Learn Med 2020; 32:380-388. [PMID: 32281403 DOI: 10.1080/10401334.2020.1749636] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Phenomenon: Detection of visual and auditory clinical findings is part of medical students' core clinical performance abilities that a medical education curriculum should teach, assess, and remediate. However, there is a limited understanding of how students develop these skills. While training physical exam technical skills has received significant attention and emphasis, teaching and assessing medical students' ability to detect and interpret visual and auditory clinical findings skills has been less systematic. Therefore, the purpose of this study is to investigate how medical students' visual and auditory clinical findings skills progress and develop over their four years of undergraduate medical education. This study will provide educators insights that can guide curriculum refinements that lead to improving students' abilities in this area. Approach: A computer-based progress exam was created to measure the longitudinal development of students' abilities to detect and interpret visual and auditory findings. After pilot testing, sixty test items were developed in collaboration with six clinical faculty members and two medical education researchers. The exam includes detection and description of ECG, x-ray, heart sounds, breath sounds, skin lesions, and movement findings. The exam was administered to students at the beginning of each training year since 2014. Additionally, the exam was administered to the Class of 2017 prior to their graduation. Measurement validity and reliability tests were conducted. Descriptive statistics and ANOVA were used to determine progress. Findings: More than 98% of students in four years of training completed the exam each year. The exam instrument had high reliabilities and demonstrated acceptable concurrent validity when compared with other academic performance data. Findings showed that students' visual and auditory clinical findings skills increased each training year until their fourth year. There was no performance improvement between incoming Year 4 students and graduating Year 4 students. While group means increased, class performance did not become more homogeneous across four years. Longitudinal data showed the same performance patterns as the cross-sectional data. Performance of the bottom quartile of graduating fourth-year students was not significantly higher than the performance of the top quartile of incoming first-year students who had not had formal medical training. Insights: A longitudinal study to follow learners' performance in detecting and interpreting visual and auditory clinical findings can provide meaningful insights regarding the effects of medical training programs on performance growth. The present study suggests that our medical curriculum is not effective in bringing all students to a higher level of performance in detecting and interpreting visual and auditory clinical findings. This study calls for further investigation how medical students can develop visual and auditory detection and interpretation skills in undergraduate medical education. There is a need for planned curriculum and assessment of medical students' skills in detecting and interpreting visual and auditory clinical findings.
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Affiliation(s)
- Heeyoung Han
- Department of Medicine Education, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Reed Williams
- J. Roland Folse Professor of Surgical Education, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Susan Hingle
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Debra L Klamen
- Department of Medicine Education, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Gary M Rull
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Ted Clark
- Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - James Daniels
- Department of Family and Community Medicine, Quincy, Illinois, USA
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Reilly JR, Artz DR, Biddinger D, Bobiwash K, Boyle NK, Brittain C, Brokaw J, Campbell JW, Daniels J, Elle E, Ellis JD, Fleischer SJ, Gibbs J, Gillespie RL, Gundersen KB, Gut L, Hoffman G, Joshi N, Lundin O, Mason K, McGrady CM, Peterson SS, Pitts-Singer TL, Rao S, Rothwell N, Rowe L, Ward KL, Williams NM, Wilson JK, Isaacs R, Winfree R. Crop production in the USA is frequently limited by a lack of pollinators. Proc Biol Sci 2020; 287:20200922. [PMID: 33043867 PMCID: PMC7423660 DOI: 10.1098/rspb.2020.0922] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/07/2020] [Indexed: 11/12/2022] Open
Abstract
Most of the world's crops depend on pollinators, so declines in both managed and wild bees raise concerns about food security. However, the degree to which insect pollination is actually limiting current crop production is poorly understood, as is the role of wild species (as opposed to managed honeybees) in pollinating crops, particularly in intensive production areas. We established a nationwide study to assess the extent of pollinator limitation in seven crops at 131 locations situated across major crop-producing areas of the USA. We found that five out of seven crops showed evidence of pollinator limitation. Wild bees and honeybees provided comparable amounts of pollination for most crops, even in agriculturally intensive regions. We estimated the nationwide annual production value of wild pollinators to the seven crops we studied at over $1.5 billion; the value of wild bee pollination of all pollinator-dependent crops would be much greater. Our findings show that pollinator declines could translate directly into decreased yields or production for most of the crops studied, and that wild species contribute substantially to pollination of most study crops in major crop-producing regions.
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Affiliation(s)
- J. R. Reilly
- Department of Ecology, Evolution and Natural Resources, Rutgers University, New Brunswick, NJ 08901, USA
| | - D. R. Artz
- USDA-Agricultural Research Service, Pollinating Insects Research Unit, Logan, UT 84322, USA
| | - D. Biddinger
- Department of Entomology, Pennsylvania State University Fruit Research and Extension Center, Biglerville, PA 17307, USA
| | - K. Bobiwash
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, V5A1S6Canada
- Department of Entomology, University of Manitoba, Winnipeg, MB R3T 2N2Canada
| | - N. K. Boyle
- USDA-Agricultural Research Service, Pollinating Insects Research Unit, Logan, UT 84322, USA
- Department of Entomology, Pennsylvania State University, University Park, PA 16802, USA
| | - C. Brittain
- Department of Entomology and Nematology, University of California Davis, Davis, CA 95616, USA
| | - J. Brokaw
- Department of Entomology, University of Minnesota, St. Paul, MN 55113, USA
| | - J. W. Campbell
- Department of Entomology and Nematology, University of Florida, Gainesville, FL 32611, USA
- USDA Agricultural Research Service, Northern Plains Agricultural Research Laboratory, Sidney, MT 59270, USA
| | - J. Daniels
- Department of Entomology and Nematology, University of Florida, Gainesville, FL 32611, USA
- Florida Museum of Natural History, University of Florida, Gainesville, FL 32611, USA
| | - E. Elle
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, V5A1S6Canada
| | - J. D. Ellis
- Department of Entomology and Nematology, University of Florida, Gainesville, FL 32611, USA
| | - S. J. Fleischer
- Department of Entomology, Pennsylvania State University, University Park, PA 16802, USA
| | - J. Gibbs
- Department of Entomology, University of Manitoba, Winnipeg, MB R3T 2N2Canada
| | - R. L. Gillespie
- Agriculture and Natural Resource Program, Wenatchee Valley College, Wenatchee, WA 98801, USA
| | - K. B. Gundersen
- Department of Entomology, Michigan State University, East Lansing, MI 48824, USA
| | - L. Gut
- Department of Entomology, Michigan State University, East Lansing, MI 48824, USA
| | - G. Hoffman
- Department of Crop and Soil Science, Oregon State University, Corvallis, OR 97331, USA
| | - N. Joshi
- Department of Entomology and Plant Pathology, University of Arkansas, Fayetteville, AR 72701, USA
| | - O. Lundin
- Department of Ecology, Swedish University of Agricultural Sciences, SE-75007 Uppsala, Sweden
| | - K. Mason
- Department of Entomology, Michigan State University, East Lansing, MI 48824, USA
| | - C. M. McGrady
- Department of Applied Ecology, North Carolina State University, Raleigh, NC 27695, USA
| | | | - T. L. Pitts-Singer
- USDA-Agricultural Research Service, Pollinating Insects Research Unit, Logan, UT 84322, USA
| | - S. Rao
- Department of Entomology, University of Minnesota, St. Paul, MN 55113, USA
| | - N. Rothwell
- Northwest Michigan Horticultural Research Center, Michigan State University, Traverse City, MI 49684, USA
| | - L. Rowe
- Department of Entomology, Michigan State University, East Lansing, MI 48824, USA
| | - K. L. Ward
- Department of Entomology and Nematology, University of California Davis, Davis, CA 95616, USA
- National Park Service, Yosemite National Park, CA 95389, USA
| | - N. M. Williams
- Department of Entomology and Nematology, University of California Davis, Davis, CA 95616, USA
| | - J. K. Wilson
- Department of Entomology, Michigan State University, East Lansing, MI 48824, USA
| | - R. Isaacs
- Department of Entomology, Michigan State University, East Lansing, MI 48824, USA
| | - R. Winfree
- Department of Ecology, Evolution and Natural Resources, Rutgers University, New Brunswick, NJ 08901, USA
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Nash N, Daniels J, Miller - Spears E, Carmichael R. Kindness For Weakness. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000681392.05706.a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, Wilson R, Asif U, Connor M, Dindyal S, Math N, Pagarkar A, Saleem H, Seth I, Sharma S, Standfield N, Swartbol T, Adamson R, Choi JE, El Tokhy O, Ho W, Javaid NR, Kelly M, Mehdi AS, Menon D, Plumptre I, Sturrock S, Turner J, Warren O, Crane E, Ferris B, Gadsby C, Smallwood J, Vipond M, Wilson V, Amarnath T, Doshi A, Gregory C, Kandiah K, Powell B, Spoor H, Toh C, Vizor R, Common M, Dunleavy K, Harris S, Luo C, Mesbah Z, Kumar AP, Redmond A, Skulsky S, Walsh T, Daly D, Deery L, Epanomeritakis E, Harty M, Kane D, Khan K, Mackey R, McConville J, McGinnity K, Nixon G, Ang A, Kee JY, Leung E, Norman S, Palaniappan SV, Sarathy PP, Yeoh T, Frost J, Hazeldine P, Jones L, Karbowiak M, Macdonald C, Mutarambirwa A, Omotade A, Runkel M, Ryan G, Sawers N, Searle C, Suresh S, Vig S, Ahmad A, McGartland R, Sim R, Song A, Wayman J, Brown R, Chang LH, Concannon K, Crilly C, Arnold TJ, Burgin A, Cadden F, Choy CH, Coleman M, Lim D, Luk J, Mahankali-Rao P, Prudence-Taylor AJ, Ramakrishnan D, Russell J, Fawole A, Gohil J, Green B, Hussain A, McMenamin L, McMenamin L, Tang M, Azmi F, Benchetrit S, Cope T, Haque A, Harlinska A, Holdsworth R, Ivo T, Martin J, Nisar T, Patel A, Sasapu K, Trevett J, Vernet G, Aamir A, Bird C, Durham-Hall A, Gibson W, Hartley J, May N, Maynard V, Johnson S, Wood CM, O'Brien M, Orbell J, Stringfellow TD, Tenters F, Tresidder S, Cheung W, Grant A, Tod N, Bews-Hair M, Lim ZH, Lim SW, Vella-Baldacchino M, Auckburally S, Chopada A, Easdon S, Goodson R, McCurdie F, Narouz M, Radford A, Rea E, Taylor O, Yu T, Alfa-Wali M, Amani L, Auluck I, Bruce P, Emberton J, Kumar R, Lagzouli N, Mehta A, Murtaza A, Raja M, Dennahy IS, Frew K, Given A, He YY, Karim MA, MacDonald E, McDonald E, McVinnie D, Ng SK, Pettit A, Sim DPY, Berthaume-Hawkins SD, Charnley R, Fenton K, Jones D, Murphy C, Ng JQ, Reehal R, Robinson H, Seraj SS, Shang E, Tonks A, White P, Yeo A, Chong P, Gabriel R, Patel N, Richardson E, Symons L, Aubrey-Jones D, Dawood S, Dobrzynska M, Faulkner S, Griffiths H, Mahmood F, Patel P, Perry M, Power A, Simpson R, Ali A, Brobbey P, Burrows A, Elder P, Ganyani R, Horseman C, Hurst P, Mann H, Marimuthu K, McBride S, Pilsworth E, Powers N, Stanier P, Innes R, Kersey T, Kopczynska M, Langasco N, Patel N, Rajagopal R, Atkins B, Beasley W, Lim ZC, Gill A, Ang HL, Williams H, Yogeswara T, Carter R, Fam M, Fong J, Latter J, Long M, Mackinnon S, McKenzie C, Osmanska J, Raghuvir V, Shafi A, Tsang K, Walker L, Bountra K, Coldicutt O, Fletcher D, Hudson S, Iqbal S, Bernal TL, Martin JWB, Moss-Lawton F, Smallwood J, Vipond M, Cardwell A, Edgerton K, Laws J, Rai A, Robinson K, Waite K, Ward J, Youssef H, Knight C, Koo PY, Lazarou A, Stanger S, Thorn C, Triniman MC, Botha A, Boyles L, Cumming S, Deepak S, Ezzat A, Fowler AJ, Gwozdz AM, Hussain SF, Khan S, Li H, Morrell BL, Neville J, Nitiahpapand R, Pickering O, Sagoo H, Sharma E, Welsh K, Denley S, Khan S, Agarwal M, Al-Saadi N, Bhambra R, Gupta A, Jawad ZAR, Jiao LR, Khan K, Mahir G, Singagireson S, Thoms BL, Tseu B, Wei R, Yang N, Britton N, Leinhardt D, Mahfooz M, Palkhi A, Price M, Sheikh S, Barker M, Bowley D, Cant M, Datta U, Farooqi M, Lee A, Morley G, Amin MN, Parry A, Patel S, Strang S, Yoganayagam N, Adlan A, Chandramoorthy S, Choudhary Y, Das K, Feldman M, France B, Grace R, Puddy H, Soor P, Ali M, Dhillon P, Faraj A, Gerard L, Glover M, Imran H, Kim S, Patrick Y, Peto J, Prabhudesai A, Smith R, Tang A, Vadgama N, Dhaliwal R, Ecclestone T, Harris A, Ong D, Patel D, Philp C, Stewart E, Wang L, Wong E, Xu Y, Ashaye T, Fozard T, Galloway F, Kaptanis S, Mistry P, Nguyen T, Olagbaiye F, Osman M, Philip Z, Rembacken R, Tayeh S, Theodoropoulou K, Herman A, Lau J, Saha A, Trotter M, Adeleye O, Cave D, Gunwa T, Magalhães J, Makwana S, Mason R, Parish M, Regan H, Renwick P, Roberts G, Salekin D, Sivakumar C, Tariq A, Liew I, McDade A, Stewart D, Hague M, Hudson-Peacock N, Jackson CES, James F, Pitt J, Walker EY, Aftab R, Ang JJ, Anwar S, Battle J, Budd E, Chui J, Crook H, Davies P, Easby S, Hackney E, Ho B, Imam SZ, Rammell J, Andrews H, Perry C, Schinle P, Ahmed P, Aquilina T, Balai E, Church M, Cumber E, Curtis A, Davies G, Dennis Y, Dumann E, Greenhalgh S, Kim P, King S, Metcalfe KHM, Passby L, Redgrave N, Soonawalla Z, Waters S, Zornoza A, Gulzar I, Hole J, Hull K, Ishaq H, Karaj J, Kelkar A, Love E, Patel S, Thakrar D, Vine M, Waterman A, Dib NP, Francis N, Hanson M, Ingleton R, Sadanand KS, Sukirthan N, Arnell S, Ball M, Bassam N, Beghal G, Chang A, Dawe V, George A, Huq T, Hussain A, Ikram B, Kanapeckaite L, Khan M, Ramjas D, Rushd A, Sait S, Serry M, Yardimci E, Capella S, Chenciner L, Episkopos C, Karam E, McCarthy C, Moore-Kelly W, Watson N, Ahluwalia V, Barnfield J, Ben-Gal O, Bloom I, Gharatya A, Khodatars K, Merchant N, Moonan A, Moore M, Patel K, Spiers H, Sundaram K, Turner J, Bath MF, Black J, Chadwick H, Huisman L, Ingram H, Khan S, Martin L, Metcalfe M, Sangal P, Seehra J, Thatcher A, Venturini S, Whitcroft I, Afzal Z, Brown S, Gani A, Gomaa A, Hussein N, Oh SY, Pazhaniappan N, Sharkey E, Sivagnanasithiyar T, Williams C, Yeung J, Cruddas L, Gurjar S, Pau A, Prakash R, Randhawa R, Chen L, Eiben I, Naylor M, Osei-Bordom D, Trenear R, Bannard-Smith J, Griffiths N, Patel BY, Saeed F, Abdikadir H, Bennett M, Church R, Clements SE, Court J, Delvi A, Hubert J, Macdonald B, Mansour F, Patel RR, Perris R, Small S, Betts A, Brown N, Chong A, Croitoru C, Grey A, Hickland P, Ho C, Hollington D, McKie L, Nelson AR, Stewart H, Eiben P, Nedham M, Ali I, Brown T, Cumming S, Hunt C, Joyner C, McAlinden C, Roberts J, Rogers D, Thachettu A, Tyson N, Vaughan R, Verma N, Yasin T, Andrew K, Bhamra N, Leong S, Mistry R, Noble H, Rashed F, Walker NR, Watson L, Worsfold M, Yarham E, Abdikadir H, Arshad A, Barmayehvar B, Cato L, Chan-lam N, Do V, Leong A, Sheikh Z, Zheleniakova T, Coppel J, Hussain ST, Mahmood R, Nourzaie R, Prowle J, Sheik-Ali S, Thomas A, Alagappan A, Ashour R, Bains H, Diamond J, Gordon J, Ibrahim B, Khalil M, Mittapalli D, Neo YN, Patil P, Peck FS, Reza N, Swan I, Whyte M, Chaudhry S, Hernon J, Khawar H, O'Brien J, Pullinger M, Rothnie K, Ujjal S, Bhatte S, Curtis J, Green S, Mayer A, Watkinson G, Chapple K, Hawthorne T, Khaliq M, Majkowski L, Malik TAM, Mclauchlan K, En BNW, Parton S, Robinson SD, Saat MI, Shurovi BN, Varatharasasingam K, Ward AE, Behranwala K, Bertelli M, Cohen J, Duff F, Fafemi O, Gupta R, Manimaran M, Mayhew J, Peprah D, Wong MHY, Farmer N, Houghton C, Kandhari N, Khan K, Ladha D, Mayes J, McLennan F, Panahi P, Seehra H, Agrawal R, Ahmed I, Ali S, Birkinshaw F, Choudhry M, Gokani S, Harrogate S, Jamal S, Nawrozzadeh F, Swaray A, Szczap A, Warusavitarne J, Abdalla M, Asemota N, Cullum R, Hartley M, Maxwell-Armstrong C, Mulvenna C, Phillips J, Yule A, Ahmed L, Clement KD, Craig N, Elseedawy E, Gorman D, Kane L, Livie J, Livie V, Moss E, Naasan A, Ravi F, Shields P, Zhu Y, Archer M, Cobley H, Dennis R, Downes C, Guevel B, Lamptey E, Murray H, Radhakrishnan A, Saravanabavan S, Sardar M, Shaw C, Tilliridou V, Wright R, Ye W, Alturki N, Helliwell R, Jones E, Kelly D, Lambotharan S, Scott K, Sivakumar R, Victor L, Boraluwe-Rallage H, Froggatt P, Haynes S, Hung YMA, Keyte A, Matthews L, Evans E, Haray P, John I, Mathivanan A, Morgan L, Oji O, Okorocha C, Rutherford A, Spiers H, Stageman N, Tsui A, Whitham R, Amoah-Arko A, Cecil E, Dietrich A, Fitzpatrick H, Guy C, Hair J, Hilton J, Jawad L, McAleer E, Taylor Z, Yap J, Akhbari M, Debnath D, Dhir T, Elbuzidi M, Elsaddig M, Glace S, Khawaja H, Koshy R, Lal K, Lobo L, McDermott A, Meredith J, Qamar MA, Vaidya A, Acquaah F, Barfi L, Carter N, Gnanappiragasam D, Ji C, Kaminski F, Lawday S, Mackay K, Sulaiman SK, Webb R, Ananthavarathan P, Dalal F, Farrar E, Hashemi R, Hossain M, Jiang J, Kiandee M, Lex J, Mason L, Matthews JH, McGeorge E, Modhwadia S, Pinkney T, Radotra A, Rickard L, Rodman L, Sales A, Tan KL, Bachi A, Bajwa DS, Battle J, Brown LR, Butler A, Calciu A, Davies E, Gardner I, Girdlestone T, Ikogho O, Keelan G, O'Loughlin P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Luni FK, Daniels J, Link MS, Joglar JA, Zungsontiporn N, Wu R, Kaplish N, Malik SA. Meta-analysis of Usefulness of Phrenic Nerve Stimulation in Central Sleep Apnea. Am J Cardiol 2020; 125:1738-1744. [PMID: 32295701 DOI: 10.1016/j.amjcard.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 11/25/2022]
Abstract
Transvenous neurostimulation of the phrenic nerve (PNS) is a potentially improved and unique approach to the treatment of central sleep apnea (CSA). There have been multiple studies with limited individuals evaluating the efficacy of PNS. Our aim was to review and pool those studies to better understand whether phrenic nerve stimulation is efficacious in the treatment of CSA. The initial search on Pubmed retrieved a total of 97 articles and after screening all articles, only 5 could be included in our quantitative analysis. Pooling of data from 5 studies with a total of 204 patients demonstrated a reduction of mean apnea hypopnea index with PNS compared to controls by -26.7 events/hour with 95% confidence interval and P value of [CI (-31.99, -21.46), I2 85, p 0.00]. The mean difference in central apnea index was -22.47 [CI (-25.19, -19.76), I2 0, p 0.00]. The mean reduction in the oxygen desaturation index of 4% or more demonstrated a decrease in PNS group by -24.16 events/hour [(CI -26.20, -22.12), I2 0, p 0.00] compared with controls. PNS resulted in mean reduction in arousal index of -13.77 [CI (-16.15, -11.40), I2 0, p 0.00]. The mean change in percent of time spent in rapid eye movement sleep demonstrated a nonsignificant increase in PNS group by 1.01 % [CI (-5.67, 7.86), I293, p 0.75]. In conclusion, PNS therapy for treating CSA demonstrated positive outcomes but larger randomized studies are needed to evaluate the safety and clinical outcomes.
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Affiliation(s)
- Faraz Khan Luni
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - James Daniels
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Mark S Link
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Jose A Joglar
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Nath Zungsontiporn
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Richard Wu
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Neeraj Kaplish
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Sonia Ali Malik
- Department of Neurology and Family Medicine, UT Southwestern Medical Center, Dallas, Texas.
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Walker KF, Morris E, Plumb J, Gray J, Thornton JG, Daniels J. Universal testing for group B streptococcus during pregnancy: need for a randomised trial. BJOG 2020; 127:693. [DOI: 10.1111/1471-0528.16116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- KF Walker
- Division of Child Health, Obstetrics and Gynaecology School of Medicine University of Nottingham Nottingham UK
| | - E Morris
- Department of Obstetrics and Gynaecology Norfolk and Norwich University Hospitals NHS Foundation Trust Norwich UK
| | - J Plumb
- Group B Strep Support Haywards Heath UK
| | - J Gray
- Department of Microbiology Birmingham Children's Hospital NHS Foundation Trust Birmingham UK
| | - JG Thornton
- Division of Child Health, Obstetrics and Gynaecology School of Medicine University of Nottingham Nottingham UK
| | - J Daniels
- Nottingham Clinical Trials Unit University of Nottingham Nottingham UK
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Affiliation(s)
- Mohita Singh
- Department of Internal Medicine, Division of Cardiology, Univeresity of Texas Southwestern Medical Center, Dallas, TX
| | - Cody McCoy
- Department of Internal Medicine, Division of Cardiology, Univeresity of Texas Southwestern Medical Center, Dallas, TX
| | - James Daniels
- Department of Internal Medicine, Division of Cardiology, Univeresity of Texas Southwestern Medical Center, Dallas, TX
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Daniels J. IBS20.01 Airway Fistulas. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Smesseim I, Comans E, Daniels J. P2.11-36 The Role of FDG-PET Scans in Pre-Invasive Endobronchial Lesions. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Horne AW, Daniels J, Hummelshoj L, Cox E, Cooper KG. Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: time for a rethink? BJOG 2019; 126:1414-1416. [PMID: 31359584 PMCID: PMC6852286 DOI: 10.1111/1471-0528.15894] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 12/03/2022]
Affiliation(s)
- A W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - J Daniels
- Department of Clinical Trials, Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - E Cox
- Endometriosis, London, UK
| | - K G Cooper
- Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, Aberdeen, UK
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Luni FK, Zungsontiporn N, Farid T, Malik SA, Khan S, Daniels J, Wu R, Link MS, Joglar JA. Percutaneous left ventricular assist device support during ablation of ventricular tachycardia: A meta-analysis of current evidence. J Cardiovasc Electrophysiol 2019; 30:886-895. [PMID: 30847997 DOI: 10.1111/jce.13907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/26/2019] [Accepted: 03/03/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Catheter ablation of ventricular tachycardia (VT) can be an effective therapy to reduce VT burden, but often it is limited by the potential for hemodynamic instability. Percutaneous left ventricular assist devices (pLVADs) have been used to maintain hemodynamic support during VT ablation but the evidence regarding its clinical impact has been inconclusive. METHODS AND RESULTS We sought to assess the clinical impact of pLVAD when used in VT ablation by conducting a meta-analysis of the current evidence. We searched Pubmed and found nine observational studies that compared clinical outcomes of VT ablation in patients with pLVAD support to controls with no pLVAD support. The pooled data did not show a significant difference in mortality between both groups, nor a difference in acute procedural success or in recurrence of VT. There was also no difference in the number of patients receiving a cardiac transplant or being enrolled in the transplant list. Although there was no difference in the ablation time between the groups, patients in the pLVAD group had a longer total procedural time and more procedure-related adverse effects. CONCLUSION This meta-analysis did not show clinical benefits from using pLVAD support during VT ablation, whereas it was associated with longer procedure times and more complications. This study was, however, limited by the observational nature of the data. In view of these data, the risk and benefit of pLVAD support during VT ablation should be considered on an individual basis.
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Affiliation(s)
- Faraz Khan Luni
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | | | - Talha Farid
- Department of Cardiology, University of Louisville, Louisville, Kentucky
| | - Sonia Ali Malik
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Sobia Khan
- Department of Cardiology, University of Louisville, Louisville, Kentucky
| | - James Daniels
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Richard Wu
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Mark S Link
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Jose A Joglar
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
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Gonsalves AJ, Nakamura K, Daniels J, Benedetti C, Pieronek C, de Raadt TCH, Steinke S, Bin JH, Bulanov SS, van Tilborg J, Geddes CGR, Schroeder CB, Tóth C, Esarey E, Swanson K, Fan-Chiang L, Bagdasarov G, Bobrova N, Gasilov V, Korn G, Sasorov P, Leemans WP. Petawatt Laser Guiding and Electron Beam Acceleration to 8 GeV in a Laser-Heated Capillary Discharge Waveguide. Phys Rev Lett 2019; 122:084801. [PMID: 30932604 DOI: 10.1103/physrevlett.122.084801] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/30/2019] [Indexed: 06/09/2023]
Abstract
Guiding of relativistically intense laser pulses with peak power of 0.85 PW over 15 diffraction lengths was demonstrated by increasing the focusing strength of a capillary discharge waveguide using laser inverse bremsstrahlung heating. This allowed for the production of electron beams with quasimonoenergetic peaks up to 7.8 GeV, double the energy that was previously demonstrated. Charge was 5 pC at 7.8 GeV and up to 62 pC in 6 GeV peaks, and typical beam divergence was 0.2 mrad.
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Affiliation(s)
- A J Gonsalves
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - K Nakamura
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J Daniels
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - C Benedetti
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - C Pieronek
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- University of California, Berkeley, California 94720, USA
| | - T C H de Raadt
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - S Steinke
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J H Bin
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - S S Bulanov
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J van Tilborg
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - C G R Geddes
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - C B Schroeder
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- University of California, Berkeley, California 94720, USA
| | - Cs Tóth
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - E Esarey
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - K Swanson
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- University of California, Berkeley, California 94720, USA
| | - L Fan-Chiang
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- University of California, Berkeley, California 94720, USA
| | - G Bagdasarov
- Keldysh Institute of Applied Mathematics RAS, Moscow 125047, Russia
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russia
| | - N Bobrova
- Keldysh Institute of Applied Mathematics RAS, Moscow 125047, Russia
- Faculty of Nuclear Science and Physical Engineering, CTU in Prague, Brehova 7, Prague 1, Czech Republic
| | - V Gasilov
- Keldysh Institute of Applied Mathematics RAS, Moscow 125047, Russia
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russia
| | - G Korn
- Institute of Physics ASCR, v.v.i. (FZU), ELI-Beamlines Project, 182 21 Prague, Czech Republic
| | - P Sasorov
- Keldysh Institute of Applied Mathematics RAS, Moscow 125047, Russia
- Institute of Physics ASCR, v.v.i. (FZU), ELI-Beamlines Project, 182 21 Prague, Czech Republic
| | - W P Leemans
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- University of California, Berkeley, California 94720, USA
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De Vos M, Ley S, Derendinger B, Dippenaar A, Grobbelaar M, Reuter A, Daniels J, Burns S, Theron G, Posey J, Warren R, Cox H. EMERGENCE OF BEDAQUILINE RESISTANCE AFTER COMPLETION OF BEDAQUILINE-BASED DRUGRESISTANT TB TREATMENT: A CASE STUDY FROM SOUTH AFRICA. ACTA ACUST UNITED AC 2019. [DOI: 10.15789/2220-7619-2018-4-6.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M. De Vos
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - S. Ley
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - B. Derendinger
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - A. Dippenaar
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - M. Grobbelaar
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - A. Reuter
- Médecins Sans Frontières, Operational Centre Brussels (OCB), Khayelitsha Project, Cape Town
| | - J. Daniels
- Médecins Sans Frontières, Operational Centre Brussels (OCB), Khayelitsha Project, Cape Town
| | - S. Burns
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - G. Theron
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - J. Posey
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - R. Warren
- DST/NRF Centre of Excellence in Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human, Faculty of Medicine and Health Science, Stellenbosch University
| | - H. Cox
- Institute of Infectious Disease and Molecular Medicine and Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town
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Abstract
The efficacy of implantable cardioverter defibrillators in reducing the risk of sudden cardiac death has been well established by several clinical trials. Several factors relating to device characteristics, patient attributes, and comorbidities should be considered when selecting the appropriate implantable cardioverter defibrillators for each patient. This review examines some of these issues.
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Affiliation(s)
- Nath Zungsontiporn
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Michael Loguidice
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - James Daniels
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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McNaughton C, Collins S, Lindenfeld J, Morrison R, Daniels J, Wang T. 40EMF Outpatient Lisinopril and Losartan Blood Levels Are Associated With In-Hospital Acute Kidney Injury Among Patients With Acute Heart Failure. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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49
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Affiliation(s)
- J Daniels
- Nottingham Clinical Trials Unit; University of Nottingham; Nottingham UK
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50
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Mohr E, Daniels J, Muller O, Furin J, Chabalala B, Steele SJ, Cox V, Dolby T, Ferlazzo G, Shroufi A, Duran LT, Cox H. Missed opportunities for earlier diagnosis of rifampicin-resistant tuberculosis despite access to Xpert ® MTB/RIF. Int J Tuberc Lung Dis 2018; 21:1100-1105. [PMID: 28911352 DOI: 10.5588/ijtld.17.0372] [Citation(s) in RCA: 5] [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: 11/10/2022] Open
Abstract
OBJECTIVE To assess the proportion of rifampicin-resistant tuberculosis (RR-TB) patients with potential earlier RR-TB diagnoses in Khayelitsha, South Africa. DESIGN We conducted a retrospective analysis among RR-TB patients diagnosed from 2012 to 2014. Patients were considered to have missed opportunities for earlier diagnosis if 1) they were incorrectly screened according to the Western Cape diagnostic algorithm; 2) the first specimen was not tested using Xpert® MTB/RIF; 3) no specimen was ever tested; or 4) the initial Xpert test showed a negative result, but no subsequent specimen was sent for follow-up testing in human immunodeficiency virus-positive patients. RESULTS Among 543 patients, 386 (71%) were diagnosed with Xpert and 112 (21%) had had at least one presentation at a health care facility within the 6 months before the presentation at which RR-TB was diagnosed. Overall, 95/543 (18%) patients were screened incorrectly at some point: 48 at diagnostic presentation only, 38 at previous presentation only, and 9 at both previous and diagnostic presentations. CONCLUSIONS These data show that a significant proportion of RR-TB patients might have been diagnosed earlier, and suggest that case detection could be improved if diagnostic algorithms were followed more closely. Further training and monitoring is required to ensure the greatest benefit from universal Xpert implementation.
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Affiliation(s)
- E Mohr
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - J Daniels
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - O Muller
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - J Furin
- Harvard Medical School, Boston, Massachusetts, USA
| | - B Chabalala
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | | | - V Cox
- MSF, Eshowe, University of Cape Town Center for Infectious Disease Epidemiology and Research, Cape Town
| | - T Dolby
- National Health Laboratory Service, Cape Town
| | | | | | - L T Duran
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - H Cox
- Division of Medical Microbiology and the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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