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Mayer TG, Gatchel RJ, Kishino N, Keeley J, Capra P, Mayer H, Barnett J, Mooney V. Objective assessment of spine function following industrial injury. A prospective study with comparison group and one-year follow-up. Spine (Phila Pa 1976) 1985; 10:482-93. [PMID: 2934829 DOI: 10.1097/00007632-198507000-00002] [Citation(s) in RCA: 268] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective functional capacity measurement techniques were used to guide a treatment program for a group of 66 chronic back pain patients. These patients were compared with a group of 38 chronic patients who were not administered the treatment program. Outcome data were collected by telephone survey at an average 1 year follow-up. In addition, functional capacity measures were collected for treatment group patients on admission and follow-up evaluations. Results demonstrated that the functional capacity measures collected for the treatment group improved in approximately 80% of the patients. These changes were also accompanied by positive changes in psychologic measures. In addition, at 1 year follow-up, the treatment group had approximately twice the rate of patients who returned to work, relative to the comparison group. Additional surgery rates were comparable for both groups (6% in the treatment and 7% in the comparison group), but the frequency of additional health-care professional visits was substantially higher in the comparison group. The findings suggest that quantitative functional capacity measures can give objective evidence of patient physical abilities and degree of effort and can significantly guide the clinician in administering an effective treatment program.
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Kelly W, Longson D, Smithard D, Fawcitt R, Wensley R, Noble J, Keeley J. An evaluation of plasma exchange for Graves' ophthalmopathy. Clin Endocrinol (Oxf) 1983; 18:485-93. [PMID: 6688205 DOI: 10.1111/j.1365-2265.1983.tb02878.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Eighteen patients with ocular manifestations of Graves' disease were treated by plasma exchange. Detailed clinical, ophthalmological and orthoptic assessments were made including computerized axial tomography and A + B scan ultrasound of the orbits. Seventeen different ocular parameters were separately rated for each patient. The changes recorded were small, statistically insignificant, and no patient was cured of ocular disease. There were no significant correlations between the ocular changes recorded and age, sex, duration of ophthalmic symptoms, the presence of thyroid antibodies, the number of exchanges, or the concurrent administration of azathioprine.
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Mayer T, Gatchel RJ, Keeley J, Mayer H, Richling D. A male incumbent worker industrial database. Part I: Lumbar spinal physical capacity. Spine (Phila Pa 1976) 1994; 19:755-761. [PMID: 8202791 DOI: 10.1097/00007632-199404000-00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A group of 160 incumbent male railroad workers volunteered for a study of lumbar spine physical capacity. METHODS They were initially subjected to inclinometric measurements of sagittal and coronal regional mobility (T12-S1). They also were tested on isokinetic trunk strength measurement devices for sagittal (bending) and axial (twisting) trunk strength at multiple speeds. RESULTS Results showed that they demonstrated mild deficits of lumbar sagittal extension mobility, trunk extensor strength, and sagittal/axial high speed (150-180 degrees/sec) trunk strength when compared with population averages from a previously derived normative database of a nonhomogeneous male population (matched for age and body weight). CONCLUSIONS It was hypothesized that instructions about "correct lifting techniques," uniformly provided to these workers, may have resulted in an unintended decrement in trunk mobility and strength.
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Comparative Study |
31 |
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Mayer T, Gatchel RJ, Keeley J, Mayer H, Richling D. A male incumbent worker industrial database. Part II: Cervical spinal physical capacity. Spine (Phila Pa 1976) 1994; 19:762-4. [PMID: 8202792 DOI: 10.1097/00007632-199404000-00006] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Quantified cervical physical examination data are provided for a group of 160 incumbent railroad workers from four laboring crafts. OBJECTIVES The subjects were tested for cervical mobility and strength, according to standardized protocols as part of a comprehensive physical examination and functional testing procedure to establish normative data associated with the axial musculoskeletal system. RESULTS Tri-planar cervical inclinometric mobility norms are provided, as are sagittal and coronal isometric cervical strength data.
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Comparative Study |
31 |
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5
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Seth R, Keeley J, Abu-Ali G, Crook S, Jackson D, Ilyas M. The putative tumour modifier gene ATP5A1 is not mutated in human colorectal cancer cell lines but expression levels correlate with TP53 mutations and chromosomal instability. J Clin Pathol 2009; 62:598-603. [PMID: 19261598 DOI: 10.1136/jcp.2009.064436] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Both the putative modifier gene ATP5a1 and the tumour suppressor gene TP53 are involved in the regulation of apoptosis and may be involved in the development of colorectal cancers. AIMS To investigate the relationship between these genes in 16 colorectal cancer cell lines. METHODS Each gene was screened for mutation using high resolution melting analysis and sequencing. Expression of ATP5a1 mRNA was tested by quantitative PCR. RESULTS Sequence changes in ATP5a1 were found in 9/16 (56%) cell lines and consisted of mainly novel single nucleotide polymorphisms (SNPs) found in the 5' UTR, introns 4/5/9 and exon 7. TP53 mutations were also found in 9/16 (56%) cell lines; these were consistent with previous reports. High levels of ATP5a1 expression were seen in cell lines with TP53 mutation compared with those with wild type TP53 (p = 0.02). Furthermore, an A-->G change at the -18 position in intron 4 of ATP5a1 was significantly associated with increased gene expression (p = 0.0391). Comparison with genotype showed that cell lines with chromosomal instability (CIN) had significantly higher levels of ATP5a1 expression than those with microsatellite instability (MSI) (p = 0.02). CONCLUSION Higher levels of ATP5a1 expression are associated with certain SNPs and with TP53 mutation. High expression also occurs in CIN and may facilitate tumour development along this pathway. Conversely, low levels of ATP5a1 expression may facilitate development of tumours with MSI.
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Journal Article |
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Keeley J, Morton B, Babcock B, Castillo P, Fish B, Jerauld E, Johnson B, Landre L, Lum H, Miller C, Parker A, Van Steenwyk G. Dark CO2-fixation and diurnal malic acid fluctuations in the submerged-aquatic Isoetes storkii. Oecologia 1981; 48:332-333. [DOI: 10.1007/bf00346490] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/1980] [Indexed: 11/29/2022]
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7
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Mayer T, Gatchel R, Keeley J, Mayer H, Richling D. A male incumbent worker industrial database. Part III: Lumbar/cervical functional testing. Spine (Phila Pa 1976) 1994; 19:765-70. [PMID: 8202793 DOI: 10.1097/00007632-199404000-00007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A group of 160 incumbent male railroad workers was administered a battery of isokinetic and isoinertial lumbar/cervical lifting tests that served as a paradigm for whole-person functional testing of manual handling tasks. RESULTS Results demonstrated that the workers' performance was near normal or somewhat above population averages according to previously derived heterogeneous normative samples. However, there were some differences among the four laboring crafts that made up the present incumbent worker sample. CONCLUSIONS The implications of these differences are discussed.
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Comparative Study |
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Callahan D, Keeley J, Alipour H, DeVirgilio C, Kaji A, Plurad D, Kim DY. Predictors of Severity in Diabetic Foot Infections. Ann Vasc Surg 2016; 33:103-8. [PMID: 26965808 DOI: 10.1016/j.avsg.2016.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/12/2015] [Accepted: 01/25/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diabetic foot infections (DFIs) constitute a large burden of the morbidity of diabetes, with more than 70,000 lower-extremity amputations (LEA) performed annually in the United States. A necrotizing infection signifies the most severe form of infection and is a key factor in the decision to proceed to LEA for source control. Key clinical and laboratory variables can assist in the identification of necrotizing infections; however, the effect of diabetes on these variables is unknown. Given the increased level and complexity of metabolic derangements in diabetic patients, we sought to examine characteristics predictive of necrotizing infection in patients with DFI who underwent LEA. METHODS We performed a single-institutional retrospective analysis of diabetic patients who underwent a LEA for DFIs over an 18-month period. Patients with necrotizing infection on final pathology were compared with patients without this pathologic finding. Multivariate analysis was performed to identify independent predictors of necrotizing infection. RESULTS Of 183 patients, 57 (31%) had evidence of necrotizing infections. Factors associated with necrotizing infection on univariate analysis were the presence of bullae (11% vs. 2%; odds ratio [OR] = 4.8, P = 0.03), a higher mean admission white blood cell count (WBC; 15 vs. 12, P = 0.002), a lower mean absolute sodium (132 vs. 134, P = 0.01), a higher hemoglobin A1C (11.3 vs. 10.3, P = 0.05), hyperglycemia (289 vs. 248, P = 0.04), elevated C-reactive protein (20 vs. 11, P = 0.02), and the presence of Pseudomonas aeruginosa on final tissue culture (12.3 vs. 1.6, P = 0.004). These patients were taken to surgery more rapidly (22.5 vs. 31 hr, P = 0.04), and they had a longer postoperative stay (7 vs. 4 days, P = 0.02). On multivariate analysis, an elevated WBC was predictive of necrotizing infection (OR = 1.1, P = 0.01), whereas alcohol use was found to be protective (OR = 0.3, P = 0.04). CONCLUSIONS Clinical and laboratory variables known to be associated with necrotizing infections among the general population appear to be predictive of disease severity among patients undergoing amputation for DFIs. Identification of these abnormalities preoperatively may allow for improved operative planning, shared decision making, and resource management. Prospective validation of these findings is potentially warranted.
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Journal Article |
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Yan H, Maximus S, Koopmann M, Keeley J, Smith B, Virgilio CD, Kim DY. Vascular Trauma Operative Experience is Inadequate in General Surgery Programs. Ann Vasc Surg 2016; 33:94-7. [DOI: 10.1016/j.avsg.2016.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 11/29/2022]
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Keeley J, Dean P, Valavanis A, Bertling K, Lim YL, Alhathlool R, Taimre T, Li LH, Indjin D, Rakić AD, Linfield EH, Davies AG. Three-dimensional terahertz imaging using swept-frequency feedback interferometry with a quantum cascade laser. OPTICS LETTERS 2015; 40:994-997. [PMID: 25768165 DOI: 10.1364/ol.40.000994] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We demonstrate coherent three-dimensional terahertz imaging by frequency modulation of a quantum cascade laser in a compact and experimentally simple self-mixing scheme. Through this approach, we can realize significantly faster acquisition rates compared to previous schemes employing longitudinal mechanical scanning of a sample. We achieve a depth resolution of better than 0.1 μm with a power noise spectral density below -50 dB/Hz, for a sampling time of 10 ms/pixel.
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11
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Keeley J, Kaji A, Kim D, Yan H, Putnam BA, Plurad D, Bricker S, Neville AL. Predictors of Mortality in Necrotizing Soft Tissue Infection. Am Surg 2014. [DOI: 10.1177/000313481408001017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Necrotizing soft tissue infections (NSTIs) are a major source of morbidity and mortality, yet predictors of mortality for these critically ill patients remain poorly characterized. The aim of this study was to identify risk factors for mortality in patients with NSTI. We performed a retrospective review of all patients presenting with an NSTI to our county-funded, academic medical center between 2008 and 2013. Admission characteristics, comorbidities, laboratory values, time to operation, and perioperative cultures were assessed to identify predictors of mortality. During the 5-year study period, 138 patients were admitted with a NSTI; 20 (14.5%) of the patients died. Univariate predictors of mortality included bandemia, elevated creatinine, low bicarbonate, elevated lactate, a lower admission temperature, and shorter duration of presenting symptoms. Using Classification And Regression Tree analysis and subsequent logistic regression, bands greater than 25 per cent (odds ratio [OR], 8.0; 95% confidence interval [CI], 2.7 to 24.1; P = 0.0002), duration of symptoms less than 3.5 days (OR, 4.0; 95% CI, 1.2 to 13.9; P = 0.03), and temperature 37°C or less (OR, 3.6; 95% CI, 1.1 to 11.8; P = 0.03) were found to be independent predictors of mortality. Awareness of these predictors should prompt aggressive management of this at-risk population.
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Keeley J, Jarvis P, Judd SJ. Coagulant Recovery from Water Treatment Residuals: A Review of Applicable Technologies. CRITICAL REVIEWS IN ENVIRONMENTAL SCIENCE AND TECHNOLOGY 2014; 44:2675-2719. [PMID: 26064036 PMCID: PMC4440624 DOI: 10.1080/10643389.2013.829766] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Conventional water treatment consumes large quantities of coagulant and produces even greater volumes of sludge. Coagulant recovery (CR) presents an opportunity to reduce both the sludge quantities and the costs they incur, by regenerating and purifying coagulant before reuse. Recovery and purification must satisfy stringent potable regulations for harmful contaminants, while remaining competitive with commercial coagulants. These challenges have restricted uptake and lead research towards lower-gain, lower-risk alternatives. This review documents the context in which CR must be considered, before comparing the relative efficacies and bottlenecks of potential technologies, expediting identification of the major knowledge gaps and future research requirements.
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research-article |
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13
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Keeley J, Koopmann M, Yan H, DeVirgilio C, Putnam B, Y. Kim D, Plurad D. Factors Associated with Amputation after Popliteal Vascular Injuries. Ann Vasc Surg 2016; 33:83-7. [DOI: 10.1016/j.avsg.2016.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 02/07/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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Keeley J, Bertling K, Rubino PL, Lim YL, Taimre T, Qi X, Kundu I, Li LH, Indjin D, Rakić AD, Linfield EH, Davies AG, Cunningham J, Dean P. Detection sensitivity of laser feedback interferometry using a terahertz quantum cascade laser. OPTICS LETTERS 2019; 44:3314-3317. [PMID: 31259948 DOI: 10.1364/ol.44.003314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
Abstract
We report on the high detection sensitivity of a laser feedback interferometry scheme based on a terahertz frequency quantum cascade laser (QCL). We show that variations on the laser voltage induced by optical feedback to the laser can be resolved with the reinjection of powers as low as ∼-125 dB of the emitted power. Our measurements demonstrate a noise equivalent power of ∼1.4 pW/√Hz, although, after accounting for the reinjection losses, we estimate that this corresponds to only ∼1 fW/√Hz being coupled to the QCL active region.
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Mayer TG, Gatchel RJ, Keeley J, Mayer H. Optimal spinal strength normalization factors among male railroad workers. Spine (Phila Pa 1976) 1993; 18:239-44. [PMID: 8441939 DOI: 10.1097/00007632-199302000-00011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In spite of increasing interest in techniques and devices for quantifying trunk strength and lifting capacity, relatively little research has been done to determine optimal normalizing factors for strength. The isolation of the ideal factors is a critical prerequisite for comparison of patient data to expected physical capacities in the uninjured population. In the present study, 160 incumbent railroad workers from four heavy laboring jobs were tested for isokinetic trunk strength and lumbar/cervical isokinetic lifting capacity as part of a study to establish normative data (Union Pacific RR, Omaha, NE). Three variables relating height and weight were studied to determine optimal normalization: actual body weight (BW), ideal weight (IW) and adjusted weight (AW). "IW" is actually a height/weight variable based on a weight control chart specifying ideal weights for given heights and genders. "AW" represents the lesser of BW or IW. Subjects were tested for isokinetic trunk extension/flexion for lumbar (floor-to-knuckle) and cervical (knuckle-to-shoulder) lifts. Results demonstrated that the isolated trunk strength tests showed the best correlation coefficients with BW for flexion-extension work at 60 and 150 per sec. Moreover, the correlation coefficients between the lumbar isokinetic lifting peak force measures and BW were high (ranging 0.49-0.67, P < 0.001), with much lower correlations for AW or IW. By contrast, cervical correlations between Liftask peak force and the height/weight variables were all lower, and were also better for AW than for BW or IW (ranging 0.37-0.50). It appears that body weight is the best normalizing factor for isokinetic trunk flexor/extensor strength and lumbar (floor-to-knuckle) lifting.(ABSTRACT TRUNCATED AT 250 WORDS)
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Mock K, Keeley J, Moazzez A, Plurad DS, Putnam B, Kim DY. Predictors of Mortality in Trauma Patients Aged 80 years or Older. Am Surg 2016. [DOI: 10.1177/000313481608201014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The population of the United States is predicted to age dramatically over the next few decades; as such older patients will comprise an increasing proportion of the injured populations. Due to multiple comorbidities and frailty, the old and very old are at greater risk for mortality than younger patients. To identify predictors of inhospital mortality in these patients, we performed a retrospective cohort study at our Level 1 trauma center. Between April 2009 and October 2014, we identified 193 trauma patients aged 80 years and older admitted to the intensive care unit. The mean age was 86 years old (4.9) and a majority of patients were white (57%) and male (54%). Univariate analysis found Injury Severity Score ( P < 0.01), initial Glasgow Coma Scale ( P < 0.01), admission pH ( P = <0.01), admission lactate ( P < 0.01), the need for mechanical ventilation ( P < 0.01), and Geriatric Trauma Outcome Score ( P < 0.01) to be predictors of mortality. Multivariate analysis identified length of mechanical ventilation [odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.60–0.90, P < 0.01], admission lactate (OR = 1.74, 95% CI = 1.21–2.51, P < 0.01), and the need for mechanical ventilation (OR = 18.2, 95% CI = 3.33–99.8, P < 0.01) as independent predictors of mortality. These predictors can help guide clinical decisions and should prompt early discussion of goals of care. The association between mechanical ventilation and mortality is confounded by withdrawal of care.
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Schellenberg M, Chong V, Cone J, Keeley J, Inaba K. Extremity compartment syndrome. Curr Probl Surg 2018; 55:256-273. [PMID: 30470346 DOI: 10.1067/j.cpsurg.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 01/04/2023]
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Review |
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4 |
18
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Veith FJ, Bakal CW, Cynamon J, Gupta SK, Keeley J, Greenberg M, Mennigus MA, Wengerter KR, Dietzek AM. Early experience with the smart laser in the treatment of atherosclerotic occlusions. Am Heart J 1991; 121:1531-8. [PMID: 1826807 DOI: 10.1016/0002-8703(91)90162-b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A dual-laser system (helium-cadmium and pulsed dye) capable of continuous computer analysis of spectroscopic characteristics of tissue fluorescence, which can distinguish atherosclerotic plaque from components of normal arterial wall, was used to deliver laser energy to ablate plaque. During a 1-year period this system was used to facilitate balloon angioplasty of short (3 to 17 cm) total occlusions of the superficial femoral or popliteal arteries only when standard angioplasty techniques were ineffective. During the year of the study, in one institution 415 patients were subjected to arteriography of the lower extremities for leg ischemia (397 for limb salvage indications). Standard angioplasty techniques were used in 94 of these patients; 218 patients were unsuitable for standard angioplasty, did not fulfill criteria for "smart" laser treatment, and underwent standard bypass operations. Only 11 patients (plus six others in the second institution) requiring treatment fulfilled the criteria for use of the "smart" laser. In 10 patients the occluding lesion was traversed by the laser wire (diameter 0.021 inch), and luminal patency was effectively restored by balloon angioplasty to greater than or equal to 70% of the most normal-appearing segment of that artery. Satisfactory luminal patency has persisted for 2 to 12 months (mean 6 months) in nine patients; the lesion in the tenth patient restenosed at 3 months. The laser procedure was unsuccessful in all three patients with occlusions greater than 10 cm and in four others. Although there were three microperforations with the laser wire, there were no clinically significant complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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Kim DY, Gifford E, Nguyen A, Moazzez A, Plurad D, Keeley J, Pham XB, Bricker S, Bongard F, Hari D, de Virgilio C. General Surgery Residents can Be a Reliable Resource in the Evaluation of Residency Applications. JOURNAL OF SURGICAL EDUCATION 2015; 72:e172-e176. [PMID: 26381925 DOI: 10.1016/j.jsurg.2015.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/10/2015] [Accepted: 08/12/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Surgical residents' ability to screen general surgery (GS) applicants has not been previously investigated. The objective of this study was to compare surgical residents' evaluation of Electronic Residency Application Service (ERAS) applicants to that of faculty using a standardized assessment instrument. DESIGN A prospective analysis of ERAS applications using a standardized assessment tool. SETTING A university-affiliated, academic, county GS residency program. PARTICIPANTS Before the interview day, 51 ERAS (2013-2014) applications were reviewed by 10 different assessors (6 GS faculty, including the program director, and 4 GS residents), who evaluated applicants on 10 characteristics (subjective and objective) using a 5-point Likert scale, a total score, and a Global Rating Scale that ranked candidates into deciles. RESULTS There were a total of 510 assessments. In 8 of 10 individual domains the interrater reliability (IRR) between residents and faculty was good. The IRRs of the total score and global score were excellent. The Spearman ρ between the total score and final rank list were similar for faculty (-0.558) and residents (-0.592). CONCLUSIONS The excellent IRR score between the total and global scores of faculty and residents demonstrates the reliability of GS residents in evaluating ERAS applications. The low correlations between the total score and final rank are consistent with those in previous studies, in which the interview has been demonstrated to be the most important factor in determining final selection.
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Review |
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Spence LH, Yan H, Moazzez A, Schwed A, Keeley J, Karimzada M, Allison M, Neville A, Plurad D, Putnam B, De Virgilio C, Kim D. Mandatory Operative Re-Exploration after Initial Debridement of Necrotizing Soft Tissue Infections: Is it Mandatory? Am Surg 2017. [DOI: 10.1177/000313481708301021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Necrotizing soft tissue infections (NSTIs) are aggressive infections requiring prompt diagnosis and extensive surgical debridement. Traditionally, patients undergo mandatory re-exploration to ensure adequacy of source control. The purpose of this study is to determine if re-exploration in the operating room is mandatory for all patients with NSTIs. An eight-year retrospective analysis of adult patients with NSTIs was performed comparing two groups: mandatory operative re-exploration versus operative re-exploration based on clinical examination findings. Outcomes measured included mortality, number of debridements, and length of stay (LOS). Twenty-two per cent of patients underwent a mandatory re-exploration. These patients were older, had a higher incidence of diabetes, and a longer duration of symptoms. There were no significant differences between groups with regard to the physical examination, severity of sepsis, time to repeat debridements, or in-hospital mortality, whereas LOS and the total number of debridements were increased in mandatory re-exploration. Bacteremia and septic shock were predictive of the need for further debridement in patients in the operative re-exploration based on clinical examination findings group. Mandatory re-exploration after initial debridement may not be necessary in all patients with NSTIs. Instead, bedside wound checks may be a safe strategy to determine the need for further operative debridement.
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Keeley J, Kaji A, Kim D, Plurad D, Putnam B, Neville A. Nutritional Status Does Not Correlate with Stump Complications in Two-stage Lower Extremity Amputations. Am Surg 2015. [DOI: 10.1177/000313481508101002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Unsalvageable foot infections require a two-staged amputation: an initial guillotine below-knee amputation (BKA) followed by formalization. No literature exists regarding the optimal timing to formalization, and the role of nutrition on outcomes remains unclear. This study was conducted to evaluate whether timing to formalization or nutritional markers correlate with stump complications. A retrospective review of all guillotine BKAs done at our county-funded, academic medical center between 2008 and 2013 was performed. Comorbidities, albumin, prealbumin, glycated hemoglobin, days to formalization, and postoperative complications were recorded. Primary outcome was surgical site infection or need for reoperation of the formalized stump within 30 days. One hundred and twenty-eight guillotine BKAs and subsequent formalizations were performed. Twenty-two (17.2%) patients developed surgical site infections and six (4.9%) required reoperation. Patients formalized within 14 days were as likely to develop stump complications as those formalized later (odds ratio 0.7, 0.3–1.8, P = 0.5). When comparing patients who developed stump complications to those who did not, there was no difference in preoperative albumin (2.6 ± 0.7 vs 2.4 ± 0.7, P = 0.3), prealbumin, (14.4 ± 6.2 vs 15.2 ± 5.5, P = 0.5), or glycated hemoglobin (8.8 ± 2.9 vs 9.0 ± 2.5, P = 0.7). Neither timing of formalization nor nutritional parameters predicted wound complications.
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Balan N, Qi X, Keeley J, Neville A. A Novel Strategy to Manage Below-Knee-Amputation (BKA) Stump Complications for Early Wound Healing and BKA Salvage. Am Surg 2023; 89:4055-4060. [PMID: 37195758 DOI: 10.1177/00031348231175504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
INTRODUCTION The optimal management of major stump complications (operative infection or dehiscence) following below-knee-amputation (BKA) is unknown. We evaluated a novel operative strategy to aggressively treat major stump complications hypothesizing it would improve our rate of BKA salvage. METHODS Retrospective review of patients requiring operative intervention for BKA stump complications between 2015 and 2021. A novel strategy employing staged operative debridement for source control, negative pressure wound therapy, and reformalization was compared to standard care (less structured operative source control or above knee amputation). RESULTS 32 patients were studied, 29 of which were male (90.6%) with an average age of 56.1 ± 9.6 y. 30 (93.8%) had diabetes and 11 (34.4%) peripheral arterial disease (PAD). The novel strategy was used in 13 patients and 19 had standard care. Novel strategy patients had higher BKA salvage rates, 100% vs 73.7% (P = .064), and postoperative ambulatory status, 84.6% vs 57.9% (P = .141). Importantly, none of the patients undergoing the novel therapy had PAD, while all progressing to above-knee amputation (AKA) did. To better assess the efficacy of the novel technique, patients progressing to AKA were excluded. Patients undergoing novel therapy who had their BKA level salvaged (n = 13) were compared to usual care (n = 14). The novel therapy's time to prosthetic referral was 72.8 ± 53.7 days vs 247 ± 121.6 days (P < .001), but they did undergo more operations (4.3 ± 2.0 vs 1.9 ± 1.1, P < .001). CONCLUSION Utilization of a novel operative strategy for BKA stump complications is effective in salvaging BKAs, particularly for patients without PAD.
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Keeley J, Keeley V, Keeley J. Possible missed diagnosis of syllogomania. BMJ (CLINICAL RESEARCH ED.) 1996; 312:513. [PMID: 8597715 PMCID: PMC2349925 DOI: 10.1136/bmj.312.7029.513b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Arora S, Sood A, Dalela D, Keeley J, Rakic N, Prokopiv U, Fotouhi A, Peabody J, Mani M, Abdollah F. Inpatient morbidity and cost of cytoreductive radical prostatectomy in the United States. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31007-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Downs J, Keeley J, Skoss R, Mills J, Nevill T, Schippers A, Lindly O, Thompson S. Perspectives on the essential skills of healthcare decision making in children and adolescents with intellectual disability. Int J Equity Health 2024; 23:119. [PMID: 38849806 PMCID: PMC11162048 DOI: 10.1186/s12939-024-02204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Involvement in healthcare decisions is associated with better health outcomes for patients. For children and adolescents with intellectual disability, parents and healthcare professionals need to balance listening to a child's wishes with the responsibility of keeping them safe. However, there is a scarcity of literature evaluating how to effectively involve them in decision making. In this context, we review the concept of health literacy, focusing on the skills of healthcare decision making for children and adolescents with intellectual disability. METHODS We describe the concept of health literacy and models explaining shared decision making (individuals and healthcare professionals collaborate in decision making process) and supported decision making (when a trusted person supports the individual to collaborate with the healthcare professional in the decision-making process), and a rapid review of the literature evaluating their efficacy. We discuss healthcare decision making for children and adolescents with intellectual disability in the context of relevant recommendations from the recent Disability Royal Commission into Violence, Abuse, Neglect, and Exploitation of People with Disability in Australia. RESULTS Health literacy skills enable individuals to access, understand, appraise, remember and use health information and services. Shared decision making has been described for children with chronic conditions and supported decision making for adults with intellectual disability. Decision-making contributes to how individuals appraise and use healthcare. The rapid review found very limited evidence of outcomes where children and adolescents with intellectual disability have been supported to contribute to their healthcare decisions. Recommendations from the Disability Royal Commission highlight current needs for greater efforts to support and build the capacity of individuals with disability to be involved in the decisions that affect their life, including healthcare decision making. CONCLUSIONS Existing rights frameworks and healthcare standards confirm the importance of providing all people with the opportunities to learn and practise health literacy skills including decision making. There is little literature examining interventions for healthcare decision making for children with intellectual disability. Childhood is a critical time for the development of skills and autonomy. Evidence for how children and adolescents with intellectual disability can learn and practice healthcare decision-making skills in preparation for adulthood is needed to reduce inequities in their autonomy.
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