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Fortunato J, Kullgren J, Houchard G, Hirsch J, Shirilla N, Bumb M, Li J. Oxycodone Extended-Release Capsule Utilization for Pain Management in a Cancer Palliative Care Clinic: A Retrospective Review. J Pain Palliat Care Pharmacother 2023; 37:286-297. [PMID: 37702455 DOI: 10.1080/15360288.2023.2253248] [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] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/19/2023] [Indexed: 09/14/2023]
Abstract
Xtampza ER™, an oxycodone extended-release capsule (OERC), was the first long-acting opioid to feature abuse-deterrent properties and various routes of administration without pharmacokinetic alterations. The primary objective of this study was to evaluate changes in reported pain scores after initiation of or rotation to OERC from a previous opioid. Baseline scores were from patients' outpatient visits immediately before starting OERC and were compared to those at the next two follow-up visits. Secondary objectives identified variables that influenced pain scores. Methods included screening for cancer patients with outpatient OERC prescriptions seen in the palliative care clinic. Eighty-two charts were reviewed with 66 included. Overall mean pain scores at both follow-ups were lower than those at baseline (-0.7 ± 2.1; -1.1 ± 2.4). Results were statistically significant between first and second-reported pain scores versus baseline (p = 0.009; 0.012) but clinically insignificant, defined as a ≥ 2-point change in numeric pain scores. Most patients discontinued OERC at the first or second follow-up (35; 53%), and 12.1% of patients who started OERC were prescribed OERC at the end of the study. There were no significant variables identified to influence pain scores either statistically or clinically. Further studies are needed to determine the long-term efficacy and safety in cancer palliative-care patients.
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Affiliation(s)
- Jordan Fortunato
- College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Justin Kullgren
- Division of Pain and Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gary Houchard
- Division of Pain and Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jessica Hirsch
- Division of Pain and Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicole Shirilla
- Division of Pain and Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Meridith Bumb
- Division of Pain and Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Junan Li
- College of Pharmacy, The Ohio State University, Columbus, OH, USA
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Hakim U, De Felice S, Pinti P, Zhang X, Noah JA, Ono Y, Burgess PW, Hamilton A, Hirsch J, Tachtsidis I. Quantification of inter-brain coupling: A review of current methods used in haemodynamic and electrophysiological hyperscanning studies. Neuroimage 2023; 280:120354. [PMID: 37666393 DOI: 10.1016/j.neuroimage.2023.120354] [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: 07/08/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023] Open
Abstract
Hyperscanning is a form of neuroimaging experiment where the brains of two or more participants are imaged simultaneously whilst they interact. Within the domain of social neuroscience, hyperscanning is increasingly used to measure inter-brain coupling (IBC) and explore how brain responses change in tandem during social interaction. In addition to cognitive research, some have suggested that quantification of the interplay between interacting participants can be used as a biomarker for a variety of cognitive mechanisms aswell as to investigate mental health and developmental conditions including schizophrenia, social anxiety and autism. However, many different methods have been used to quantify brain coupling and this can lead to questions about comparability across studies and reduce research reproducibility. Here, we review methods for quantifying IBC, and suggest some ways moving forward. Following the PRISMA guidelines, we reviewed 215 hyperscanning studies, across four different brain imaging modalities: functional near-infrared spectroscopy (fNIRS), functional magnetic resonance (fMRI), electroencephalography (EEG) and magnetoencephalography (MEG). Overall, the review identified a total of 27 different methods used to compute IBC. The most common hyperscanning modality is fNIRS, used by 119 studies, 89 of which adopted wavelet coherence. Based on the results of this literature survey, we first report summary statistics of the hyperscanning field, followed by a brief overview of each signal that is obtained from each neuroimaging modality used in hyperscanning. We then discuss the rationale, assumptions and suitability of each method to different modalities which can be used to investigate IBC. Finally, we discuss issues surrounding the interpretation of each method.
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Affiliation(s)
- U Hakim
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, Gower Street, London WC1E 6BT, United Kingdom.
| | - S De Felice
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom; Department of Psychology, University of Cambridge, United Kingdom
| | - P Pinti
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, Gower Street, London WC1E 6BT, United Kingdom; Centre for Brain and Cognitive Development, Birkbeck, University of London, London, United Kingdom
| | - X Zhang
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - J A Noah
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Y Ono
- Department of Electronics and Bioinformatics, School of Science and Technology, Meiji University, Kawasaki, Kanagawa, Japan
| | - P W Burgess
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - A Hamilton
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - J Hirsch
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, Gower Street, London WC1E 6BT, United Kingdom; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States; Departments of Neuroscience and Comparative Medicine, Yale School of Medicine, New Haven, CT, United States; Yale University, Wu Tsai Institute, New Haven, CT, United States
| | - I Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, Gower Street, London WC1E 6BT, United Kingdom
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Gossard TR, Teigen LN, Yoo S, Timm PC, Jagielski J, Bibi N, Feemster JC, Steele T, Carvalho DZ, Junna MR, Lipford MC, Tippmann Peikert M, LeClair-Visonneau L, McCarter SJ, Boeve BF, Silber MH, Hirsch J, Sharp RR, St. Louis EK. Patient values and preferences regarding prognostic counseling in isolated REM sleep behavior disorder. Sleep 2023; 46:zsac244. [PMID: 36259668 PMCID: PMC9832520 DOI: 10.1093/sleep/zsac244] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 01/13/2022] [Revised: 06/19/2022] [Indexed: 11/27/2022] Open
Abstract
STUDY OBJECTIVES Isolated REM sleep behavior disorder (iRBD) carries a high lifetime risk for phenoconversion to a defined neurodegenerative disease (NDD) including Parkinson disease, dementia with Lewy bodies, and multiple system atrophy. We aimed to examine iRBD patient values and preferences regarding prognostic counseling. METHODS One hundred thirteen iRBD patient participants enrolled in the Mayo Clinic iRBD Patient Registry were sent an email survey concerning their values and preferences concerning NDD prognostic counseling and their experiences following diagnosis with iRBD. RESULTS Of 81 respondents (71.7% response rate), the majority were men (74.0%) with an average age of 65.7 (±9.7) years. Responses indicated a strong preference toward receiving prognostic information about possible future NDD development. 92.5% of respondents felt knowledge concerning personal NDD risk was important, while 87.6% indicated prognostic discussions were important to maintaining trust in their physician. 95.7% indicated a desire for more information, while only 4.3% desired less information regarding their NDD prognostic risk. Most respondents strongly agreed that prognostic information was important to discuss with their family and friends and inform future life planning, and most expressed interest in learning more about future neuroprotective therapies and symptomatic treatments for parkinsonism and dementia. CONCLUSIONS Most iRBD patients indicated strong preferences for disclosure of NDD prognostic risk and indicated that prognostic information was important for family discussions and future life planning. Future broader surveys and qualitative studies of clinic-based and ultimately community dwelling iRBD patients' values and preferences are needed to guide appropriately tailored and individualized prognostic counseling approaches following iRBD diagnosis.
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Affiliation(s)
- Thomas R Gossard
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | - Luke N Teigen
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | - Seeley Yoo
- Mayo Center for Sleep Medicine, Minnesota, USA
| | - Paul C Timm
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | | | - Noor Bibi
- Mayo Center for Sleep Medicine, Minnesota, USA
| | - John C Feemster
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Tyler Steele
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Diego Z Carvalho
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | | | - Melissa C Lipford
- Mayo Center for Sleep Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Maja Tippmann Peikert
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | | | | | | | - Michael H Silber
- Mayo Center for Sleep Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Jessica Hirsch
- Biomedical Ethics, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Erik K St. Louis
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, Wisconsin, USA
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Pölzl L, Thielmann M, Cymorek S, Nägele F, Hirsch J, Engler C, Eder J, Graber M, Lohmann R, Abfalterer H, Holfeld J, Grimm M, Ruttmann-Ulmer E, Bonaros N, Gollmann-Tepeköylü C. Impaired Outcome after CABG in Women. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
| | | | | | | | | | - C. Engler
- Department of Cardiac Surgery, Innsbruck, Austria
| | - J. Eder
- Department of Cardiac Surgery, Innsbruck, Austria
| | | | - R. Lohmann
- Department of Cardiac Surgery, Innsbruck, Austria
| | - H. Abfalterer
- Medizinische Universität Innsbruck, Innsbruck, Austria
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Pölzl L, Sterzinger P, Lohmann R, Eder J, Nägele F, Holfeld J, Hirsch J, Graber M, Ruttmann-Ulmer E, Bonaros N, Grimm M, Engler C, Gollmann-Tepeköylü C. High-Sensitivity Troponin T and Creatine Kinase MB Predict Mortality after Cardiac Surgery. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
| | | | - R. Lohmann
- Department of Cardiac Surgery, Innsbruck, Austria
| | - J. Eder
- Department of Cardiac Surgery, Innsbruck, Austria
| | | | | | | | | | | | | | | | - C. Engler
- Department of Cardiac Surgery, Innsbruck, Austria
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Brunelli L, Poelzl L, Hirsch J, Engler C, Naegele F, Egelseer-Bruendl T, Scheffauer T, Rassel C, Schmit C, Nawabi F, Luckner-Hornischer A, Bauer A, Poelzl G. The effectiveness of a telemedical program for COVID-19 positive high-risk patients in domestic isolation. Eur Heart J 2022. [PMCID: PMC9619603 DOI: 10.1093/eurheartj/ehac544.2802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background For almost two years, the Covid-19 pandemic has posed an enormous challenge to healthcare systems. Recurrent waves of disease brought the health systems to the limit of their resilience. Purpose The Tele-Covid telemedicine care program was installed in December 2020 to monitor high-risk patients in home isolation. Close monitoring allows early detection of disease deterioration and timely intensification of therapy, ideally avoiding intensive care. Conversely, if the course of the disease is stable, unnecessary hospitalisation can be avoided, thus reducing the burden on the healthcare system. Methods Patient acquisition was performed in collaboration with the local public health service and primary care physicians. Covid-19 positive high-risk patients (age >65 years and/or severe comorbidities) from the greater Innsbruck area were fitted with an ear sensor-based home monitoring system. The ear sensor measures SpO2, respiratory rate, body temperature and heart rate. The monitoring team (25 medical students supervised by 6 physicians) provided continuous monitoring of vital signs (24/7). After validation of the measurements, the collected parameters were evaluated using a specially developed risk score. If a defined risk score was exceeded, the patient was contacted by telephone. The combination of the clinical condition and the risk score determined the further course of action: (a) wait and see, (b) notify the primary care physician, or (c) refer for inpatient admission. The program was active from December 2020 to March 2022. In Summer 2021, the program was temporarily paused due to the epidemiological situation. Results A total of 132 patients (59.8% women) were monitored. The median age was 74 years (IQR: [67.3–80.8]). 91 patients (68.9%) had at least one relevant comorbidity. During the monitoring period, hospitalisation was required in 20 patients (15.2%), 3 of whom were transferred to the intensive care unit. Of the hospitalised patients, 3 (15%) patients died. During the same monitoring period, the Austrian Ministry of Health reported a mortality rate of 20.5% of all hospitalised patients in Austria aged 70–79 years. Subjectively, the patients felt safe due to close monitoring. Conclusion The Tele-Covid program is the successful implementation of a remote monitoring system in a pandemic situation. In the future, a broad application of the program is feasible. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Region of the Tyrol
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Affiliation(s)
- L Brunelli
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - L Poelzl
- Medical University of Innsbruck, Department of Cardiac Surgery , Innsbruck , Austria
| | - J Hirsch
- Medical University of Innsbruck, Department of Cardiac Surgery , Innsbruck , Austria
| | - C Engler
- Medical University of Innsbruck, Department of Cardiac Surgery , Innsbruck , Austria
| | - F Naegele
- Medical University of Innsbruck, Department of Cardiac Surgery , Innsbruck , Austria
| | - T Egelseer-Bruendl
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - T Scheffauer
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - C Rassel
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - C Schmit
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - F Nawabi
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | | | - A Bauer
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - G Poelzl
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
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Fortunato J, Kullgren J, Houchard G, Hirsch J, Shirilla N, Bumb M, Li J. RS4: Descriptive Review of Xtampza ER™ in Cancer Palliative Care Patients. J Pain Palliat Care Pharmacother 2022. [DOI: 10.1080/15360288.2022.2067452] [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: 10/17/2022]
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Gollmann-Tepeköylü C, Thielmann M, Pölzl L, Nägele F, Hirsch J, Graber M, Grimm M, Ruttmann-Ulmer E, Holfeld J, Bonaros N. The Impact of Current Various Definitions of Perioperative Myocardial Infarction after Coronary Artery Bypass Grafting on Long-Term Prognosis. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | | | - M. Grimm
- Anichstraße 35, Innsbruck, Deutschland
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Holfeld J, Nägele F, Stoessel L, Graber M, Zellmer B, Hirsch J, Pölzl L, Ruttmann-Ulmer E, Bonaros N, Oezpeker CU, Semsroth S, Grimm M, Gollmann-Tepeköylü C. Different Calcification Patterns of Tricuspid and Bicuspid Aortic Valves and Their Clinical Impact. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Offenbächer M, Toussaint L, Weigl M, Dezutter J, Kohls N, Vallejo M, Rivera J, Sirois F, Hirsch J. POS1484-HPR THE ASSOCIATION OF STIGMA WITH DISEASE VARIABLES IN PATIENTS WITH FIBROMYALGIA (FM). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1974] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Stigma, defined as social devaluation of an individual, can be an important stressor for chronic pain patients [1]. Not every condition is stigmatized. A relevant factor for illness stigmatization seems to be whether the cause is mental-behavioural or physical. Chronic pain is often regarded as an imaginary illness or caused by psychological problems [2]. Sources of stigma for chronic pain patients are perceived negative attitudes from family members, the general public, and physicians [1]..Objectives:To assess perceived stigma and the associations with disease variables in a cohort of patients with FM.Methods:We invited 18 FM self-help groups in Germany to participate anonymously in our survey, and we sent the survey battery to 192 potential participants via postal mail. To measure perceived stigma, we used the Chronic Pain Stigma Scale (CPSS) developed by Reed [3], which has 30 items and 3 subscales (public, physicians, family). We also assessed sociodemographic characteristics, disease related variables (e.g., pain, stress, depression, anxiety), and other health-related factors, including health related quality of life [Healthy Days Core Module (CDC HDQOL-4)], disease specific impact (FIQ), fear avoidance belief questionnaire (physical activity subscale) (FABQ-PA), pain catastrophizing scale (PCS) and pain self-efficacy questionnaire (PSEQ).Results:In total 162 FM patients participated (=84% response rate). Their mean age was 58 years (SD=10), 84% (N=135) were female. Highest level of education was: Elementary School 29%, Junior High School 35%, High School 15%, College 12%, and other 10%. Duration of chronic pain was 18.2 years (SD=12.0). There was no significant gender difference in the stigma subscales, nor was there an association with duration of chronic pain. Table 1 presents the significant Pearson correlations.Table 1.Correlations of CPSS stigma subscales with health variables. *<.05; **<.01; ns=not significant.CPSS-publicCPSS-physicianCPSS-familyRegional pain scalens.19*.20*VAS pain todaynsnsNsFIQ.20*.16*.22**HADS-anxiety.37*.20*.24*HADS-depression.41**.16*.25**CDC-HDQOL-4 General health.19*.18*.22** Physical health.19*nsns Mental health.20*ns.21* Impairment.24*nsnsPerceived stress scale.44**.24**.37**FABQ-PAns-.17*nsPCS.21*nsnsPSEQ.19*ns.18*Conclusion:Perceived stigma in our FM patient cohort has an important impact on a variety of different disease variables including mental and general health, physical functioning, and on pain coping. Stigmatizing attitudes perceived from the general public exhibited the greatest association with most variables in our chronic pain patients. Perceived stigma from physicians and the family were also related to negative disease consequences in our FM patients. To conclude, we assert that assessing and addressing multi-source perceived stigmatization in routine clinical care may improve the management and wellbeing of patients with FM.References:[1]Waugh OC, Byrne DG, Nicholas MK. Internalized stigma in people living with chronic pain. J Pain 2014;15(5):550 e1-10.[2]Werner A, Isaksen LW, Malterud K. ‘I am not the kind of woman who complains of everything’: illness stories on self and shame in women with chronic pain. Soc Sci Med 2004;59(5): 1035-45[3]Reed P. Chronic pain stigma: developement of the Chronic Pain Stigma Scale. 2005.Disclosure of Interests:None declared
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Offenbächer M, Toussaint L, Hirsch J, Weigl M, Kohls N, Vallejo M, Rivera J, Sirois F, Dezutter J. AB0889-HPR PERCEIVED SATISFACTION WITH CHRONIC PAIN CARE IN GERMAN PATIENTS WITH FIBROMYALGIA (FM). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1993] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In chronic pain care a multidimensional perspective with attention to patients’ cognitions, emotions, and their ability to cope is needed (1). Previous studies are also pointing to the role of experiencing meaningfulness in life in the adjustment to disability.Therefore care should additionally focus on the existential domain of patients’ lives to live up to a holistic care approach (2). However, there are only a few studies on how FM patients are satisfied with practitioners’ attention to multiple aspects of life with a chronic pain condition.Objectives:To assess perceived satisfaction with chronic pain care and its associations with health variables in a cohort of patients with FM.Methods:We invited 18 FM self-help groups in Germany to participate anonymously in our survey and sent them in total 192 paper-and-pencil surveys. Sociodemographics, disease related variables (e.g. pain, general health) and psychological variables [e.g. depression, anxiety, hope, stress] were assessed with standardized instruments, including 5 items (answer format 1=very unsatisfied – 10=very satisfied) assessing subjective satisfaction with medical care in different domains with the following questions: How satisfied are you with the attention of your treatment team/physician at home for physiological aspects of your pain (Physio)/ the consequences of the pain on your physical functioning (Physical)/ on your psychological well-being (Mental)/ on your social life (Social)/ on your meaning in life (Meaning).Results:In total 162 FM patients participated (=84% response rate). Their mean age was 58 years (SD=10), 84% (N=135) were female. Highest level of education was: Elementary School 29%, Junior High School 35%, High School 15%, College 12%, and other 10%. Duration of chronic pain was 18.2 years (SD=12.0). The satisfaction with care scale showed good internal consistency and measured one factor. The means of the subscale were: Physio 5.7 (SD=2.5)/ Physical 5.5 (SD=2.5)/ Mental 5.5 (SD=2.6)/ Social 5.0 (SD=2.5)/ Meaning 5.3 (SD=2.6). Correlations of the subscales are depicted in Table 1. There were no associations between pain variables and satisfaction with care, but satisfaction with care was associated with mental health, but not physical health, outcomes.Table 1.Correlations of satisfaction of care with different health variables. Subscales physiological and physical aspects and HADS-anxiety were not significantly correlated. *<.05; **<.01; ns=not significant.PhysioPhysicalMentalSocialMeaningHADS-depression-.10 (ns)-.12 (ns)-.19*-.16*-.14 (ns)General Health .02 (ns) .14 (ns) .13 (ns) .18* .12 (ns)Stress-.15 (ns)-.14 (ns)-.17*-.17*-.13 (ns)Hope .18 (ns) .18 (ns) .26** .26* .22*Conclusion:In this cohort of German FM patients the average satisfaction with care overall, as well as the specific aspects of care, was only moderate. Interestingly we found associations between satisfaction with care in mental, social and meaning in life aspects with psychological well-being pointing to the fact that care for chronic pain patients should also include those aspects in addition to just addressing biomedical aspects.References:[1]Flor H and Turk D. Chronic pain: an integrated approach. Seattle, WA: IASP Press, 2011.[2]Dezutter J, Casalin S, Wacholtz A, et al. Meaning in life: An important factor for the psychological well-being of chronically ill patients? Rehabilitat Psychol 2013; 58:334–341.Disclosure of Interests:None declared
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Hirsch J, Kale SS, Palletas M, Saphire ML, Kullgren JG. RS9: Transdermal Buprenorphine Use for Pain Management in Palliative Care. J Pain Palliat Care Pharmacother 2020. [DOI: 10.1080/15360288.2020.1846433] [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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Hirsch J, Mehta B, Finik J, Navarro-Millan I, Brantner C, Mirza S, Figgie M, Parks M, Russell L, Orange D, Goodman S. Racial disparities in pre-operative pain, function and disease activity for patients with rheumatoid arthritis undergoing Total knee or Total hip Arthroplasty: a New York based study. BMC Rheumatol 2020; 4:17. [PMID: 32161847 PMCID: PMC7049203 DOI: 10.1186/s41927-020-0117-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/30/2020] [Indexed: 01/02/2023] Open
Abstract
Background Black and Hispanic patients with osteoarthritis have more pain and worse function than Whites at the time of arthroplasty. Whether this is true for patients with rheumatoid arthritis (RA) is unknown. Methods This cross-sectional study used data on RA patients acquired between October 2013 and November 2018 prior to elective total knee (TKA) or hip arthroplasty (THA). Pain, function, and disease activity were assessed using the visual analogue scale (VAS), the Multidimensional Health Assessment Questionnaire (MDHAQ), and the Disease Activity Score (DAS28-ESR). We linked the cases to census tracts using geocoding to determine the community poverty level. Race, education, income, insurance and medications were collected via self-report. Using multivariable linear and logistic models we examined whether minority status predicted pain, function and RA disease activity at the time of arthroplasty. Results Thirty seven (23%) of the 164 patients were Black or Hispanic (minorities). The MDHAQ and DAS28-ESR were not significantly worse while VAS pain score was significantly worse in minority patients (p = 0.03). There was no significant difference in education between the groups. Insurance varied significantly; 29% of minority patients had Medicaid vs. 0% of Whites (p < 0.0001). In the multivariable analyses minority status was not significantly associated with DAS28-ESR [p = 0.66], MDHAQ [p = 0.26], or VAS pain [p = 0.18]. Conclusions For Black and/or Hispanic patients with RA undergoing THA or TKA at a high-volume specialty hospital, unlike Black or Hispanic patients with osteoarthritis (OA), there was no association with worse pain, function, or RA disease activity at the time of elective arthroplasty.
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Affiliation(s)
- J Hirsch
- 1Mount Sinai St. Luke's-West, New York, NY USA
| | - B Mehta
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA.,3Weill Cornell Medicine, New York, NY USA
| | - J Finik
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - I Navarro-Millan
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA.,3Weill Cornell Medicine, New York, NY USA
| | - C Brantner
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - S Mirza
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - M Figgie
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - M Parks
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - L Russell
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA.,3Weill Cornell Medicine, New York, NY USA
| | - D Orange
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA.,4The Rockefeller University, New York, NY USA
| | - S Goodman
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA.,3Weill Cornell Medicine, New York, NY USA
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14
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Abstract
We describe how our institution responded when an interpreter who participated in the consent process involving an individual with limited English proficiency refused to cosign consent documents attesting that the individual enrolling in the study understood the consent information and that her consent to enroll was voluntary. In developing our approach, our institution took into account ethical tensions between the Belmont principles of respect for persons, beneficence, and justice that apply to the protection of research participants and the professional principles of beneficence, fidelity, and respect for the importance of culture that are outlined in ethical guidelines for medical interpreters.
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Affiliation(s)
- Amelia Barwise
- Assistant professor of medicine and a research associate in the Division of Pulmonary and Critical Care Medicine at the Mayo Clinic Rochester
| | - Richard Sharp
- Professor of biomedical ethics and medicine at the Mayo Clinic Rochester
| | - Jessica Hirsch
- Instructor in biomedical ethics in the Biomedical Ethics Research Program at the Mayo Clinic Rochester
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15
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Gollmann-Tepeköylü C, Graber M, Pölzl L, Nägele F, Hirsch J, Bonaros N, Grimm M, Schneeberger S, Resch T, Holfeld J. RNA Release Triggers Ischemia/Reperfusion Injury in Cardiac Transplantation. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Kander EM, Zhao Q, Bhat SA, Hirsch J, Byrd JC, Ooka L, Wiczer T, Woyach JA, Awan FT, Rogers KA, Wang TF. Venous and arterial thrombosis in patients with haematological malignancy during treatment with ibrutinib. Br J Haematol 2019; 187:399-402. [PMID: 31531846 DOI: 10.1111/bjh.16209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/31/2019] [Indexed: 01/08/2023]
Affiliation(s)
| | - Qiuhong Zhao
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Seema A Bhat
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jessica Hirsch
- Department of Pharmacy, Spectrum Health, Grand Rapids, MI, USA
| | - John C Byrd
- Division of Hematology, The Ohio State University, Columbus, OH, USA.,Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Lauren Ooka
- Department of Pharmacy, Franciscan Health Indianapolis, Indianapolis, IN, USA
| | - Tracy Wiczer
- Department of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Jennifer A Woyach
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Farrukh T Awan
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Tzu-Fei Wang
- Division of Hematology, The Ohio State University, Columbus, OH, USA
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17
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Gollmann-Tepeköylü C, Graber M, Pölzl L, Hirsch J, Nägele F, Lobenwein D, Sladky V, Kirchmair E, Demetz E, Wegmayr A, Lener D, Villunger A, Grimm M, Holfeld J. Thoracic Radiation Induces Toll-Like Receptor–Mediated Calcific Aortic Valve Disease. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - M. Graber
- Medical University Innsbruck, Cardiac Surgery, Innsbruck, Austria
| | - L. Pölzl
- Medical University Innsbruck, Cardiac Surgery, Innsbruck, Austria
| | - J. Hirsch
- Medical University Innsbruck, Cardiac Surgery, Innsbruck, Austria
| | - F. Nägele
- Medical University Innsbruck, Cardiac Surgery, Innsbruck, Austria
| | - D. Lobenwein
- Medical University Innsbruck, Cardiac Surgery, Innsbruck, Austria
| | - V. Sladky
- Division of Developmental Immunology, Medical University Innsbruck, Innsbruck, Austria
| | - E. Kirchmair
- Medical University Innsbruck, Cardiac Surgery, Innsbruck, Austria
| | - E. Demetz
- Medical University Innsbruck, Internal Medicine IV, Innsbruck, Austria
| | - A. Wegmayr
- Medical University Innsbruck, Radiotherapy, Innsbruck, Austria
| | - D. Lener
- Medical University Innsbruck, Internal Medicine III, Innsbruck, Austria
| | - A. Villunger
- Division of Developmental Immunology, Medical University Innsbruck, Innsbruck, Austria
| | - M. Grimm
- Medical University Innsbruck, Cardiac Surgery, Innsbruck, Austria
| | - J. Holfeld
- Medical University Innsbruck, Cardiac Surgery, Innsbruck, Austria
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18
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Skornitzke S, Hirsch J, Kauczor HU, Stiller W. Evaluation of the effect of image noise on CT perfusion measurements using digital perfusion phantoms. Eur Radiol 2018; 29:2089-2097. [PMID: 30311031 DOI: 10.1007/s00330-018-5709-3] [Citation(s) in RCA: 3] [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] [Received: 05/19/2018] [Revised: 07/05/2018] [Accepted: 08/06/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the influence of image noise on computed tomography (CT) perfusion studies, CT perfusion software algorithms were evaluated for susceptibility to image noise and results applied to clinical perfusion studies. METHODS Digital perfusion phantoms were generated using a published deconvolution model to create time-attenuation curves (TACs) for 16 different combinations of blood flow (BF; 30/60/90/120 ml/100 ml/min) and flow extraction product (FEP; 10/20/30/40 ml/100 ml/min) corresponding to values encountered in clinical studies. TACs were distorted with Gaussian noise at 50 different strengths to approximate image noise, performing 200 repetitions for each noise level. A total of 160,000 TACs were evaluated by measuring BF and FEP with CT perfusion software, comparing results for the maximum slope and Patlak models with those obtained with a deconvolution model. To translate results to clinical practice, data of 23 patients from a CT perfusion study were assessed for image noise, and the accuracy of reported CT perfusion measurements was estimated. RESULTS Perfusion measurements depend on image noise as means and standard deviations of BF and FEP over repetitions increase with increasing image noise, especially for low BF and FEP values. BF measurements derived by deconvolution show larger standard deviations than those performed with the maximum slope model. Image noise in the evaluated CT perfusion study was 26.46 ± 3.52 HU, indicating possible overestimation of BF by up to 85% in a clinical setting. CONCLUSIONS Measurements of perfusion parameters depend heavily upon the magnitude of image noise, which has to be taken into account during selection of acquisition parameters and interpretation of results, e.g., as a quantitative imaging biomarker. KEY POINTS • CT perfusion results depend heavily upon the magnitude of image noise. • Different CT perfusion models react differently to the presence of image noise. • Blood flow may be overestimated by 85% in clinical CT perfusion studies.
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Affiliation(s)
- Stephan Skornitzke
- Diagnostic & Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Jessica Hirsch
- CHRESTOS Institut, Emil-Figge-Straße 43, 44227, Dortmund, Germany
| | - Hans-Ulrich Kauczor
- Diagnostic & Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Wolfram Stiller
- Diagnostic & Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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19
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Tepekoylu C, Graber M, Poelzl L, Hirsch J, Lobenwein D, Naegele F, Sladky V, Kirchmair E, Demetz E, Wegmayr A, Lener D, Villunger A, Grimm M, Holfeld J. P5127Toll-Like receptor 3 mediates radiation induced calcific aortic valve disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Tepekoylu
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - M Graber
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - L Poelzl
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - J Hirsch
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - D Lobenwein
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - F Naegele
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - V Sladky
- Innsbruck Medical University, Division of Developmental Immunology, Innsbruck, Austria
| | - E Kirchmair
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - E Demetz
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
| | - A Wegmayr
- Innsbruck Medical University, Department for Radiation Medicine and Radiooncology, Innsbruck, Austria
| | - D Lener
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
| | - A Villunger
- Innsbruck Medical University, Division of Developmental Immunology, Innsbruck, Austria
| | - M Grimm
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - J Holfeld
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
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20
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Holfeld J, Poelzl L, Graber M, Hirsch J, Lobenwein D, Zipperle J, Blumer M, Davidson S, Grimm M, Tepekoylu C. P532Mechanical preconditioning causes microvesicle release and induces angiogenesis via thrombospondin 1. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Holfeld
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - L Poelzl
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - M Graber
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - J Hirsch
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - D Lobenwein
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - J Zipperle
- AUVA trauma research center, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - M Blumer
- Innsbruck Medical University, Department of Anatomy, Innsbruck, Austria
| | - S Davidson
- University College London, Hatter Cardiovascular Institute, London, United Kingdom
| | - M Grimm
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - C Tepekoylu
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
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21
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Tepekoylu C, Graber M, Poelzl L, Hirsch J, Lobenwein D, Naegele F, Fuchs C, Troppmair J, Grimm M, Holfeld J. 52Mechanical strain upon aortic valves causes release of danger associated molecular patterns and activates innate immunity. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C Tepekoylu
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - M Graber
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - L Poelzl
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - J Hirsch
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - D Lobenwein
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - F Naegele
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - C Fuchs
- FH Technikum, Signaltissue, Institute for Biochemical Engineering, Vienna, Austria
| | - J Troppmair
- Innsbruck Medical University, Daniel Swarovski Laboratory, Innsbruck, Austria
| | - M Grimm
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - J Holfeld
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
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22
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Ong K, Beall D, Lau E, Frohbergh M, Hirsch J. Abstract No. 592 How many VCF patients were exposed to elevated mortality risk from the diminution in vertebral augmentation referrals? J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.637] [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: 11/17/2022] Open
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23
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Abstract
Obstetric services have long recognized the need for ongoing evaluation of their experiences. Manual »departmental statistics« systems sufficed, but with the advent of more sophisticated care, perinatal re-gionalization and increased research activity, the potential usefulness of computer technology became obvious. At Cleveland Metropolitan General Hospital, a laboratory computer based patient information file system was designed and implemented beginning in 1974. Over the succeeding six years, data have been collected and stored for all delivered pregnancies. There are now over 61,000 files for more than 20,000 consecutively delivered patients. The system provides over 40,000 clinical reports per year. However, the use of a file-oriented system has limited our ability to respond to specific research queries. The application of a relational database management system, INGRES, for perinatal information is reported here. Examples of its use for efficiently »answering questions« are presented, as are guidelines for the development and implementation of computer-based perinatal record systems.
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24
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Tepeköylü C, Graber M, Pölzl L, Hirsch J, Kirchmair E, Degenhart G, Demetz E, Lobenwein D, Lener D, Fuchs C, Feuchtner G, Grimm M, Holfeld J. Toll-like Receptor 3 Mediates the Onset of Calcific Aortic Valve Disease. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C. Tepeköylü
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - M. Graber
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - L. Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - J. Hirsch
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - E. Kirchmair
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - G. Degenhart
- Department of Trauma Surgery, Core Facility for MicroCT, Medical University of Innsbruck, Innsbruck, Austria
| | - E. Demetz
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - D. Lobenwein
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - D. Lener
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - C. Fuchs
- AUVA Research Centre Vienna, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Innsbruck, Austria
| | - G. Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - M. Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - J. Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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25
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Holfeld J, Pölzl L, Graber M, Hirsch J, Lobenwein D, Zipperle J, Blumer M, Kirchmair E, Kirchmair R, Paulus P, Davidson S, Grimm M, Tepeköylü C. miR-19a-3p Containing Exosomes Improve Cardiac Function in Ischemic Myocardium. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J. Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - L. Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - M. Graber
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - J. Hirsch
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - D. Lobenwein
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - J. Zipperle
- AUVA Research Centre Vienna, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Innsbruck, Austria
| | - M. Blumer
- Department of Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - E. Kirchmair
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - R. Kirchmair
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - P. Paulus
- Department of Anesthesiology, Medical University of Linz, Linz, Austria
| | - S. Davidson
- Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - M. Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - C. Tepeköylü
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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26
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Meyers A, Caldwell E, Hirsch J, Jacobs K, Pohlig R, Signorile J. Orthotic bicycle shoe insoles show no effects on leg muscle activation patterns or performance in recreational cyclists. Footwear Science 2017. [DOI: 10.1080/19424280.2017.1344327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A.C. Meyers
- Department of Kinesiology, Augusta University, Augusta, GA, USA
| | | | - J. Hirsch
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - K.A. Jacobs
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - R.T. Pohlig
- Dean's Office, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - J.F. Signorile
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
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27
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Tepekoylu C, Graber M, Poelzl L, Hirsch J, Kirchmair E, Degenhart G, Demetz E, Lobenwein D, Lener D, Fuchs C, Feuchtner G, Grimm M, Holfeld J. 39Toll-like receptor 3 mediates the onset of calcific aortic valve disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.39] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Tepekoylu C, Poelzl L, Graber M, Hirsch J, Lobenwein D, Zipperle J, Blumer M, Kirchmair E, Kirchmair R, Paulus P, Davidson S, Grimm M, Holfeld J. 5921miR-19a-3p containing exosomes improve cardiac function in ischemic myocardium. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5921] [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: 11/13/2022] Open
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29
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Pugh C, Hirsch J, Voss C, Sims-Gould J, Lear S, McKay H, Winters M. CHANGES IN PHYSICAL ACTIVITY AMONG OLDER ADULTS AFTER A NEW GREENWAY DEVELOPMENT IN VANCOUVER, BC. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C. Pugh
- Simon Fraser University, Vancouver, British Columbia, Canada,
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada,
| | - J. Hirsch
- University of North Carolina, Chapel Hill, North Carolina
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada,
| | - C. Voss
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - J. Sims-Gould
- University of British Columbia, Vancouver, British Columbia, Canada,
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada,
| | - S. Lear
- Simon Fraser University, Vancouver, British Columbia, Canada,
| | - H.A. McKay
- University of British Columbia, Vancouver, British Columbia, Canada,
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada,
| | - M. Winters
- Simon Fraser University, Vancouver, British Columbia, Canada,
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada,
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30
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Sprengel S, Schlett C, Stackelberg O, Kauczor H, Bertheau R, Hirsch J, Bamberg F, Günther M, Weckbach S. Management von Zufallsergebnissen in der NAKO Gesundheitsstudie. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S Sprengel
- Universitätsklinik Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - C Schlett
- Universitätsklinik Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - O Stackelberg
- Universitätsklinik Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - H Kauczor
- Universitätsklinik Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - R Bertheau
- Universitätsklinik Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | | | - F Bamberg
- Universitätsklinik Tübingen, Diagnostische und Interventionelle Radiologie, Tübingen
| | | | - S Weckbach
- Universitätsklinik Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
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Hirsch J, Leung J. Reply: heterogeneous population. Br J Anaesth 2016; 117:262. [DOI: 10.1093/bja/aew198] [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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Raymond S, Leslie-Mazwi T, Rost N, Schaefer P, Hirsch J, Gonzalez R, Rabinov J. E-039 Comparison of Medical Therapy vs. Intra-Arterial Therapy for Acute Vertebrobasilar Stroke. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.111] [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: 11/03/2022]
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Fargen K, Mocco J, Rai A, Hirsch J. O-023 The Current State of Neurointerventional Surgery Research Highlights the Need for Collaboration. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Misono A, Mueller P, Hirsch J, Harbaugh A, Sheridan R, Liu R. Outpatient interventional radiology clinic: profitability within reach. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Misono A, Mueller P, Hirsch J, Harbaugh A, Sheridan R, Liu R. Outpatient interventional radiology clinic: financial modeling predicts revenues and profitability. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.127] [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: 11/27/2022] Open
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Mehta S, Hirsch J, Harbaugh A, Rodrigues C, Sheridan R, Ganguli S, Mueller P, Liu R. Analysis of device economics in interventional radiology: experience of an academic tertiary care medical center. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Langenbruch C, Muhl C, Krummenauer F, Hirsch J, Isenmann S. Systemische Thrombolyse beim akuten ischämischen Schlaganfall: Retrospektiver Vergleich von Patienten mit Indikationsstellung innerhalb vs. außerhalb der Zulassungskriterien. Akt Neurol 2015. [DOI: 10.1055/s-0035-1555937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Langenbruch
- Klinik für Neurologie und klinische Neurophysiologie, Helios Klinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM) und Lehrstuhl Neurologie der Universität Witten/Herdecke
| | - C. Muhl
- Klinik für Neurologie und klinische Neurophysiologie, Helios Klinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM) und Lehrstuhl Neurologie der Universität Witten/Herdecke
| | - F. Krummenauer
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin Fakultät für Gesundheit der Universität Witten/Herdecke, Witten
| | - J. Hirsch
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin Fakultät für Gesundheit der Universität Witten/Herdecke, Witten
| | - S. Isenmann
- Klinik für Neurologie und klinische Neurophysiologie, Helios Klinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM) und Lehrstuhl Neurologie der Universität Witten/Herdecke
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Heit J, Pastena G, Nogueira R, Yoo A, Leslie-Mazwi T, Hirsch J, Rabinov J. O-034 cerebral angiography for evaluation of patients with ct angiogram negative subarachnoid hemorrhage: an 11-year experience. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.34] [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: 11/03/2022]
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Hirschfeld G, von Glischinski M, Knop C, Wiesel T, Reinehr T, Aksu F, Blankenburg M, Hirsch J, Zernikow B. Difficulties in screening for peripheral neuropathies in children with diabetes. Diabet Med 2015; 32:786-9. [PMID: 25640325 DOI: 10.1111/dme.12684] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 01/27/2023]
Abstract
AIMS To assess the diagnostic utility of a novel abbreviated monofilament test in comparison with the tuning fork test to detect diabetic peripheral neuropathy in children. METHODS A total of 88 children with Type 1 diabetes mellitus were screened for diabetic peripheral neuropathy using the monofilament test and the tuning fork. Nerve conduction studies were performed according to the 'gold standard' for neuropathy. We assessed the diagnostic utility and inter-rater agreement of the two screening methods. RESULTS A total of 43 (49%) children (aged 6-18 years) had at least one abnormal nerve conduction study result. Diagnostic utility and inter-rater agreement were very low for both screening methods. The monofilament test yielded a sensitivity of 18% and a specificity of 80%. The tuning fork yielded a sensitivity of 0% and a specificity of 98%. CONCLUSION The present study found that an abbreviated monofilament test has low diagnostic utility for the detection of early diabetic peripheral neuropathy because of its low reliability. The problem of reliability needs to be more thoroughly addressed in order to improve the screening procedures in diabetes management in childhood and adolescence.
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Affiliation(s)
- G Hirschfeld
- Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück
- German Paediatric Pain Centre, Children's Hospital Datteln, Datteln
| | | | - C Knop
- Pediatric Diabetology and Endocrinology, Children's Hospital Datteln, Datteln
| | - T Wiesel
- Pediatric Diabetology and Endocrinology, Children's Hospital Datteln, Datteln
| | - T Reinehr
- Witten/Herdecke University, Witten
- Pediatric Diabetology and Endocrinology, Children's Hospital Datteln, Datteln
| | - F Aksu
- Witten/Herdecke University, Witten
- Pediatric Neurology, Children's Hospital Datteln, Datteln
| | | | - J Hirsch
- Institute of Medical Biometrics and Epidemiology, Witten/Herdecke University, Witten, Germany
| | - B Zernikow
- German Paediatric Pain Centre, Children's Hospital Datteln, Datteln
- Witten/Herdecke University, Witten
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Hirsch J, DePalma G, Tsai TT, Sands LP, Leung JM. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth 2015; 115:418-26. [PMID: 25616677 DOI: 10.1093/bja/aeu458] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2014] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Postoperative delirium is common in older patients. Despite its prognostic significance, the pathophysiology is incompletely understood. Although many risk factors have been identified, no reversible factors, particularly ones potentially modifiable by anaesthetic management, have been identified. The goal of this prospective cohort study was to investigate whether intraoperative hypotension was associated with postoperative delirium in older patients undergoing major non-cardiac surgery. METHODS Study subjects were patients >65 years of age, undergoing major non-cardiac surgery, who were enrolled in an ongoing prospective observational study of the pathophysiology of postoperative delirium. Intraoperative blood pressure was measured and predefined criteria were used to define hypotension. Delirium was measured by the Confusion Assessment Method on the first two postoperative days. Data were analysed using t-tests, two-sample proportion tests and ordered logistic regression multivariable models, including correction for multiple comparisons. RESULTS Data from 594 patients with a mean age of 73.6 years (sd 6.2) were studied. Of these 178 (30%) developed delirium on day 1 and 176 (30%) on day 2. Patients developing delirium were older, more often female, had lower preoperative cognitive scores, and underwent longer operations. Relative hypotension (decreases by 20, 30, or 40%) or absolute hypotension [mean arterial pressure (MAP)<50 mm Hg] were not significantly associated with postoperative delirium, nor was the duration of hypotension (MAP<50 mm Hg). Conversely, intraoperative blood pressure variance was significantly associated with postoperative delirium. DISCUSSION These results showed that increased blood pressure fluctuation, not absolute or relative hypotension, was predictive of postoperative delirium.
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Affiliation(s)
- J Hirsch
- Department of Anesthesia and Perioperative Care, University of California, San Francisco 94143-0648, USA
| | - G DePalma
- Department of Statistics, Purdue University, West Lafayette, IN 47907-2069, USA
| | - T T Tsai
- Department of Anesthesia and Perioperative Care, University of California, San Francisco 94143-0648, USA
| | - L P Sands
- Department of Statistics, Purdue University, West Lafayette, IN 47907-2069, USA
| | - J M Leung
- Department of Anesthesia and Perioperative Care, University of California, San Francisco 94143-0648, USA
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Skornitzke S, Fritz F, Klauss M, Pahn G, Hansen J, Hirsch J, Grenacher L, Kauczor HU, Stiller W. Qualitative and quantitative evaluation of rigid and deformable motion correction algorithms using dual-energy CT images in view of application to CT perfusion measurements in abdominal organs affected by breathing motion. Br J Radiol 2014; 88:20140683. [PMID: 25465353 DOI: 10.1259/bjr.20140683] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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
OBJECTIVE To compare six different scenarios for correcting for breathing motion in abdominal dual-energy CT (DECT) perfusion measurements. METHODS Rigid [RRComm(80 kVp)] and non-rigid [NRComm(80 kVp)] registration of commercially available CT perfusion software, custom non-rigid registration [NRCustom(80 kVp], demons algorithm) and a control group [CG(80 kVp)] without motion correction were evaluated using 80 kVp images. Additionally, NRCustom was applied to dual-energy (DE)-blended [NRCustom(DE)] and virtual non-contrast [NRCustom(VNC)] images, yielding six evaluated scenarios. After motion correction, perfusion maps were calculated using a combined maximum slope/Patlak model. For qualitative evaluation, three blinded radiologists independently rated motion correction quality and resulting perfusion maps on a four-point scale (4 = best, 1 = worst). For quantitative evaluation, relative changes in metric values, R(2) and residuals of perfusion model fits were calculated. RESULTS For motion-corrected images, mean ratings differed significantly [NRCustom(80 kVp) and NRCustom(DE), 3.3; NRComm(80 kVp), 3.1; NRCustom(VNC), 2.9; RRComm(80 kVp), 2.7; CG(80 kVp), 2.7; all p < 0.05], except when comparing NRCustom(80 kVp) with NRCustom(DE) and RRComm(80 kVp) with CG(80 kVp). NRCustom(80 kVp) and NRCustom(DE) achieved the highest reduction in metric values [NRCustom(80 kVp), 48.5%; NRCustom(DE), 45.6%; NRComm(80 kVp), 29.2%; NRCustom(VNC), 22.8%; RRComm(80 kVp), 0.6%; CG(80 kVp), 0%]. Regarding perfusion maps, NRCustom(80 kVp) and NRCustom(DE) were rated highest [NRCustom(80 kVp), 3.1; NRCustom(DE), 3.0; NRComm(80 kVp), 2.8; NRCustom(VNC), 2.6; CG(80 kVp), 2.5; RRComm(80 kVp), 2.4] and had significantly higher R(2) and lower residuals. Correlation between qualitative and quantitative evaluation was low to moderate. CONCLUSION Non-rigid motion correction improves spatial alignment of the target region and fit of CT perfusion models. Using DE-blended and DE-VNC images for deformable registration offers no significant improvement. ADVANCES IN KNOWLEDGE Non-rigid algorithms improve the quality of abdominal CT perfusion measurements but do not benefit from DECT post processing.
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Affiliation(s)
- S Skornitzke
- 1 Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Grinband J, Teichert T, Ferrera V, Hirsch J. Sensory and response interference is resolved locally. J Vis 2014. [DOI: 10.1167/14.10.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Patel K, Hirsch J, Beck L, Herlitz L, Radhakrishnan J. De novo membranous nephropathy in renal allograft associated with antibody-mediated rejection and review of the literature. Transplant Proc 2014; 45:3424-8. [PMID: 24182829 DOI: 10.1016/j.transproceed.2013.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 04/26/2013] [Accepted: 05/09/2013] [Indexed: 11/17/2022]
Abstract
A 71-year-old woman with unknown renal failure etiology received living donor transplantation had normal graft function for many years. At 11 years from transplantation, she developed nephrotic syndrome. Allograft biopsy showed membranous nephropathy (MN) and C4d positivity in the peritubular capillaries, suggestive of antibody-mediated rejection. At the time of nephrosis onset, she had new donor-specific antibody positivity. The case is unusual in that the diagnosis of de novo MN is based on evidence that she had antibody-mediated rejection. De novo MN remains relatively uncommon; we have reviewed the literature on this diagnosis.
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Affiliation(s)
- K Patel
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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Sennoune SR, Bermudez LE, Lees JC, Hirsch J, Filleur S, Martínez-Zaguilán R. Vacuolar H+-ATPase is down-regulated by the angiogenesis-inhibitory pigment epithelium-derived factor in metastatic prostate cancer cells. Cell Mol Biol (Noisy-le-grand) 2014; 60:45-52. [PMID: 24857383] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 05/13/2014] [Indexed: 06/03/2023]
Abstract
The Vacuolar H+-ATPases (V-ATPases), a multi-subunits nanomotor present in all eukaryotic cells resides in the endomembranes of exocytotic and endocytotic pathways. Plasmalemmal V-ATPases have been shown to be involved in tumor cell metastasis. Pigment epithelium-derived factor (PEDF), a potent endogenous inhibitor of angiogenesis, is down-regulated in prostate cancer cells. We hypothesized that the transduction of PEDF in prostate cancer cells will down-regulate V-ATPase function; that in turn will decrease the expression of the V-ATPase accessory protein ATP6ap2 and a-subunit isoforms that target V-ATPase to the cell surface. To test these hypotheses, we used the human androgen-sensitive prostate cancer cells LNCaP, and its castration-refractory-derivative CL1 that were engineered to stably co-express the DsRed Express Fluorescent Protein with or without PEDF. To determine if PEDF down-regulates the function of V-ATPase, we measured the rate of proton fluxes (JH+) of the cytosolic and endosome/lysosome compartments. The mRNA levels for subunit-a isoforms and the ATP6ap2 were measured using quantitative reverse transcription-PCR. The results showed that PEDF expression decreased the rate of JH+ in metastatic CL1 cells without affecting JH+ in non-metastatic LNCaP cells, when studying pH(cyt). Interestingly, PEDF did not affect JH+ in endosomes/lysosomes either in metastatic cells or in non-metastatic cells. We also showed that PEDF significantly decreases the levels of a4 isoform and ATP6ap2 in metastatic CL1 cells, without affecting the levels of a4 isoform in the non-metastatic LNCaP cells. These data identify PEDF as a novel regulator of V-ATPase suggesting a new way by which PEDF may inhibit prostate tumor growth.
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Affiliation(s)
- S R Sennoune
- Texas Tech University Health Sciences Center Department of Cell Physiology & Molecular Biophysics Lubbock USA souad.sennoune@ttuhsc.edu
| | - L E Bermudez
- Texas Tech University Health Sciences Center Department of Cell Physiology & Molecular Biophysics Lubbock USA
| | - J C Lees
- Texas Tech University Health Sciences Center Department of Cell Physiology & Molecular Biophysics Lubbock USA
| | - J Hirsch
- Texas Tech University Health Sciences Center Department of Urology Lubbock USA
| | - S Filleur
- Texas Tech University Health Sciences Center Department of Urology Lubbock USA
| | - R Martínez-Zaguilán
- Texas Tech University Health Sciences Center Department of Cell Physiology & Molecular Biophysics Lubbock USA
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Nelius T, Martinez-Marin D, Hirsch J, Miller B, Rinard K, Lopez J, de Riese W, Filleur S. Pigment epithelium-derived factor expression prolongs survival and enhances the cytotoxicity of low-dose chemotherapy in castration-refractory prostate cancer. Cell Death Dis 2014; 5:e1210. [PMID: 24810046 PMCID: PMC4047872 DOI: 10.1038/cddis.2014.180] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 02/02/2014] [Accepted: 02/03/2014] [Indexed: 01/24/2023]
Abstract
There is currently no cure for advanced castration-refractory prostate cancer (CRPC) despite the recent approval of several new therapeutic agents. We report here the anti-tumor effect of the angio-inhibitory pigment epithelium-derived factor (PEDF) in the metastatic LNCaP-derivative CRPC CL1 model and explore PEDF anti-neoplasic efficacy in combination with low-dose chemotherapy. Androgen-sensitive LNCaP and CRPC PC3 cell lines were examined as comparison. Using a retroviral expression system, we showed that PEDF limited the proliferation of all prostatic cell lines tested; an effect attributed to interleukin 8 (IL8)-CXCR1/IL8RA inhibition. PEDF also reduced the number and size of 3D tumor spheroids in vitro, but only induced cell differentiation in CRPC spheroids. Similarly, PEDF inhibited the migration of CRPC cells suggesting both anti-proliferative and anti-migratory functions. In vivo, PEDF decreased by 85% and 65% the growth of subcutaneous (s.c.) PC3 and CL1 tumors, respectively. In the CL1 orthotopic model, tumor intake with lethal metastases was found in all animals; nevertheless, PEDF prolonged the median survival of tumor-bearing mice (95% confidence interval: 53±0.001 to 57±1 days). Accordingly, PEDF delayed the emergence of skeletal-related event in intra-tibial xenografts. Next, we evaluated low-dose docetaxel (DTX; 5, 1, 0.5 mg/kg) or cyclophosphamide (CTX; 10–20 mg/kg) on established s.c. PC3 tumors that conditionally express PEDF anti-tumoral epitope/NT3. Although NT3–DTX-5 mg/kg combination was inefficient, NT3–DTX-1 mg/kg and -0.5 mg/kg inhibited by 95% and 87.8%, respectively, tumor growth compared with control and induced tumor stasis. Both NT3–CTX combinations were advantageous. Inversely, PEDF–DTX-5 mg/kg and PEDF–CTX-10 mg/kg delayed the most CL1 tumor growth (15, 11 and 5 days for PEDF–DTX-5 mg/kg, PEDF–CTX-10 mg/kg and single treatments, respectively) with elevated apoptosis and serum thrombospondin-1 as possible mechanism and marker, respectively. As well, both PEDF–CTX-10 mg/kg and PEDF–DTX-5 mg/kg prolonged significantly the survival of tumor-bearing mice compared with single treatments. Metastases were reduced in PEDF–DTX-5 mg/kg compared with other treatments, suggesting that PEDF–DTX delayed metastases formation. Our results advocate that PEDF/low-dose chemotherapy may represent a new therapeutic alternative for CRPC.
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Affiliation(s)
- T Nelius
- Department of Urology, Texas Tech University-Health Sciences Center, 3601 4th Street, Lubbock, TX, USA
| | - D Martinez-Marin
- Department of Urology, Texas Tech University-Health Sciences Center, 3601 4th Street, Lubbock, TX, USA
| | - J Hirsch
- Department of Urology, Texas Tech University-Health Sciences Center, 3601 4th Street, Lubbock, TX, USA
| | - B Miller
- Department of Pathology, Texas Tech University-Health Sciences Center, 3601 4th Street, Lubbock, TX, USA
| | - K Rinard
- Department of Urology, Texas Tech University-Health Sciences Center, 3601 4th Street, Lubbock, TX, USA
| | - J Lopez
- Department of Urology, Texas Tech University-Health Sciences Center, 3601 4th Street, Lubbock, TX, USA
| | - W de Riese
- Department of Urology, Texas Tech University-Health Sciences Center, 3601 4th Street, Lubbock, TX, USA
| | - S Filleur
- 1] Department of Urology, Texas Tech University-Health Sciences Center, 3601 4th Street, Lubbock, TX, USA [2] Department of Immunology and Molecular Microbiology, Texas Tech University-Health Sciences Center, 3601 4th Street, Lubbock, TX, USA
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Knippschild S, Hirsch J, Krummenauer F. [Metaanalysis to estimate the expected drop out-rates reported in clinical trials on cataract surgery]. Klin Monbl Augenheilkd 2014; 231:151-7. [PMID: 24532403 DOI: 10.1055/s-0033-1360200] [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: 10/25/2022]
Abstract
BACKGROUND A realistic sample size calculation is crucial to achieve significant results in clinical trials. As an expected drop out-rate has to be included in the sample size calculation, current practice consists in the presumption of drop out-rates published in previous similar investigations. This approach may, however, result in severely over- or under-estimated sample sizes. Therefore this meta-analysis sought to aggregate the drop out-rates from published clinical trial reports on cataract surgery to derive a quantitative suggestion for the planning of future clinical trials. METHODS The data collection was a complete review of all prospective and retrospective studies in five journals of the years 2002-2012; trial-wise recall rates of subjects at follow-up 3, 6, 12, and 24 months after recruitment were documented. The primary endpoint of the meta-analysis was the reported drop out-rates after 6 months. 95 % confidence intervals were calculated for each trial, respectively; a median drop out-rate was estimated including its 95 % confidence interval. The drop-out-rate estimates were furthermore stratified by design characteristics of the reported studies. RESULTS For randomised clinical trials on cataract surgery, the median drop out-rate increased during the follow-up period of 24 months from 4 % at three months to 17 % at 24 months after recruitment; for the six-month drop out-rate a median drop-out rate of 3 % (95 % CI 0 %; 14 %) was estimated. CONCLUSION Drop out-rates in sample size calculations for clinical trials on cataract surgery were found to be over-estimated in general, ending up in the calculation of overly large patient numbers and thereby in both ethical and economic consequences. For randomised clinical trials on cataract surgery the median drop out-rate can be expected to be 5 % during a six-month follow-up and may rise up to 15 % during a 12-month trial period.
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Affiliation(s)
- S Knippschild
- Institut für Medizinische Biometrie und Epidemiologie, Fakultät für Gesundheit der Universität Witten/Herdecke
| | - J Hirsch
- Institut für Medizinische Biometrie und Epidemiologie, Fakultät für Gesundheit der Universität Witten/Herdecke
| | - F Krummenauer
- Institut für Medizinische Biometrie und Epidemiologie, Fakultät für Gesundheit der Universität Witten/Herdecke
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Hechler T, Ruhe AK, Schmidt P, Hirsch J, Wager J, Dobe M, Krummenauer F, Zernikow B. Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: randomized controlled trial of efficacy and economic effects. Pain 2013; 155:118-128. [PMID: 24060708 DOI: 10.1016/j.pain.2013.09.015] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [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: 06/12/2013] [Revised: 08/22/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
Pediatric chronic pain, which can result in deleterious effects for the child, bears the risk of aggravation into adulthood. Intensive interdisciplinary pain treatment (IIPT) might be an effective treatment, given the advantage of consulting with multiple professionals on a daily basis. Evidence for the effectiveness of IIPT is scarce. We investigated the efficacy of an IIPT within a randomized controlled trial by comparing an intervention group (IG) (n=52) to a waiting-list control group (WCG) (n=52). We made assessments before treatment (PRE), immediately after treatment (POST), as well as at short-term (POST6MONTHS) and long-term (POST12MONTHS) follow-up. We determined a combined endpoint, improvement (pain intensity, disability, school absence), and investigated 3 additional outcome domains (anxiety, depression, catastrophizing). We also investigated changes in economic parameters (health care use, parental work absenteeism, subjective financial burden) and their relationship to the child's improvement. Results at POST showed that significantly more children in the IG than in the WCG were assigned to improvement (55% compared to 14%; Fisher P<.001; 95% confidence interval for incidence difference: 0.21% to 0.60%). Although immediate effects were achieved for disability, school absence, depression, and catastrophizing, pain intensity and anxiety did not change until short-term follow-up. More than 60% of the children in both groups were improved long-term. The parents reported significant reductions in all economic parameters. The results from the present study support the efficacy of the IIPT. Future research is warranted to investigate differences in treatment response and to understand the changes in economic parameters in nonimproved children.
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Affiliation(s)
- Tanja Hechler
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany Institute of Medical Biometrics and Epidemiology, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
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Wiedemann A, Meziane N, Hirsch J, Füsgen I. [Men with type 2 diabetes and erectile dysfunction are a particular risk group for LUTS - results of the Witten Diabetes Survey]. Aktuelle Urol 2013; 44:280-4. [PMID: 23888407 DOI: 10.1055/s-0033-1348243] [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: 10/26/2022]
Abstract
INTRODUCTION According to our data on 4 071 patients with type 2 diabetes, 65.5% of the men and 70.4% of the women complain of lower urinary tract symptoms (LUTS). That is twice as much as the normal population for the same age group. The most common symptom was overactive bladder (OAB). In patients with a diabetes-related complication such as retinopathy or nephropathy, the incidence for LUTS was about 20% higher than that in patients without complications, whereas in men with diabetes mellitus type 2 and erectile dysfunction (ED) the incidence for LUTS was 31.9% higher than without ED. We wanted to compare the incidence of LUTS in patients with type 2 diabetes and ED against patients without ED as well as women with type 2 diabetes. RESULTS Men with ED had a statistically significant longer history of diabetes, a higher HbA1c and increased serum creatinine compared to men without ED (p value <0.0001). The length of diabetes history was not statistically relevant compared to women with type 2 diabetes. However the HbA1c and serum creatinine were higher than those of the women from the data bank (p value <0.0001). Diabetic men with ED complained more often of urinary incontinence, urge incontinence and made more often use of incontinence pads (p value <0.0001). As for pollakisuria and nocturia the difference was not significant. 42.3% of type 2 diabetic patients with ED were diagnosed with OAB by their urologist or GP. That was significantly more than type 2 diabetic patients without ED and type 2 diabetic women (see graph). The same was true of stress incontinence, overflow incontinence and non-classified incontinence with the exception of faecal incontinence. Patients with type 2 diabetes and ED had to take drugs more often than type 2 diabetic men without ED and women with diabetes. CONCLUSION Amongst patients with type 2 diabetes, ED increases the risk of developing lower urinary tract disorders. Moreover it is connected with a higher HbA1c and a higher risk for LUTS, especially for OAB. The regular use of incontinence pads in every fourth patient with type 2 diabetes and erectile dysfunction demonstrates a high number of under-treated patients. Patients with type 2 diabetes and especially patients with type 2 diabetes AND erectile dysfunction represent a risk group that needs special attention and a special management plan from urologists and GPs.
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Affiliation(s)
- A. Wiedemann
- Urologische Abteilung, Evangelisches Krankenhaus Witten
| | - N. Meziane
- Urologische Abteilung, Evangelisches Krankenhaus Witten
| | - J. Hirsch
- Institut für Medizinische Biometrie und Epidemiologie, Department für Humanmedizin, Universität Witten/Herdecke
| | - I. Füsgen
- Lehrstuhl für Geriatrie der Universität Witten/Herdecke
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Rabinov J, Yoo A, Leslie-Mazwi T, Ogilvy C, Hirsch J. E-073 Transarterial Venous Sinus Occlusion for Cranial Dural Arteriovenous Fistulas. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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