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Last J, Herrmann E, Birschmann I, Lindau S, Konstantinides S, Grottke O, Nowak-Göttl U, Zydek B, von Heymann C, Sümnig A, Beyer-Westendorf J, Schellong S, Meybohm P, Greinacher A, Lindhoff-Last E. Clinical Course and Management of Patients with Emergency Surgery Treated with Direct Oral Anticoagulants or Vitamin K Antagonists-Results of the German Prospective RADOA-Registry. J Clin Med 2024; 13:272. [PMID: 38202279 PMCID: PMC10780086 DOI: 10.3390/jcm13010272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: The clinical management of anticoagulated patients treated with direct oral anticoagulants (DOAC) or Vitamin K antagonists (VKA) needing emergency surgery is challenging. (2) Methods: The prospective German RADOA registry investigated treatment strategies in DOAC- or VKA-treated patients needing emergency surgery within 24 h after admission. Effectiveness was analysed by clinical endpoints including major bleeding. Primary observation endpoint was in hospital mortality until 30 days after admission. (3) Results: A total of 78 patients were included (DOAC: 44; VKA: 34). Median age was 76 years. Overall, 43% of the DOAC patients and 79% of the VKA patients were treated with prothrombin complex concentrates (PCC) (p = 0.002). Out of the DOAC patients, 30% received no hemostatic treatment compared to 3% (1/34) of the VKA patients (p = 0.002), and 7% of the DOAC patients and 21% of the VKA patients developed major or clinically relevant non-major bleeding at the surgical site (p = 0.093). In-hospital mortality was 13% with no significant difference between the two treatment groups (DOAC: 11%, VKA: 15%; p > 0.20). (4) Conclusions: The 30-day in-hospital mortality rate was comparable between both patient groups. VKA patients required significantly more hemostatic agents than DOAC patients in the peri- and postoperative surgery period.
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Affiliation(s)
- Jana Last
- Coagulation Research Centre Bethanien Hospital, 63089 Frankfurt, Germany; (B.Z.); (E.L.-L.)
- Deutsches Herzzentrum der Charité (DHZC) Berlin, Department of Cardiology, Angiology and Intensive Care Medicine, Charité Berlin, 12203 Berlin, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, 60596 Frankfurt, Germany;
| | - Ingvild Birschmann
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Centre, Ruhr University, 44801 Bochum, Germany;
| | - Simone Lindau
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, 60596 Frankfurt, Germany;
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, 55122 Mainz, Germany;
| | - Oliver Grottke
- Department of Anaesthesiology, RWTH Aachen University Hospital, 52062 Aachen, Germany;
| | - Ulrike Nowak-Göttl
- Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Centre, University Hospital, Kiel-Lübeck, 24105 Kiel, Germany;
| | - Barbara Zydek
- Coagulation Research Centre Bethanien Hospital, 63089 Frankfurt, Germany; (B.Z.); (E.L.-L.)
- Coagulation Centre at the Cardiology Angiology Centre Bethanien Hospital (CCB), 63089 Frankfurt, Germany
| | - Christian von Heymann
- Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, 10249 Berlin, Germany;
| | - Ariane Sümnig
- Institute for Transfusions Medicine, Universitätsmedizin Greifswald, 17489 Greifswald, Germany; (A.S.); (A.G.)
| | - Jan Beyer-Westendorf
- Department of Medicine 1, Division of Thrombosis & Hemostasis, Dresden University Clinic, 01307 Dresden, Germany;
| | | | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080 Wuerzburg, Germany;
| | - Andreas Greinacher
- Institute for Transfusions Medicine, Universitätsmedizin Greifswald, 17489 Greifswald, Germany; (A.S.); (A.G.)
| | - Edelgard Lindhoff-Last
- Coagulation Research Centre Bethanien Hospital, 63089 Frankfurt, Germany; (B.Z.); (E.L.-L.)
- Coagulation Centre at the Cardiology Angiology Centre Bethanien Hospital (CCB), 63089 Frankfurt, Germany
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Chun JKR, Bordignon S, Last J, Mayer L, Tohoku S, Zanchi S, Bianchini L, Bologna F, Nagase T, Urbanek L, Chen S, Schmidt B. Cryoballoon Versus Laserballoon: Insights From the First Prospective Randomized Balloon Trial in Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2021; 14:e009294. [PMID: 33417476 DOI: 10.1161/circep.120.009294] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) represents the cornerstone in atrial fibrillation ablation. Cryoballoon and laserballoon catheters have emerged as promising devices but lack randomized comparisons. Therefore, we sought to compare efficacy and safety comparing both balloons in patients with persistent and paroxysmal atrial fibrillation (AF). METHODS Symptomatic AF patients (n=200) were prospectively randomized (1:1) to receive either cryoballoon or laserballoon PVI (cryoballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF versus laserballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF). All antiarrhythmic drugs were stopped after ablation. Follow-up included 3-day Holter-ECG recordings and office visits at 3, 6, and 12 months. Primary efficacy end point was defined as freedom from atrial tachyarrhythmia between 90 and 365 days after a single ablation. Secondary end points included procedural parameters and periprocedural complications. RESULTS Patient baseline parameters were not different between both groups. In all (n=200) complete PVI was obtained and the entire follow-up accomplished. Balloon only PVI was obtained in 98% (cryoballoon) versus 95% (laserballoon) requiring focal touch-up in 2 and 5 patients, respectively. Procedure but not fluoroscopy time was significantly shorter in the cryoballoon group (50.9±21.0 versus 96.0±20.4 minutes; P<0.0001 and 7.4±4.4 versus 8.4±3.2 minutes, P=0.083). Overall, the primary end point of no atrial tachyarrhythmia recurrence was met in 79% (cryoballoon: 80.0% versus laserballoon: 78.0%, P=ns). No death, atrio-esophageal fistula, tamponade, or vascular laceration requiring surgery occurred. In the cryoballoon group, 8 transient but no persistent phrenic nerve palsy were noted compared with 2 persistent phrenic nerve palsy and one transient ischemic attack in the laserballoon group. CONCLUSIONS Both balloon technologies represent highly effective and safe tools for PVI resulting in similar favorable rhythm outcome after 12 months. Use of the cryoballoon is associated with significantly shorter procedure but not fluoroscopy time.
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Affiliation(s)
- Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.).,Medizinische Klinik II, Kardiologie/Angiologie/Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Germany (J.K.R.C.)
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lukas Mayer
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
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Tohoku S, Chen S, Last J, Bordignon S, Bologna F, Trolese L, Zanchi S, Bianchini L, Schmidt B, Chun KRJ. Phrenic nerve injury in atrial fibrillation ablation using balloon catheters: Incidence, characteristics, and clinical recovery course. J Cardiovasc Electrophysiol 2020; 31:1932-1941. [DOI: 10.1111/jce.14567] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 03/16/2020] [Accepted: 05/12/2020] [Indexed: 08/29/2023]
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Luca Trolese
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
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Chen S, Schmidt B, Bordignon S, Tohoku S, Urbanek L, Plank K, Willems F, Throm C, Konstantinou A, Hilbert M, Zanchi S, Bianchini L, Bologna F, Tsianakas N, Kreuzer C, Nagase T, Perrotta L, Last J, Chun KRJ. Cryoballoon pulmonary vein isolation in treating atrial fibrillation using different freeze protocols: The “ICE‐T 4 minutes vs 3 minutes” propensity‐matched study (Frankfurt ICE‐T 4 vs. 3). J Cardiovasc Electrophysiol 2020; 31:1923-1931. [DOI: 10.1111/jce.14602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/04/2020] [Accepted: 05/31/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Karin Plank
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Franziska Willems
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Christina Throm
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Max Hilbert
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Nikolaos Tsianakas
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Claudia Kreuzer
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Medizinische Klinik II, Kardiologie/Angiologie/IntensivmedizinUniversitätsklinikum Schleswig‐Holstein, Universität zu Lübeck Lübeck Germany
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Dowling S, Last J, Finnegan H, Bourke J, Daly P, Hanrahan C, Harrold P, McCoombe G, Cullen W. How does small group continuing medical education (CME) impact on practice for rural GPs and their patients, a mixed-methods study. Educ Prim Care 2020; 31:153-161. [PMID: 32089106 DOI: 10.1080/14739879.2020.1728704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Studies which report outcomes of continuing medical education (CME) interventions for rural general practitioners (GPs) are limited. This mixed methods study recruited GPs from four CME small group learning (SGL) tutor groups based in different rural locations in the Republic of Ireland. A two-hour teaching module on deprescribing in older patients was devised and implemented. Assessment of educational outcomes was via questionnaires, prescribing audits and qualitative focus groups. All GPs (n = 43) in these CME-SGL groups agreed to participate, 27 of whom (63%) self-identified as being in rural practice. Rural GPs were more likely to be male (56%), in practice for longer (19 years), and attending CME for longer (13 years). The questionnaires indicated learning outcomes were achieved knowledge increased immediately after the education, and was maintained 6 months later. Twenty-four GPs completed audits involving 191 patients. Of these, 152 (79.6%) were de-prescribed medication. In the qualitative focus groups, GPs reported sharing experiences with their peers during CME-SGL helped them to improve patient care and ensured that clinical practice is more consistent across the group. For rural GPs, CME-SGL involving discussion of cases and the practical implementation of guidelines, associated with audit, can lead to changes in patient care.
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Affiliation(s)
- Stephanie Dowling
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
| | - J Last
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
| | - H Finnegan
- Irish College of General Practice, Dublin, Ireland
| | - John Bourke
- Irish College of General Practice, Dublin, Ireland
| | - Pat Daly
- Irish College of General Practice, Dublin, Ireland
| | | | - Pat Harrold
- Irish College of General Practice, Dublin, Ireland
| | - Geoff McCoombe
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
| | - W Cullen
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
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Dowling S, Last J, Finnegan H, O’Connor K, Cullen W. Does locally delivered small group continuing medical education (CME) meet the learning needs of rural general practitioners? Education for Primary Care 2019; 30:145-151. [PMID: 30747043 DOI: 10.1080/14739879.2019.1573109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- S. Dowling
- Health Sciences Centre, UCD, University College Dublin School of Medicine, West Waterford, Ireland
| | - J. Last
- Health Sciences Centre, UCD, University College Dublin School of Medicine, West Waterford, Ireland
| | - H. Finnegan
- Irish College of General Practitioners, Irish College of General Practitioners National CME Director, Dublin, Ireland
| | - K. O’Connor
- Public Health, St Canices Hospital, Kilkenny, Ireland
| | - W. Cullen
- Health Sciences Centre, UCD, University College Dublin School of Medicine, West Waterford, Ireland
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Grehan J, Butler ML, Last J, Rainford L. The introduction of mandatory CPD for newly state registered diagnostic radiographers: An Irish perspective. Radiography (Lond) 2018; 24:115-121. [DOI: 10.1016/j.radi.2017.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
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Jolicoeur M, Derashodian T, Last J, Wakil G, Mondat M. Multimodality Image Registrations for Combined MRI/CT HDR Prostate Brachytherapy: The Concept of the Iurethra. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1185] [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: 10/18/2022]
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Derashodian T, Le M, Mondat M, Wakil G, Last J, Jolicoeur M. V150 and Urethral Dmax Predict Radiation Induced Prostatitis. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1146] [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: 10/18/2022]
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Noll P, Sonnerup L, Froger C, Huguet M, Last J. Forces on the JET Vacuum Vessel During Disruptions and Consequent Operational Limits. ACTA ACUST UNITED AC 2017. [DOI: 10.13182/fst89-a39713] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- P Noll
- JET Joint Undertaking, Abingdon, Oxford, OX14 3EA, United Kingdom (0235) 464565
| | - L Sonnerup
- JET Joint Undertaking, Abingdon, Oxford, OX14 3EA, United Kingdom (0235) 464565
| | - C Froger
- JET Joint Undertaking, Abingdon, Oxford, OX14 3EA, United Kingdom (0235) 464565
| | - M Huguet
- JET Joint Undertaking, Abingdon, Oxford, OX14 3EA, United Kingdom (0235) 464565
| | - J Last
- JET Joint Undertaking, Abingdon, Oxford, OX14 3EA, United Kingdom (0235) 464565
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11
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Gouda P, Kitt K, Evans DS, Goggin D, McGrath D, Last J, Hennessy M, Arnett R, O'Flynn S, Dunne F, O'Donovan D. Irish Medical Students Understanding of the Intern Year. Ir Med J 2016; 109:387. [PMID: 27685481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Upon completion of medical school in Ireland, graduates must make the transition to becoming interns. The transition into the intern year may be described as challenging as graduates assume clinical responsibilities. Historically, a survey of interns in 1996 found that 91% felt unprepared for their role. However, recent surveys in 2012 have demonstrated that this is changing with preparedness rates reaching 52%. This can be partially explained by multiple initiatives at the local and national level. Our study aimed evaluate medical student understanding of the intern year and associated factors. An online, cross-sectional survey was sent out to all Irish medical students in 2013 and included questions regarding their understanding of the intern year. Two thousand, two hundred and forty-eight students responded, with 1,224 (55.4%) of students agreeing or strongly agreeing that they had a good understanding of what the intern year entails. This rose to 485 (73.7%) among senior medical students. Of junior medical students, 260 (42.8%) indicated they understood what the intern year, compared to 479 (48.7%) of intermediate medical students. Initiatives to continue improving preparedness for the intern year are essential in ensuring a smooth and less stressful transition into the medical workforce.
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Affiliation(s)
- P Gouda
- National University of Ireland, Galway
- University of Alberta
| | - K Kitt
- National University of Ireland, Galway
| | - D S Evans
- Department of Public Health, HSE West
| | - D Goggin
- Department of Public Health, HSE West
| | | | - J Last
- University College Dublin
| | | | | | | | | | - D O'Donovan
- National University of Ireland, Galway
- Department of Public Health, HSE West
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12
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Morris J, Kemp R, Kovari M, Last J, Knight P. Implications of toroidal field coil stress limits on power plant design using PROCESS. Fusion Engineering and Design 2015. [DOI: 10.1016/j.fusengdes.2015.06.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Remedios L, Ho K, Last J, Anderson C, Walmsley D, Davies W, Fytiwar A, Lu Y, Lee L, Zou R, Cutts E, Torres E, Khatoon B, Voisine C. An international and interprofessional exploration of health professional educator and student use of social media. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1185] [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: 11/28/2022]
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14
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Last J, Weisser B. Der Einfluss von moderater sportlicher Aktivität und Alter auf Kraft, Ausdauer und Gleichgewicht im Erwachsenenalter. Dtsch Z Sportmed 2015. [DOI: 10.5960/dzsm.2014.160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Stevens L, Kelly ME, Hennessy M, Last J, Dunne F, O'Flynn S. Medical students' views on selection tools for medical school--a mixed methods study. Ir Med J 2014; 107:229-231. [PMID: 25282958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
It is important to ensure that the tools used in Medical School selection are acceptable to students and applicants. A questionnaire was administered to year 1 medical students in 2010 to determine the suitability of a variety of selection tools and the acceptability of HPAT-Ireland in particular. There were 291 respondents a 77% response rate representing approximately one third of all school leaver entrants that year. While the majority 285 (98%) were in favour of using school leaving examinations there was also support for the use of interviews 215 (74%) and other tools. Three quarters of Irish respondents 159 (76%) agreed that HPAT-Ireland is a fair test overall however section 3 (non-verbal reasoning) appeared less acceptable and relevant than other sections. A little over half had taken a preparatory HPAT-Ireland course 112 (54%). Medical school applicants appear to accept the use of non-traditional tools in the selection process.
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Chroinin DN, Cullen W, Kyne L, Carberry C, Last J, Molphy A, Nevin E, Steele M, Bury G, Wilkinson I. Education and training. Age Ageing 2013. [DOI: 10.1093/ageing/aft099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Rossotti MA, Carlomagno M, González-Techera A, Hammock BD, Last J, González-Sapienza G. Phage anti-immunocomplex assay for clomazone: two-site recognition increasing assay specificity and facilitating adaptation into an on-site format. Anal Chem 2010; 82:8838-43. [PMID: 20886819 DOI: 10.1021/ac101476f] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The impact of the use of herbicides in agriculture can be minimized by compliance with good management practices that reduce the amount used and their release into the environment. Simple tests that provide real time on-site information about these chemicals are a major aid for these programs. In this work, we show that phage anti-immunocomplex assay (PHAIA), a method that uses phage-borne peptides to detect the formation of antibody-analyte immunocomplexes, is an advantageous technology to produce such field tests. A monoclonal antibody to the herbicide clomazone was raised and used in the development of conventional competitive and noncompetitive PHAIA immunoassays. The sensitivity attained with the PHAIA format was over 10 times higher than that of the competitive format. The cross-reactivity of the two methods was also compared using structurally related compounds, and we observed that the two-site binding of PHAIA "double-checks" the recognition of the analyte, thereby increasing the assay specificity. The positive readout of the noncompetitive PHAIA method allowed adaptation of the assay into a rapid and simple format where as little as 0.4 ng/mL clomazone (more than 10-fold lower than the proposed standard) in water samples from a rice field could be easily detected by simple visual inspection.
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Affiliation(s)
- M A Rossotti
- Cátedra de Inmunología, Facultad de Química, Instituto de Higiene, UDELAR, Montevideo, Uruguay, and Department of Entomology and Cancer Center and Pulmonary/Critical Care Medicine, School of Medicine, University of California, Davis, California, United States
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Abstract
Four separate lines of thought relevant to a theory of early memories (EMs) have appeared in the literature--Freud's, Adler's, an ego psychology view and one adapted from memory theory, Each view was presented in turn and discussed in terms of its implications for assessment and treatment. It was pointed out that none of these four theories addresses several issues relevant to the individual who plans to do research with EMs.
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Affiliation(s)
- A R Burhn
- The George Washington University, Dept. of Psychology, Washington, DC 20052, USA
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Butler ML, Rainford L, Last J, Brennan PC. Are exposure index values consistent in clinical practice? A multi-manufacturer investigation. Radiat Prot Dosimetry 2010; 139:371-374. [PMID: 20223849 DOI: 10.1093/rpd/ncq094] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The advent of digital radiography poses the risk of unnoticed increases in patient dose. Manufacturers have responded to this by offering an exposure index (EI) value to the clinician. Whilst the EI value is a measure of the air kerma at the detector surface, it has been recommended by international agencies as a method of monitoring radiation dose to the patient. Recent studies by the group have shown that EI values are being used in clinical practice to monitor radiation dose and assess image quality. This study aims to compare the clinical consistency of the EI value in computed radiography (CR) and direct digital radiography (DR) systems. An anthropormorphic phantom was used to simulate four common radiographic examinations: skull, pelvis, chest and hand. These examinations were chosen as they provide contrasting exposure parameters, image detail and radiation dose measurements. Four manufacturers were used for comparison: Agfa Gaevert CR, Carestream CR, Philips Digital Diagnost DR and Siemens DR. For each examination, the phantom was placed in the optimal position and exposure parameters were chosen in accordance with European guidelines and clinical practice. Multiple exposures were taken and the EI recorded. All exposure parameters and clinical conditions remained constant throughout. For both DR systems, the EI values remained consistent throughout. No significant change was noted in any examination. In both CR systems, there were noteworthy fluctuations in the EI values for all examinations. The largest for the Agfa system was a variation of 1.88-2.21 for the skull examination. This represents to the clinician a doubling of detector dose, despite all exposure parameters remaining constant. In the Kodak system, the largest fluctuation was seen for the chest examination where the EI ranged from 2560 to 2660, representing approximately an increase of 30 % in radiation dose, despite consistent parameters. The fluctuations seen with the CR systems are most likely due to image processing delay, replacing of the imaging plate and calibration factors. Fluctuations in EI values may result in confusion to the clinician and unnecessary repeat examinations. The reliability of EI values as a feedback mechanism for CR is also questionable.
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Affiliation(s)
- M L Butler
- School of Medicine and Medical Science, University College Dublin, Dublin, UK.
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20
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Pearman L, Last J, Fitzgerald O, Veale D, Joyce M, Rainford L, McEntee M, McNulty J, Thomas E, Ryan J, McGee A, Toomey R, D'Helft C, Lowe J, Brennan PC. Rheumatoid arthritis: a novel radiographic projection for hand assessment. Br J Radiol 2009; 82:554-60. [PMID: 19153184 DOI: 10.1259/bjr/42223683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Rheumatoid arthritis (RA) is the most common form of inflammatory disease, affecting 1-2% of the population. Posteroanterior (PA) and Brewerton projections are well established in radiographic practice for scoring and monitoring RA, but there is little evidence to demonstrate the diagnostic efficacy of these techniques. This work, by varying the positioning of a cadaveric hand, investigates whether an alternative radiographic projection could yield greater diagnostic information than the traditional techniques. Phase I of the study evaluated moving the hand 15 degrees from the anteroposterior position and then in 5 degrees increments in four directions: medial rotation, lateral rotation, flexion of the wrist and extension of the wrist. Phase II of the study took the optimum projections from Phase I and further manipulated these positions in a direction at right angles to the original position. Images were scored based on joint space visualisation in 29 joints. Results demonstrated that significantly higher diagnostic efficacy was evident with 15 degrees lateral rotation of the hand or 15 degrees flexion at the wrist compared to the Brewerton projection. Either projection is recommended, but on the basis of patient comfort, the latter of these novel positions, now known as the UCD projection, was chosen as the optimum procedure to replace the Brewerton projection. The value of using cadavers for the establishment of optimum radiographic procedures is highlighted.
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Affiliation(s)
- L Pearman
- UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
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21
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AlDahlawi I, Evans M, Reniers B, Asiev K, Last J, Parker W, DeBlois F. Poster - Thurs Eve-05: An assessment of PDDs and outputs predicted by a Monte Carlo-based treatment planning system for electron beams. Med Phys 2008; 35:3402. [DOI: 10.1118/1.2965924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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22
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O'Connor JE, Bogue C, Spence LD, Last J. A method to establish the relationship between chronological age and stage of union from radiographic assessment of epiphyseal fusion at the knee: an Irish population study. J Anat 2008; 212:198-209. [PMID: 18179475 DOI: 10.1111/j.1469-7580.2007.00847.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Characteristic changes during epiphyseal union provide a skeletal age, which when compared with age-based standards provides an estimation of chronological age. Currently there are no data on epiphyseal union for the purposes of age estimation specific to an Irish population. This cross-sectional study aims to investigate the relationship between stage of epiphyseal union at the knee joint and chronological age in a modern Irish population. A novel radiographic method that sub-divides the continuum of development into five specific stages of union is presented. Anteroposterior and lateral knee radiographs of 148 males and 86 females, aged 9-19 years, were examined. Fusion was scored as Stage 0, non-union; Stage 1, beginning union; Stage 2, active union; Stage 3, recent union; or Stage 4, complete union. Stage of epiphyseal union is correlated with chronological age in both males and females. Mean age gradually increases with each stage of union and also varies between male and female subjects. A statistically significant difference in mean age was recorded between stages when compared to the previous stage, for the three epiphyses. Irish children are comparable to those from previously published studies with epiphyseal union in females occurring earlier than males. A significant difference was noted between the mean age of union for males and females for each of Stages 1 and 2 for the femur and Stages 0, 1, 2 and 3 for the tibia and the fibula. The results also suggest that the stages of union occur at earlier ages in this Irish population. Implementation of standardized methodology is necessary to investigate if this is due to a secular or population variation in maturation or to a methodology which clearly identifies five stages of union.
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Affiliation(s)
- J E O'Connor
- UCD School of Medicine and Medical Science, Dublin, Ireland.
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González-Techera A, Vanrell L, Last J, Hammock B, González-Sapienza G. Phage anti-immune complex assay: general strategy for noncompetitive immunodetection of small molecules. Anal Chem 2007; 79:7799-806. [PMID: 17845007 PMCID: PMC2519879 DOI: 10.1021/ac071323h] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Due to their size, small molecules cannot be simultaneously bound by two antibodies, precluding their detection by noncompetitive two-site immunoassays, which are superior to competitive ones in terms of sensitivity, kinetics, and working range. This has prompted the development of anti-immune complex antibodies, but these are difficult to produce, and often exhibit high cross-reactivity with the unliganded primary antibody. This work demonstrates that anti-immune complex antibodies can be substituted by phage particles isolated from phage display peptide libraries. Phages bearing specific small peptide loops allowed to focus the recognition to changes in the binding area of the immune complex. The concept was tested using environmental and drug analytes; with improved sensitivity and ready adaptation into on-site formats. Peptides specific for different immune complexes can be isolated from different peptide libraries in a simple and systematic fashion allowing the rapid development of noncompetitive assays for small molecules.
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Affiliation(s)
- A González-Techera
- Cátedra de Inmunología, Facultad de Química, Instituto de Higiene, UDELAR, Montevideo, Uruguay
| | - L Vanrell
- Cátedra de Inmunología, Facultad de Química, Instituto de Higiene, UDELAR, Montevideo, Uruguay
| | - J. Last
- Pulmonary/Critical Care Medicine, School of Medicine, University of California, Davis, CA, USA
| | - B.D Hammock
- Department of Entomology and Cancer Research Center, University of California, Davis, CA, USA
| | - G. González-Sapienza
- Cátedra de Inmunología, Facultad de Química, Instituto de Higiene, UDELAR, Montevideo, Uruguay
- Corresponding author. Av. A. Navarro 3051, piso 2. 11600 Montevideo, Uruguay, , tel (5982) 4874334
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Last J. Archie Cochrane: Back to the Front. Barcelona: Special edition for the XI Cochrane Colloquium, Barcelona, Spain, October 2003. Bosch FX, Molas R (eds), pp. 328 ISBN: 84-607-8958-6. No price stated. Int J Epidemiol 2004. [DOI: 10.1093/ije/dyh172] [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: 11/13/2022] Open
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Last J, Johnson KS, Herrick G. High tolerance of alderfly larvae (Sialis spp: Megaloptera) to metals is not affected by water pH. Bull Environ Contam Toxicol 2002; 69:370-377. [PMID: 12177758 DOI: 10.1007/s00128-002-0072-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- J Last
- Environmental Studies, Ohio University, Athens, OH 45701, USA
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Abstract
Many diseases are influenced by weather conditions or display strong seasonality, suggestive of a possible climatic contribution. Projections of future climate change have, therefore, compelled health scientists to re-examine weather/disease relationships. There are three projected physical consequences of climate change: temperature rise, sea level rise, and extremes in the hydrologic cycle. This century, the Earth has warmed by about 0.5 degrees centigrade, and the mid-range estimates of future temperature change and sea level rise are 2.0 degrees centigrade and 49 centimeters, respectively, by the year 2100. Extreme weather variability associated with climate change may especially add an important new stress to developing nations that are already vulnerable as a result of environmental degradation, resource depletion, overpopulation, or location (e.g. low-lying coastal deltas). The regional impacts of climate change will vary widely depending on existing population vulnerability. Health outcomes of climate change can be grouped into those of: (a) direct physical consequences, e.g. heat mortality or drowning; (b) physical/chemical sequelae, e.g. atmospheric transport and formation of air pollutants; (c) physical/biological consequences, e.g. response of vector- and waterborne diseases, and food production; and (d) sociodemographic impacts, e.g. climate or environmentally induced migration or population dislocation. Better understanding of the linkages between climate variability as a determinant of disease will be important, among other key factors, in constructing predictive models to guide public health prevention.
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Affiliation(s)
- J A Patz
- Department of Environmental Health Sciences, Johns Hopkins School of Public Health, Baltimore, Maryland 21205-2179, USA.
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Last J. Needed: tenable values or five to ten more earth-sized planets. Interview by Desmond Avery. Bull World Health Organ 2001; 79:896-7. [PMID: 11584743 PMCID: PMC2566638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
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Last J. Distress symptoms may be easy to miss. BMJ 2000; 320:717. [PMID: 10710599 PMCID: PMC1117728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Last J, Logan H. Monitoring, surveillance and research needs. Public health planning priorities and policy options. Can J Public Health 1999; 90:SU 1-16. [PMID: 10702006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- J Last
- University of Ottawa, Ontario, Canada
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Goldkorn T, Balaban N, Matsukuma K, Chea V, Gould R, Last J, Chan C, Chavez C. EGF-Receptor phosphorylation and signaling are targeted by H2O2 redox stress. Am J Respir Cell Mol Biol 1998; 19:786-98. [PMID: 9806743 DOI: 10.1165/ajrcmb.19.5.3249] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Inflammation of the respiratory tract is associated with the production of reactive oxygen species, such as hydrogen peroxide (H2O2) and superoxide (O2-), which contribute extensively to lung injury in diseases of the respiratory tract. The mechanisms and target molecules of these oxidants are mainly unknown but may involve modifications of growth-factor receptors. We have shown that H2O2 induces epidermal growth factor (EGF)-receptor tyrosine phosphorylation in intact cells as well as in membranes of A549 lung epithelial cells. On the whole, total phosphorylation of the EGF receptor induced by H2O2 was lower than that induced by the ligand EGF. Phosphorylation was confined to tyrosine residues and was inhibited by addition of genistein, indicating that it was due to the activation of protein tyrosine kinase (PTK). Phosphoamino acid analysis revealed that although the ligand, EGF, enhanced the phosphorylation of serine, threonine, and tyrosine residues, H2O2 preferentially enhanced tyrosine phosphorylation of the EGF receptor. Serine and threonine phosphorylation did not occur, and the turnover rate of the EGF receptor was slower after H2O2 exposure. Selective H2O2-mediated phosphorylation of tyrosine residues on the EGF receptor was sufficient to activate phosphorylation of an SH2-group-bearing substrate, phospholipase C-gamma (PLC-gamma), but did not increase mitogen-activated protein (MAP) kinase activity. Moreover, H2O2 exposure decreased protein kinase C (PKC)-alpha activity by causing translocation of PKC-alpha from the membrane to the cytoplasm. These studies provide novel insights into the capacity of a reactive oxidant, such as H2O2, to modulate EGF-receptor function and its downstream signaling. The H2O2-induced increase in tyrosine phosphorylation of the EGF receptor, and the receptor's slower rate of turnover and altered downstream phosphorylation signals may represent a mechanism by which EGF-receptor signaling can be modulated during inflammatory processes, thereby affecting cell proliferation and thus having implications in wound repair or tumor formation.
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Affiliation(s)
- T Goldkorn
- Department of Medicine, University of California, Davis School of Medicine, Davis, California, USA
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Prineas RJ, Goodman K, Soskolne CL, Buck G, Feinleib M, Last J, Andrews JS. Findings from the American College of Epidemiology's survey on Ethics guidelines. The American College of Epidemiology Ethics and Standards of Practice Committee. Ann Epidemiol 1998; 8:482-9. [PMID: 9802592 DOI: 10.1016/s1047-2797(98)00016-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE A survey to establish both the need and subject areas for a possible new set of ethics guidelines for epidemiologists was conducted among a random sample of 300 North American (Canada, Mexico, and United States) members of three major United States-based professional epidemiology organizations. METHODS An 88% response rate revealed wide agreement on topics to be included in any new set of guidelines, but uncertainty prevailed about the need for new guidelines; 41% agreed that there was a need to develop a new set, 43% had no opinion, and 16% disagreed. RESULTS There was almost no difference in preferences between men and women for topics to be included in a new set of guidelines, or between those aware or unaware of extant ethics guidelines in epidemiology. Fifty-four percent were aware of such guidelines and only 29% of these said they could describe the content of the guidelines. CONCLUSION More needs to be done to evaluate the utility of ethics codes in epidemiology.
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Affiliation(s)
- R J Prineas
- University of Miami School of Medicine, Department of Epidemiology and Public Health, FL, USA
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Last J. The cultural context of ethical problems. Ann R Coll Physicians Surg Can 1997; 30:397-8. [PMID: 12408160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Reiser K, Summers P, Medrano JF, Rucker R, Last J, McDonald R. Effects of elevated circulating IGF-1 on the extracellular matrix in "high-growth" C57BL/6J mice. Am J Physiol 1996; 271:R696-703. [PMID: 8853393 DOI: 10.1152/ajpregu.1996.271.3.r696] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Collagen biosynthesis was analyzed in C57BL/6J mice homozygous for the high-growth locus. Plasma levels of insulin-like growth factor-1 (IGF-1) were significantly elevated in high-growth mice at all ages studied (3 wk-6 mo); IGF-binding proteins were also elevated. Skin biopsies were obtained from mice aged 3, 6, and 9 wk under halothane anesthesia. Mice were killed at 6 mo of age. Collagen, expressed per weight of tissue, was significantly increased in all tissues from high-growth mice, as was collagen cross-linking, expressed as moles of cross-link per mole of collagen. Expression of types I and III collagen, lysyl oxidase, and lysyl hydroxylase was increased in all tissues analyzed. There was a preferential increase in type III expression relative to type I expression. Rate and extent of accumulation of collagen in granulation tissue were measured in polyvinyl alcohol sponges implanted subcutaneously; collagen accumulation was significantly greater in the high-growth mice. These results suggest that 1) elevated circulating IGF-1 may increase collagen deposition both in normal tissue as well as in granulation tissue by increasing collagen gene expression, 2) IGF-1 may increase collagen cross-linking by stimulating expression of lysyl oxidase, and 3) the preferential increase in dihydroxylated cross-links observed in high-growth mice may be due to the stimulation of lysyl hydroxylase expression by IGF-1. In summary, elevated levels of IGF-1 appear to affect collagen both quantitatively and qualitatively, primarily through their effects on gene expression of collagen and of those enzymes responsible for posttranslational modifications of collagen.
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Affiliation(s)
- K Reiser
- Department of Internal Medicine, School of Medicine, University of California, Davis 95616, USA
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Affiliation(s)
- J Last
- Faculty of Medicine, University of Ottawa, Ontario, Canada
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Ahmad I, Austin SM, Back BB, Betts RR, Calaprice FP, Chan KC, Chishti A, Chowdhury P, Conner C, Dunford RW, Fox JD, Freedman SJ, Freer M, Gazes SB, Hallin AL, Happ T, Henderson D, Kaloskamis NI, Kashy E, Kutschera W, Last J, Lister CJ, Liu M, Maier MR, Mercer DJ, Mikolas D, Perera PA, Rhein MD, Roa DE, Schiffer JP, Trainor TA, Wilt P, Winfield JS, Wolanski M, Wolfs FL, Wuosmaa AH, Xu G, Young A, Yurkon JE. Search for narrow sum-energy lines in electron-positron pair emission from heavy-ion collisions near the Coulomb barrier. Phys Rev Lett 1995; 75:2658-2661. [PMID: 10059372 DOI: 10.1103/physrevlett.75.2658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Last J. Human rights, doctors' rights, and patients' rights/Droits humains, droits des medicins et des malades. Ann R Coll Physicians Surg Can 1995; 28:262-3. [PMID: 12199231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Affiliation(s)
- J Last
- Department of Epidemiology and Community Medicine, University of Ottawa, Ontario, Canada
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Last J. Medical records, 2: security and confidentiality. Ann R Coll Physicians Surg Can 1994; 27:8-9. [PMID: 15362241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Last J. Health and climate change. Lancet 1994; 343:304. [PMID: 7905135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Mondorf W, Ehrenforth S, Vigh Z, Last J, Tippmann G, Kreuz W, Scharrer I. Screening of F.VIII:C Antibodies by an Enzyme-Linked Immunosorbent Assay. Vox Sang 1994. [DOI: 10.1159/000462463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
An enzyme-linked immunosorbent assay (Elisa) method was developed in order to examine prevalence and titer of antibodies directed against the factor VIII coagulant protein (F.VIII:C) in hemophilia A and nonhemophilia A patients. Highly purified F.VIII:C was used as immunosorbent on microtiter plates with a peroxidase-conjugated goat anti human IgG antibody for F.VIII:C antibody detection. Results determined by Elisa were compared with measurements according to the Bethesda method. Initially 24 plasma samples containing an F.VIII:C inhibitory activity ranging from 0 to 7,700 Bethesda units (BU) were analysed. At plasma dilutions of 1:128 the optical density determined by our Elisa measurement and the corresponding BU showed a logarithmic correlation. The coefficient of correlation was r = 0.92 with a standard deviation of 0.002 from the regression curve. Plasma samples were analysed from 53 hemophilia A patients, from 21 nonhemophilia patients with acquired F.VIII:C antibodies and from 460 randomly selected nonhemophilia patients presenting for routine preoperative coagulation examination. F.VIII:C antibody-positive Elisa results and positive BU were found in 7 hemophilia A patients and the 2 patients with a history of acquired F.VIII:C antibodies. Positive Elisa results and negative BU were found in 1 hemophilia A patient and 25 out of 460 nonhemophilia A patients (5.43%) suggesting F.VIII:C antibodies without inhibitory potency on F.VIII:C in these cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W Mondorf
- Department of Internal Medicine, University Hospital, Frankfurt, FRG
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Last J, Angell M, Woolf P, Squires B, Kenny N. Professional integrity. Ann R Coll Physicians Surg Can 1993; 26:301-2. [PMID: 15362242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- J Last
- Department of Epidemiology and Community Medicine, University of Ottawa, Ont., Canada
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Last J. War and the health of children. Am J Prev Med 1991; 7:253. [PMID: 1756065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Dunford RW, Liu CJ, Last J, Berrah-Mansour N, Vondrasek R, Church DA, Curtis LJ. Direct observation of hyperfine quenching of the 2 (3)P0 level in heliumlike nickel. Phys Rev A 1991; 44:764-767. [PMID: 9905729 DOI: 10.1103/physreva.44.764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Döhner J, Last J, Arnold M, Freedman SJ, Dubbers D. Pair decay of the 2.2-MeV excited state of the deuteron: Limits on light-particle emission. Phys Rev D Part Fields 1988; 38:2722-2728. [PMID: 9959441 DOI: 10.1103/physrevd.38.2722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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