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McCarthy L, Verma G, Hangel G, Neal A, Moffat BA, Stockmann JP, Andronesi OC, Balchandani P, Hadjipanayis CG. Application of 7T MRS to High-Grade Gliomas. AJNR Am J Neuroradiol 2022; 43:1378-1395. [PMID: 35618424 PMCID: PMC9575545 DOI: 10.3174/ajnr.a7502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/11/2022] [Indexed: 01/26/2023]
Abstract
MRS, including single-voxel spectroscopy and MR spectroscopic imaging, captures metabolites in high-grade gliomas. Emerging evidence indicates that 7T MRS may be more sensitive to aberrant metabolic activity than lower-field strength MRS. However, the literature on the use of 7T MRS to visualize high-grade gliomas has not been summarized. We aimed to identify metabolic information provided by 7T MRS, optimal spectroscopic sequences, and areas for improvement in and new applications for 7T MRS. Literature was found on PubMed using "high-grade glioma," "malignant glioma," "glioblastoma," "anaplastic astrocytoma," "7T," "MR spectroscopy," and "MR spectroscopic imaging." 7T MRS offers higher SNR, modestly improved spatial resolution, and better resolution of overlapping resonances. 7T MRS also yields reduced Cramér-Rao lower bound values. These features help to quantify D-2-hydroxyglutarate in isocitrate dehydrogenase 1 and 2 gliomas and to isolate variable glutamate, increased glutamine, and increased glycine with higher sensitivity and specificity. 7T MRS may better characterize tumor infiltration and treatment effect in high-grade gliomas, though further study is necessary. 7T MRS will benefit from increased sample size; reductions in field inhomogeneity, specific absorption rate, and acquisition time; and advanced editing techniques. These findings suggest that 7T MRS may advance understanding of high-grade glioma metabolism, with reduced Cramér-Rao lower bound values and better measurement of smaller metabolite signals. Nevertheless, 7T is not widely used clinically, and technical improvements are necessary. 7T MRS isolates metabolites that may be valuable therapeutic targets in high-grade gliomas, potentially resulting in wider ranging neuro-oncologic applications.
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Affiliation(s)
- L McCarthy
- From the Department of Neurosurgery (L.M., C.G.H.), Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - G Verma
- BioMedical Engineering and Imaging Institute (G.V., P.B.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - G Hangel
- Department of Neurosurgery (G.H.)
- High-field MR Center (G.H.), Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - A Neal
- Department of Medicine (A.N.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Neurology (A.N.), Royal Melbourne Hospital, Melbourne, Australia
| | - B A Moffat
- The Melbourne Brain Centre Imaging Unit (B.A.M.), Department of Radiology, The University of Melbourne, Melbourne, Australia
| | - J P Stockmann
- A. A. Martinos Center for Biomedical Imaging (J.P.S., O.C.A.), Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (J.P.S., O.C.A.), Boston, Massachusetts
| | - O C Andronesi
- A. A. Martinos Center for Biomedical Imaging (J.P.S., O.C.A.), Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (J.P.S., O.C.A.), Boston, Massachusetts
| | - P Balchandani
- BioMedical Engineering and Imaging Institute (G.V., P.B.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - C G Hadjipanayis
- From the Department of Neurosurgery (L.M., C.G.H.), Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
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Foley JF, Defer G, Ryerson LZ, Cohen JA, Arnold DL, Butzkueven H, Cutter G, Giovannoni G, Killestein J, Wiendl H, Smirnakis K, Xiao S, Kong G, Kuhelj R, Campbell N, Dwyer C, Buzzard K, Spies J, Parratt J, van Pesch V, Willekens B, Perrotta G, Bartholomé E, Grand'Maison F, Jacques F, Giacomini P, Vosoughi R, Girard JM, de Seze J, Lebrun Frenay C, Ruet A, Laplaud DA, Reifschneider G, Wagner B, Rauer S, Pul R, Seipelt M, Berthele A, Klotz L, Kallmann BA, Paul F, Achiron A, Lus G, Centonze D, Patti F, Grimaldi L, Hupperts R, Frequin S, Fermont J, Madueno SE, Alonso Torres AM, Costa-Frossard França L, Meca-Lallana JE, Ruiz LB, Pearson O, Rog D, Evangelou N, Ismail A, Lathi E, Fox E, Leist T, Sloane J, Wu G, Khatri B, Steingo B, Thrower B, Gudesblatt M, Calkwood J, Bandari D, Scagnelli J, Laganke C, Robertson D, Kipp L, Belkin M, Cohan S, Goldstick L, Courtney A, Vargas W, Sylvester A, Srinivasan J, Kannan M, Picone M, English J, Napoli S, Balabanov R, Zaydan I, Nicholas J, Kaplan J, Lublin F, Riser E, Miller T, Alvarez E, Wray S, Gross J, Pawate S, Hersh C, McCarthy L, Crayton H, Graves J. Comparison of switching to 6-week dosing of natalizumab versus continuing with 4-week dosing in patients with relapsing-remitting multiple sclerosis (NOVA): a randomised, controlled, open-label, phase 3b trial. Lancet Neurol 2022; 21:608-619. [PMID: 35483387 DOI: 10.1016/s1474-4422(22)00143-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/28/2022] [Accepted: 03/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Treatment with natalizumab once every 4 weeks is approved for patients with relapsing-remitting multiple sclerosis, but is associated with a risk of progressive multifocal leukoencephalopathy. Switching to extended-interval dosing is associated with lower progressive multifocal leukoencephalopathy risk, but the efficacy of this approach is unclear. We aimed to assess the safety and efficacy of natalizumab once every 6 weeks compared with once every 4 weeks in patients with relapsing-remitting multiple sclerosis. METHODS We did a randomised, controlled, open-label, phase 3b trial (NOVA) at 89 multiple sclerosis centres across 11 countries in the Americas, Europe, and Western Pacific. Included participants were aged 18-60 years with relapsing-remitting multiple sclerosis and had been treated with intravenous natalizumab 300 mg once every 4 weeks with no relapses for at least 12 months before randomisation, with no missed doses in the previous 3 months. Participants were randomly assigned (1:1), using a randomisation sequence generated by the study funder and contract personnel with interactive response technology, to switch to natalizumab once every 6 weeks or continue with once every 4 weeks. The centralised MRI reader, independent neurology evaluation committee, site examining neurologists, site backup examining neurologists, and site examining technicians were masked to study group assignments. The primary endpoint was the number of new or newly enlarging T2 hyperintense lesions at week 72, assessed in all participants who received at least one dose of assigned treatment and had at least one postbaseline MRI, relapse, or neurological examination or efficacy assessment. Missing primary endpoint data were handled under prespecified primary and secondary estimands: the primary estimand included all data, regardless of whether participants remained on the assigned treatment; the secondary estimand classed all data obtained after treatment discontinuation or study withdrawal as missing. Safety was assessed in all participants who received at least one dose of study treatment. Study enrolment is closed and an open-label extension study is ongoing. This study is registered with EudraCT, 2018-002145-11, and ClinicalTrials.gov, NCT03689972. FINDINGS Between Dec 26, 2018, and Aug 30, 2019, 605 patients were assessed for eligibility and 499 were enrolled and assigned to receive natalizumab once every 6 weeks (n=251) or once every 4 weeks (n=248). After prespecified adjustments for missing data, mean numbers of new or newly enlarging T2 hyperintense lesions at week 72 were 0·20 (95% CI 0·07-0·63) in the once every 6 weeks group and 0·05 (0·01-0·22) in the once every 4 weeks group (mean lesion ratio 4·24 [95% CI 0·86-20·85]; p=0·076) under the primary estimand, and 0·31 (95% CI 0·12-0·82) and 0·06 (0·01-0·31; mean lesion ratio 4·93 [95% CI 1·05-23·20]; p=0·044) under the secondary estimand. Two participants in the once every 6 weeks group with extreme new or newly enlarging T2 hyperintense lesion numbers (≥25) contributed most of the excess lesions. Adverse events occurred in 194 (78%) of 250 participants in the once every 6 weeks group and 190 (77%) of 247 in the once every 4 weeks group, and serious adverse events occurred in 17 (7%) and 17 (7%), respectively. No deaths were reported. There was one case of asymptomatic progressive multifocal leukoencephalopathy (without clinical signs) in the once every 6 weeks group, and no cases in the once every 4 weeks group; 6 months after diagnosis, the participant was without increased disability and remained classified as asymptomatic. INTERPRETATION We found a numerical difference in the mean number of new or newly enlarging T2 hyperintense lesions at week 72 between the once every 6 weeks and once every 4 weeks groups, which reached significance under the secondary estimand, but interpretation of statistical differences (or absence thereof) is limited because disease activity in the once every 4 weeks group was lower than expected. The safety profiles of natalizumab once every 6 weeks and once every 4 weeks were similar. Although this trial was not powered to assess differences in risk of progressive multifocal leukoencephalopathy, the occurrence of the (asymptomatic) case underscores the importance of monitoring and risk factor consideration in all patients receiving natalizumab. FUNDING Biogen.
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Affiliation(s)
- John F Foley
- Rocky Mountain MS Clinic, Salt Lake City, UT, USA.
| | - Gilles Defer
- Department of Neurology, Centre Hospitalier Universitaire de Caen, Caen, France
| | | | - Jeffrey A Cohen
- Mellen MS Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada; NeuroRx Research, Montréal, QC, Canada
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Gary Cutter
- University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Queen Mary University of London, London, UK
| | - Joep Killestein
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
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Yuzefpolskiy Y, Morawski P, Fahning M, Speake C, Lord S, Chaudhary A, Morishima C, Wener MH, Kita M, McCarthy L, Buckner JH, Campbell DJ, Bettelli E. Cutting Edge: Effect of Disease-Modifying Therapies on SARS-CoV-2 Vaccine-Induced Immune Responses in Multiple Sclerosis Patients. J Immunol 2022; 208:1519-1524. [PMID: 35288472 DOI: 10.4049/jimmunol.2101142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
Multiple sclerosis (MS) is a demyelinating inflammatory disease of the CNS treated by diverse disease-modifying therapies that suppress the immune system. Severe acute respiratory syndrome coronavirus 2 mRNA vaccines have been very effective in immunocompetent individuals, but whether MS patients treated with modifying therapies are afforded the same protection is not known. This study determined that dimethyl fumarate caused a momentary reduction in anti-Spike (S)-specific Abs and CD8 T cell response. MS patients treated with B cell-depleting (anti-CD20) or sphingosine 1-phosphate receptor agonist (fingolimod) therapies lack significant S-specific Ab response. Whereas S-specific CD4 and CD8 T cell responses were largely compromised by fingolimod treatment, T cell responses were robustly generated in anti-CD20-treated MS patients, but with a reduced proportion of CD4+CXCR5+ circulating follicular Th cells. These data provide novel information regarding vaccine immune response in patients with autoimmunity useful to help improve vaccine effectiveness in these populations.
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Affiliation(s)
- Yevgeniy Yuzefpolskiy
- Center for Fundamental Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA
| | - Peter Morawski
- Center for Fundamental Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA
| | - Mitch Fahning
- Center for Fundamental Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA
| | - Cate Speake
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA
| | - Sandra Lord
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA
| | - Anu Chaudhary
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Chihiro Morishima
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Mark H Wener
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Mariko Kita
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA
| | - Lucas McCarthy
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA
| | - Jane H Buckner
- Translational Research Program, Benaroya Research Institute at Virginia Mason, Seattle, WA; and
| | - Daniel J Campbell
- Center for Fundamental Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA
- Department of Immunology, University of Washington School of Medicine, Seattle, WA
| | - Estelle Bettelli
- Center for Fundamental Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA;
- Department of Immunology, University of Washington School of Medicine, Seattle, WA
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Peters N, Bambury RM, Power DG, McCarthy L, Lyons C, Kelly P, Jamaluddin MF. Radium-223 in the Treatment of Metastatic Castrate-Resistant Prostate Cancer. Ir Med J 2022; 115:536. [PMID: 35416462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Radium 223 (Ra-223) has been successfully utilised for the treatment of men with metastatic castrate resistant prostate cancer (mCRPC). To date, no real world outcomes from its use in the Irish population have been described. Methods All men referred to our institution for Ra-223 from September 2016 to March 2019 were included. Patient demographics, treatments received, toxicities and outcomes were recorded. Overall survival (OS) and progression free survival (PFS) were analysed using the Kaplan-Meier method. Results Complete data was available for 54 men. Median age was 75 years (range 61-86 years). The median number of prior systemic treatments for mCRPC was 2 (range 0-4). Median ECOG performance status was 1 at the start of treatment and 2 at completion. The median number of Ra-223 cycles received was 4 with 37%(n=20) completing all 6 planned cycles. The most common treatment-related toxicity was fatigue seen in 52% of patients ( n=28). Improved pain scores were documented in 76% of men requiring opioid analgesia at the start of treatment. The median OS was 7 months. A good ECOG performance status, fewer than 6 bone metastases, normal alkaline phosphatase level at start of treatment and chemotherapy naivety were associated with improved OS. Conclusions Ra-223 is a moderately well tolerated palliative treatment amongst Irish men with mCRPC.
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Affiliation(s)
- N Peters
- Department of Medical Oncology, Cork University Hospital
| | - R M Bambury
- Department of Medical Oncology, Cork University Hospital
| | - D G Power
- Department of Medical Oncology, Cork University Hospital
| | - L McCarthy
- Department of Radiation Oncology, Cork University Hospital
| | - C Lyons
- Department of Radiation Oncology, Cork University Hospital
| | - P Kelly
- Department of Radiation Oncology, Cork University Hospital
- Department of Radiation Oncology, Bon Secours University Hospital
| | - M F Jamaluddin
- Department of Radiation Oncology, Cork University Hospital
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McCarthy L, Hayward S. Implementation of a mobilisation guideline and training programme to increase mobilisation levels on a cardiothoracic intensive therapy unit (CITU). Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.303] [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: 12/01/2022]
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Orchard J, Fleming G, Gini N, Ellis A, Gordon L, Harley K, Holmes K, Hutching K, Lally E, McCarthy L, McIntosh A, McInnes J, Pegg D, Purcell H, Sampson H, Suna J, Tallon M, Vink M, Wilson M, Ullman A. Wound Management Across Australian and New Zealand Paediatric Cardiac Services: A Cross-Sectional Survey. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.441] [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: 10/16/2022]
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McCarthy L. In ASCVD, 81 mg and 325 mg of aspirin did not differ for CV or bleeding events. Ann Intern Med 2021; 174:JC118. [PMID: 34606309 DOI: 10.7326/acpj202110190-118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Jones WS, Mulder H, Wruck LM, et al. Comparative effectiveness of aspirin dosing in cardiovascular disease. N Engl J Med. 2021;384:1981-90. 33999548.
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Affiliation(s)
- Lucas McCarthy
- Virginia Mason Medical Center, Seattle, Washington, USA (L.M.)
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Wilson AM, Benish SM, McCarthy L, Romano JG, Lundgren KB, Byrne M, Schierman B, Jones LK. Quality of Neurologic Care in the United States: Initial Report From the Axon Registry. Neurology 2021; 97:e651-e659. [PMID: 34145002 DOI: 10.1212/wnl.0000000000012378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/14/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To provide the initial description of the quality of outpatient US neurologic care as collected and reported in the Axon Registry. METHODS We describe characteristics of registry participants and the performance of neurology providers on 20 of the 2019 Axon Registry quality measures. From the distribution of providers' scores on a quality measure, we calculate the median performance for each quality measure. We test for associations between quality measure performance, provider characteristics, and intrinsic measure parameters. RESULTS There were 948 neurology providers who contributed a total of 6,480 provider-metric observations. Overall, the average quality measure performance score at the provider level was 66 (median 77). At the measure level (n = 20), the average quality measure performance score was 53 (median 55) with a range of 2 to 100 (interquartile range 20-91). Measures with a lower-complexity category (e.g., discrete orders, singular concepts) or developed through the specialty's qualified clinical data registry pathway had higher performance distributions. There was no difference in performance between Merit-Based Incentive Payment System (MIPS) and non-MIPS providers. There was no association between quality measure performance and practice size, measure clinical topic/neurologic condition, or measure year of entry. CONCLUSIONS This cross-sectional assessment of quality measure performance in 2019 Axon Registry data demonstrates modest performance scores and considerable variability across measures and providers. More complex measures were associated with lower performance. These findings serve as a baseline assessment of quality of ambulatory neurologic care in the United States and provide insights into future measure design.
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Affiliation(s)
- Andrew M Wilson
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN.
| | - Sarah M Benish
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Lucas McCarthy
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Jose G Romano
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Karen B Lundgren
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Margaret Byrne
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Becky Schierman
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Lyell K Jones
- From the Department of Neurology (A.M.W.), University of California Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (L.M.), Virginia Mason Medical Center, Seattle, WA; Department of Neurology (J.G.R.), University of Miami, FL; American Academy of Neurology (K.B.L., M.B., B.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
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McCarthy L. Orally disintegrating rimegepant increased freedom from pain and from most bothersome symptom at 2 h in acute migraine. Ann Intern Med 2019; 171:JC58. [PMID: 31739341 DOI: 10.7326/acpj201911190-058] [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: 11/22/2022] Open
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McCarthy L. Oral rimegepant increased freedom from pain and from most bothersome symptom at 2 h in acute migraine. Ann Intern Med 2019; 171:JC59. [PMID: 31739342 DOI: 10.7326/acpj201911190-059] [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: 11/22/2022] Open
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Barnet M, Pathmanandavel S, McCarthy L, Goodnow C, Joshua A. The Australian Exceptional Responders Program: A national collaboration. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.104] [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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Ban JK, Hao BB, McCarthy L, Guilcher SJT, Cadarette SM. Denosumab utilization among older adults in Ontario: patient characteristics, persistence with therapy, and return to therapy after an extended gap. Osteoporos Int 2019; 30:1865-1872. [PMID: 31317248 DOI: 10.1007/s00198-019-05051-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED We studied 46,797 older adults who initiated denosumab in Ontario, Canada. Patient characteristics remained relatively stable over time and aligned with public reimbursement restrictions. Almost half of patients persisted with therapy for at least 3 years. Fifty-nine percent of patients who discontinued denosumab returned to treatment within 3.6 years. INTRODUCTION The purpose of this study was to describe the characteristics of patients who initiated denosumab and estimate persistence with therapy. METHODS We identified older adults (aged ≥ 66 years) in Ontario who initiated denosumab between 2012/02 and 2015/03 and followed them to 2016/03. Patient characteristics were summarized using medical and pharmacy claims in the year before starting denosumab and osteoporosis drug use considered since 1996/10. Persistence with denosumab and return after discontinuation (> 90-day gap) were estimated using Kaplan-Meier curves. Analyses were stratified by community and long-term care (LTC) residence. RESULTS We identified 46,797 patients (monthly mean = 1263, SD = 187); 97% female, 13% LTC. Community-dwelling patients had a higher prevalence of bone mineral density testing (62% vs. 5%), yet were younger (mean age 78.5 vs. 86.6 years) and had lower prevalence of hip fractures (3% vs. 10%) compared to LTC patients. Eighty-two percent of patients had used osteoporosis medications in the past; 99% of whom took an oral bisphosphonate. Persistence was similar between community-dwelling and LTC patients: 59% persisted ≥ 2 years, 48% ≥ 3 years, and 38% ≥ 4 years, yet a larger proportion of LTC patients returned to denosumab after discontinuation (76% vs. 57%). CONCLUSIONS Denosumab utilization is increasing at a steady rate in Ontario. However, persistence remains a concern given the highly reversible pharmacokinetic profile of denosumab that results in a rapid increased fracture risk following discontinuation. Over 80% of patients had a history of oral bisphosphonate therapy, which may persist in bone despite discontinuing denosumab. Consequently, better understanding of denosumab safety and effectiveness among real-world users is important.
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Affiliation(s)
- J K Ban
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada
| | - B B Hao
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada
| | - L McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - S J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - S M Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada.
- ICES, Toronto, ON, Canada.
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Hughes LA, McKay-Bounford K, Webb EA, Dasani P, Clokie S, Chandran H, McCarthy L, Mohamed Z, Kirk JMW, Krone NP, Allen S, Cole TRP. Next generation sequencing (NGS) to improve the diagnosis and management of patients with disorders of sex development (DSD). Endocr Connect 2019; 8:100-110. [PMID: 30668521 PMCID: PMC6373624 DOI: 10.1530/ec-18-0376] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/16/2019] [Indexed: 11/08/2022]
Abstract
Disorders of sex development (DSDs) are a diverse group of conditions where the chromosomal, gonadal or anatomical sex can be atypical. The highly heterogeneous nature of this group of conditions often makes determining a genetic diagnosis challenging. Prior to next generation sequencing (NGS) technologies, genetic diagnostic tests were only available for a few of the many DSD-associated genes, which consequently had to be tested sequentially. Genetic testing is key in establishing the diagnosis, allowing for personalised management of these patients. Pinpointing the molecular cause of a patient's DSD can significantly impact patient management by informing future development needs, altering management strategies and identifying correct inheritance pattern when counselling family members. We have developed a 30-gene NGS panel, designed to be used as a frontline test for all suspected cases of DSD (both 46,XX and 46,XY cases). We have confirmed a diagnosis in 25 of the 80 patients tested to date. Confirmed diagnoses were linked to mutations in AMH, AMHR2, AR, HSD17B3, HSD3B2, MAMLD1, NR5A1, SRD5A2 and WT1 which have resulted in changes to patient management. The minimum diagnostic yield for patients with 46,XY DSD is 25/73. In 34/80 patients, only benign or likely benign variants were identified, and in 21/80 patients only variants of uncertain significance (VOUS) were identified, resulting in a diagnosis not being confirmed in these individuals. Our data support previous studies that an NGS panel approach is a clinically useful and cost-effective frontline test for patients with DSDs.
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Affiliation(s)
- L A Hughes
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - K McKay-Bounford
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - E A Webb
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - P Dasani
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - S Clokie
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - H Chandran
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - L McCarthy
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Z Mohamed
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - J M W Kirk
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - N P Krone
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - S Allen
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - T R P Cole
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- Correspondence should be addressed to T R P Cole:
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Farley E, McCarthy L, Pergolotti M. Rehabilitation Strategies in Older Adult Oncology Patients: a Focus on Occupational and Physical Therapy. Curr Geri Rep 2017. [DOI: 10.1007/s13670-017-0228-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Farrell B, Conklin J, Raman-Wilms L, McCarthy L, Pottie K, Rojas-Fernandez C, Bjerre L, Irving H. DEVELOPMENT AND IMPLEMENTATION OF DEPRESCRIBING GUIDELINES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2475] [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)
- B. Farrell
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- University of Ottawa, Ottawa, Ontario, Canada,
- University of Waterloo, Kitchener, Ontario, Canada,
| | - J. Conklin
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- Concordia University, Montreal, Quebec, Canada,
| | | | - L. McCarthy
- University of Toronto, Toronto, Ontario, Canada,
- Women’s College Hospital, Toronto, Ontario, Canada
| | - K. Pottie
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- University of Ottawa, Ottawa, Ontario, Canada,
| | | | - L. Bjerre
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- University of Ottawa, Ottawa, Ontario, Canada,
| | - H. Irving
- Bruyere Research Institute, Ottawa, Ontario, Canada,
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Niyogi A, Lumpkins K, Robb A, McCarthy L. Cystometrogram appearance in PUV is reliably quantified by the shape,wall, reflux and diverticuli (SWRD) score, and presages the need for intervention. J Pediatr Urol 2017; 13:265.e1-265.e6. [PMID: 28159527 DOI: 10.1016/j.jpurol.2016.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 12/03/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Radiological bladder abnormalities in boys with posterior urethral valves (PUV) are well recognised; however, the assessment is subjective. The shape, wall, reflux and diverticuli (SWRD) score objectively assesses shape, wall, reflux and diverticuli in a simple way. This study was undertaken to demonstrate that the SWRD score is reliable, reproducible and correlates with bladder outcome and videourodynamic (VUD) assessment in boys with PUV. MATERIALS AND METHODS Three blinded assessors determined the SWRD scores of PUV bladders from cystometrograms taken during VUD from September 2012 to October 2013. The scores were correlated with clinical outcome and VUD pressure measurements. Data were given as median (interquartile range), non-parametric tests used as appropriate (Mann-Whitney U test, or Kruskall-Wallis) and P < 0.05 was taken as significant. RESULTS A total of 55 boys with PUV underwent VUD assessment, for which 52 cystometrograms were available. The SWRD score for non-operative management was 1.0 (0.1-1.9) vs 2.0 (1.0-3.3) for operative intervention, P = 0.018 (Summary Figure). The SWRD score for compliant bladders was 1.1 (0.6-2.0) vs hypercompliant 1.7 (0.5-2.8) vs non-compliant 3.3 (2.8-5.0), Kruskall-Wallis P = 0.011. The hostile detrusor overactivity (DO) bladders (Pdet >40 cmH2O) had a SWRD score of 2.0 (1.3-3.7) vs 1.0 (0.5-2.5) for low-pressure DO bladders, P < 0.05. DISCUSSION In this series of patients, increasingly distorted bladder shape was seen to be associated with poor bladder dynamics on VUD. Patients with poorly compliant bladders had a significantly higher SWRD score than normal or megacystis patients. Severe DO was also significantly associated with a high SWRD score. Therefore, the radiological appearance of a hostile bladder represented a marker for high intravesical pressure. VUR and bladder diverticuli may lead to spurious pressure measurements during VUD; however, the SWRD score provided an independent mechanism with which to objectively assess these patients, even in the presence of gross VUR. CONCLUSIONS The SWRD score is a simple and objective scoring system for the radiological abnormalities of PUV bladders. It correlates with clinical outcome and VUD assessment of compliance and DO, but is independent of pressure measurements and so not confounded by VUR acting as a 'pop-off' mechanism.
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Affiliation(s)
- A Niyogi
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B46NH, United Kingdom
| | - K Lumpkins
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B46NH, United Kingdom
| | - A Robb
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B46NH, United Kingdom
| | - L McCarthy
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B46NH, United Kingdom.
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McCarthy L. Pooled RCTs: In patients with acute ischemic stroke, alteplase increases intracerebral hemorrhage. Ann Intern Med 2016; 165:JC42. [PMID: 27750302 DOI: 10.7326/acpjc-2016-165-8-042] [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: 11/22/2022] Open
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Lee B, Featherstone N, Nagappan P, McCarthy L, O'Toole S. British Association of Paediatric Urologists consensus statement on the management of the neuropathic bladder. J Pediatr Urol 2016; 12:76-87. [PMID: 26946946 DOI: 10.1016/j.jpurol.2016.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/06/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A large number of children with spina bifida develop a neuropathic bladder and this group of patients still forms the largest group of children who require urological management. Although there are published guidelines on the management of the neuropathic bladder, they are not specific to children. It is unsurprising, therefore, that the initial investigation, assessment and management of children with spina bifida vary considerably. The 2014 British Association of Paediatric Urologists (BAPU) meeting was devoted to the management of the neuropathic bladder. The aim was to produce a consensus on the appropriate investigation and management of a child with a neuropathic bladder. METHODS AND MATERIALS A questionnaire was devised and the members were polled on their current practice. Six paediatric urology fellows presented an evidence-based literature review on different aspects of the neuropathic bladder. At the end of the session, the members of the organisation present were polled again using the same questions. RESULTS The BAPU felt that the use of urodynamics in the neuropathic bladder should be selectively determined by clinical parameters. Regarding CIC, the group was evenly split between universal use or only when poor emptying was established. Oxybutinin was the first-line anticholinergic of choice. Most paediatric urologists routinely used Botox and were happy to use it repeatedly. The surgical intervention most frequently employed was determined to be an ileocystoplasty, with most surgeons deferring the need for surveillance cystoscopy until at least 10 years after surgery. CONCLUSION It was felt that a consensus statement is not a guideline or a way to establish best practice; however, it serves as a way of surveying current practice and providing a benchmark for clinicians involved in the management of these patients.
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Affiliation(s)
- B Lee
- Department of Paediatric Surgery and Urology, Royal Hospital for Children, Glasgow, UK
| | - N Featherstone
- Department of Paediatric Surgery and Urology, Great Ormond Street Hospital for Sick Children, London, UK
| | - P Nagappan
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
| | - L McCarthy
- Department of Paediatric Urology, Birmingham Children's Hospital, Birmingham, UK
| | - S O'Toole
- Department of Paediatric Surgery and Urology, Royal Hospital for Children, Glasgow, UK. stuart.o'
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Coleman R, King T, Nicoara CD, Bader M, McCarthy L, Chandran H, Parashar K. Nadir creatinine in posterior urethral valves: How high is low enough? J Pediatr Urol 2015; 11:356.e1-5. [PMID: 26292912 DOI: 10.1016/j.jpurol.2015.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 06/18/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Large retrospective studies of people with posterior urethral valves (PUV) have reported chronic renal insufficiency (CRI) in up to one third of the participants and end-stage renal failure in up to one quarter of them. Nadir creatinine (lowest creatinine during the first year following diagnosis) is the recognised prognostic indicator for renal outcome in PUV, the most commonly used cut-off being 1 mg/dl (88.4 umol/l). OBJECTIVE To conduct a statistical analysis of nadir creatinine in PUV patients in order to identify the optimal cut-off level as a prognostic indicator for CRI. STUDY DESIGN Patients treated by endoscopic valve ablation at the present institution between 1993 and 2004 were reviewed. Chronic renal insufficiency was defined as CKD2 or higher. Statistical methods included receiver operating characteristic (ROC) curve analysis, Fisher exact test and diagnostic utility tests. Statistical significance was defined as P < 0.05. RESULTS AND DISCUSSION Nadir creatinine was identified in 96 patients. The median follow-up was 9.4 (IQR 7.0, 13.4) years. A total of 29 (30.2%) patients developed CRI, with nine (9.4%) reaching end-stage renal failure. On ROC analysis, Nadir creatinine was highly prognostic for future CRI, with an Area Under the Curve of 0.887 (P < 0.001). Renal insufficiency occurred in all 10 (100%) patients with nadir creatinine >88.4 umol/l compared with 19 of 86 (22.2%) patients with lower nadir creatinine (P < 0.001). As a test for future CRI, a nadir creatinine cut-off of 88.4 umol/l gave a specificity of 100%, but poor sensitivity of 34.5%. Lowering the cut-off to 75 umol/l resulted in improvement in all diagnostic utility tests (Table). All 14 (100%) patients with nadir creatinine >75 umol/l developed CRI, compared with 15 of 82 (18.3%) patients with lower nadir creatinine (P < 0.001). Sensitivity only approached 95% at 35 umol/l, at which level specificity was low (Table). Two out of 36 (5.6%) patients with nadir creatinine <35 umol/l developed CRI. Multivariate analysis found recurrent UTI (OR 4.733; CI 1.297-17.280) and nadir creatinine >75 umol/l (OR 48.988; CI 4.9-490.11) to be independent risk factors for progression to CRI. Using cut-off values of 35 umol/l and 75 umol/l, patients can be stratified into low-, intermediate- and high-risk groups, with development of CRI in 5.3%, 28.3% and 100%, respectively (P <0.001). The stage of CKD was higher in higher risk groups. CONCLUSION Patients with nadir creatinine >75 umol/l (0.85 mg/dl) should be considered at high risk for CRI, while patients with nadir creatinine ≤35 umol/l (0.4 mg/dl) should be considered low risk. Patients with nadir creatinine between these two values have an intermediate risk of CRI.
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Affiliation(s)
- R Coleman
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - T King
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - C-D Nicoara
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - M Bader
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - L McCarthy
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - H Chandran
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - K Parashar
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
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McCarthy L. ACP Journal Club: ECG monitoring with implanted monitors increased AF detection more than usual follow-up after cryptogenic stroke. Ann Intern Med 2014; 161:JC3. [PMID: 25402536 DOI: 10.7326/0003-4819-161-10-201411180-02003] [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: 11/22/2022] Open
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Moloney F, Ryan D, McCarthy L, McCarthy J, Burke L, Henry MT, Kennedy MP, Hinchion J, McSweeney S, Maher MM, O'Regan K. Increasing the accuracy of 18F-FDG PET/CT interpretation of "mildly positive" mediastinal nodes in the staging of non-small cell lung cancer. Eur J Radiol 2014; 83:843-7. [PMID: 24581594 DOI: 10.1016/j.ejrad.2014.01.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 01/20/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of this study was to identify radiological factors that may reduce false-positive results and increase diagnostic accuracy when staging the mediastinum of patients with non-small cell lung carcinoma (NSCLC). METHODS This was a retrospective, interdisciplinary, per-node analysis study. We included patients with NSCLC and mediastinal nodes with an SUV max in the range of 2.5-4.0 on PET-CT. We hypothesized that the greatest number of false positive cases would occur in this cohort of patients. RESULTS A total of 92 mediastinal lymph nodes were analyzed in 44 patients. Mediastinal disease (N2/N3) was histologically confirmed in 15 of 44 patients and in 34 of 92 lymph nodes; positive predictive value of 37% and false positive rate of 63%. Lymph node SUV max, tumor size, ratio of node SUV max to tumor SUV max (SUVn/SUVp), and ratio of node SUV max to node size (SUV n/SADn) were significantly higher in true positive cases. Using a threshold of 0.3 for SUV node/tumor and 3 for SUV node/size yielded sensitivities of 91% and 71% and specificities of 71% and 69% respectively for the detection of mediastinal disease. Using both ratios in combination resulted in a sensitivity of 65% and a specificity of 88%. Concurrent benign lung disease was observed significantly more frequently in false-positive cases. CONCLUSION SUVn/SUVpt and SUVn/SADn may be complimentary to conventional visual interpretation and SUV max measurement in the assessment of mediastinal disease in patients with NSCLC.
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Affiliation(s)
- F Moloney
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - D Ryan
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - L McCarthy
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - J McCarthy
- Department of Pathology, Cork University Hospital, Cork - 0214922000, Ireland.
| | - L Burke
- Department of Pathology, Cork University Hospital, Cork - 0214922000, Ireland.
| | - M T Henry
- Department of Respiratory Medicine, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - M P Kennedy
- Department of Respiratory Medicine, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - J Hinchion
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - S McSweeney
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - M M Maher
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - K O'Regan
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
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Newman B, McCarthy L, Thomas PW, May P, Layzell M, Horn K. A comparison of pre-operative nerve stimulator-guided femoral nerve block and fascia iliaca compartment block in patients with a femoral neck fracture. Anaesthesia 2013; 68:899-903. [DOI: 10.1111/anae.12321] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- B. Newman
- Acute Pain Service; Poole Hospital NHSFT; Poole; UK
| | - L. McCarthy
- Acute Pain Service; Poole Hospital NHSFT; Poole; UK
| | - P. W. Thomas
- Clinical Research Unit; Bournemouth University; Bournemouth; UK
| | - P. May
- Acute Pain Service; Poole Hospital NHSFT; Poole; UK
| | - M. Layzell
- Acute Pain Service; Royal Bournemouth & Christchurch Hospital NHSFT; Bournemouth; UK
| | - K. Horn
- Acute Pain Service; Poole Hospital NHSFT; Poole; UK
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McCarthy L, Ameerally P. Retrospective and prospective study of factors influencing success and failure of skin grafts to the head and neck following excision of skin cancers. A single surgeon experience. Br J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.bjoms.2012.04.179] [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: 11/16/2022]
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Baliousis M, Huband N, Duggan C, McCarthy L, Völlm B. P-683 - Development and validation of a scale to evaluate treatment progress in secure mental health settings. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74850-2] [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: 10/28/2022] Open
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Netto I, Bostan V, McCarthy L, Laursen A, Gilbride K, Mehrvar M, Pushchak R. Automated image analysis of Euglena gracilis Klebs (Euglenophyta) for measuring sublethal effects of three model contaminants. Water Sci Technol 2012; 66:1708-1715. [PMID: 22907455 DOI: 10.2166/wst.2012.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The short-term impacts of atrazine (herbicide), tributyltin (organometal) and copper on the behaviour of Euglena gracilis Klebs (Euglenophyta) were assessed. First, the ECOTOX automated image analysis system was used, which measured swimming velocity, cell shape, percentage of cells swimming upwards, and randomness of swimming. Next, visual observation by microscopy was used to measure percentage of cell motility and cell shape. Behavioural changes can be used as an indicator of stress in less than 24 h, potentially making them suitable for inclusion in early-warning systems for water quality. Findings indicate that E. gracilis is a very sensitive organism to copper, showing inhibition of motility with visual observation at 0.8 μmol/L within 1 h. The image analysis system was in general less sensitive than visual observation for detecting behavioural changes after incubation in copper. In contrast, after exposure to organic contaminants atrazine and tributyltin, the ECOTOX system detected small changes in the number of cells swimming upwards (antigravitactic behaviour) at higher concentrations.
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Affiliation(s)
- I Netto
- Department of Chemistry and Biology, Ryerson University, Toronto, ON M5B 2K3, Canada
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Smith GM, Carroll D, Mukherjee S, Aldridge R, Jayakumar S, McCarthy L, Chandran H, Parashar K. Health-related quality of life in patients reliant upon mitrofanoff catheterisation. Eur J Pediatr Surg 2011; 21:263-5. [PMID: 21590655 DOI: 10.1055/s-0031-1275748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Aim of the study was determine health care outcomes from the patients' perspective in patients reliant on Mitrofanoff catheterisation for bladder emptying. SUBJECTS/PATIENTS Patients over the age of 16 dependent on Mitrofanoff catheterisation for bladder emptying were asked to complete a health care outcome questionnaire, the SF-36 (®) Health Survey v2. Quality of life measures for 8 health concepts were compared against published data for the normal population. RESULTS Out of a total of 25 patients who were eligible for enrolment into our study, we were able to contact 19 patients. The norm-based score for Physical Functioning (PF=50.4), Role Physical (RP=53.8), Bodily Pain (BP=55.6), Vitality (VT=56.9), Social Functioning (SF=51.5), Role Emotional (RE=52.2), and Mental Health (MH=54.6) were all higher than those reported within the normal population (normal=50.0). Physical and mental component summary measures were higher than in the normal population. When compared against age-matched norms our patient group scored higher than the normal population for all measures except Physical Functioning (50.4 vs. 53.4) and physical component summary (51.9 vs. 53.5). The self-reported scores for Vitality, Mental Health and the mental component summary were all statistically significantly better than those seen in the age-matched control population (p<0.01). CONCLUSIONS Quality of life in patients dependent on Mitrofanoff catheterisation for bladder emptying is good. The SF-36 measures 8 major health care outcomes and in our patients these measures of health were similar to those seen in the general population, rather than the poorer outcomes reported in patients with other chronic medical conditions.
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Affiliation(s)
- G M Smith
- Birmingham Children's Hospital, Paediatric Urology, Birmingham, United Kingdom.
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Mukherjee S, Joshi A, Carroll D, Chandran H, Parashar K, McCarthy L. What is the effect of circumcision on risk of urinary tract infection in boys with posterior urethral valves? J Pediatr Surg 2009; 44:417-21. [PMID: 19231547 DOI: 10.1016/j.jpedsurg.2008.10.102] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [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] [Received: 10/03/2008] [Accepted: 10/24/2008] [Indexed: 12/20/2022]
Abstract
PURPOSE Boys with posterior urethral valves (PUV) have increased risks of urinary tract infection (UTI) voiding dysfunction and ongoing renal damage. Circumcision has been shown epidemiologically to reduce UTIs, but no trial has yet confirmed this in PUV. Circumcision is not routinely performed in boys with PUV in our unit, but one quarter of our patients are circumcised for religious reasons. It may be hypothesized that circumcision reduces the risk of subsequent urinary tract infection in boys with PUV. This study aims to test this hypothesis by comparing the risk of UTI, and subsequent renal outcome, in PUV in uncircumcised boys with those who were circumcised. METHODS A retrospective cross-sectional case note review of boys with PUV was performed, and the following were documented: age at presentation, method of diagnosis, method of treatment, initial renal status, and timing of treatment; use and timing of urinary tract diversion; timing of circumcision; and UTIs-date, organism, and treatment. RESULTS Seventy-eight patients were identified, mean age 6.7 years (range, 1-18). These boys experienced 78 UTIs in the uncircumcised state. Subsequently, 27 were circumcised, experiencing 8 UTIs. Eighteen boys were diverted. The incidence of UTI was reduced from 0.50 +/- 0.14 (mean +/- SEM) UTIs annually uncircumcised to 0.09 +/- 0.02 (mean +/- SEM) circumcised (P < .01, Student's t test). CONCLUSION In PUV, circumcision reduces the incidence of UTI by 83%, every circumcision prevents 1 UTI on average. Early circumcision in all PUV is beneficial, but a larger randomised control trial should be considered to confirm this.
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Affiliation(s)
- S Mukherjee
- Birmingham Children's Hospital, Birmingham, United Kingdom
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Hannam S, Hasib A, McCarthy L. Confusion over markings on a percutaneous long line. Eur J Pediatr 2008; 167:455. [PMID: 17429691 DOI: 10.1007/s00431-007-0479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 03/19/2007] [Indexed: 10/23/2022]
Affiliation(s)
- S Hannam
- Department of Child Health, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
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McCarthy L, Dolovich L, Haq M, Thabane L, Kaczorowski J. Frequency of risk factors that potentially increase harm from medications in older adults receiving primary care. Can J Clin Pharmacol 2007; 14:e283-e290. [PMID: 18025543] [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] [Indexed: 05/25/2023]
Abstract
BACKGROUND Many circumstances elevate patients, especially older adults, risk for drug-related morbidity and misadventures. Understanding the frequency of these situations can help with the design of initiatives to address or alter these circumstances with the aim of reducing medication therapy-related concerns and associated expenditures. OBJECTIVE To describe the frequency of circumstances that may place older adults at higher risk for drug-related morbidity and misadventures in a large sample of elderly patients visiting family medicine clinics. METHODS Elderly adults at 7 family medicine practices across Ontario self-completed the 10-item Medication Risk Questionnaire (MRQ). RESULTS Surveys were completed by 907 patients, with a mean age of 72.4 (SD 10.7) years and a mean number of 4.8 medical conditions (SD 2.3; min-max: 0-14). Many subjects were taking multiple medications (mean 6.9 (SD 3.8; min-max: 0-21)) and over 90% of respondents reported at least one indicator that potentially increases their risk of drug-related morbidity. CONCLUSION Number of medications, number of medical conditions and number of daily medication doses were the most frequently observed risks for medication-related issues in this large sample of elderly patients visiting family medicine clinics.
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Affiliation(s)
- L McCarthy
- Centre for Evaluation of Medicines, St. Joseph's Healthcare, Hamilton, Canada.
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Abstract
The cause of intestinal obstruction in children can occasionally be obscure although history and examination usually directs the clinician to the correct diagnosis. Pica, the ingestion of non-nutrient material, however can be surreptitious and escape detection. A case report is presented of a 9-year-old child with an extensive and complicated surgical history. Following lengthy investigation and progression of sub-acute to acute intestinal obstruction over a long period, the cause was finally found to be due to persistent ingestion of Blu-Tack -- a common household putty-like adhesive.
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Affiliation(s)
- M Chand
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, UK
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Shen L, Pei Y, McCarthy L, Poblenz C, Corrion A, Fichtenbaum N, Keller S, Denbaars SP, Speck JS, Mishra UK. Deep-recessed GaN HEMTs using selective etch technology exhibiting high microwave performance without surface passivation. ACTA ACUST UNITED AC 2007. [DOI: 10.1109/mwsym.2007.379978] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Poulos AE, Llewellyn G, Balandin S, Dew A, Dark L, McCarthy L. 'What's the point of it?': radiographers, women with disability and mammography screening. Breast Cancer Res 2006. [PMCID: PMC3332723 DOI: 10.1186/bcr1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Poulos AE, Llewellyn G, Balandin S, Dew A, Dark L, McCarthy L. 'I want to go home': women with disability and the mammography procedure. Breast Cancer Res 2006. [PMCID: PMC3332724 DOI: 10.1186/bcr1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
BACKGROUND Borderline personality disorder (BPD) is a relatively common personality disorder with a major impact on health services as those affected often present in crisis, often self-harming. OBJECTIVES To evaluate the effects of psychological interventions for people with borderline personality disorder. SEARCH STRATEGY We conducted a systematic search of 26 specialist and general bibliographic databases (December 2002) and searched relevant reference lists for further trials. SELECTION CRITERIA All relevant clinical randomised controlled trials involving psychological treatments for people with BPD. The definition of psychological treatments included behavioural, cognitive-behavioural, psychodynamic and psychoanalytic. DATA COLLECTION AND ANALYSIS We independently selected, quality assessed and data extracted studies. For binary outcomes we calculated a standard estimation of the risk ratio (RR), its 95% confidence interval (CI), and where possible the number need to help/harm (NNT/H). For continuous outcomes, endpoint data were preferred to change data. Non-skewed data from valid scales were summated using a weighted mean difference (WMD). MAIN RESULTS We identified seven studies involving 262 people, and five separate comparisons. Comparing dialectical behaviour therapy (DBT) with treatment as usual studies found no difference for the outcome of still meeting SCID-II criteria for the diagnosis of BPD by six months (n=28, 1 RCT, RR 0.69 CI 0.35 to 1.38) or admission to hospital in previous three months (n=28, 1 RCT, RR 0.77 CI 0.28 to 2.14). Self harm or parasuicide may decrease at 6 to 12 months (n=63, 1 RCT, RR 0.81 CI 0.66 to 0.98, NNT 12 CI 7 to 108). One study detected statistical difference in favour of people receiving DBT compared with those allocated to treatment as usual for average scores of suicidal ideation at 6 months (n=20, MD -15.30 CI -25.46 to -5.14). There was no difference for the outcome of leaving the study early (n=155, 3 RCTs, RR 0.74 CI 0.52 to 1.04). For the outcome of interviewer-assessed alcohol free days, skewed data are reported and tend to favour DBT. When a substance abuse focused DBT was compared with comprehensive validation therapy plus 12-step substance misuse programme no clear differences were found for service outcomes (n=23, 1 RCT, RR imprisoned 1.09 CI 0.64 to 1.87) or leaving the study early (n=23, 1 RCT, RR 7.58 CI 0.44 to 132.08). When dialectical behaviour therapy-oriented treatment is compared with client centred therapy no differences were found for service outcomes (n=24, 1 RCT, RR admitted 0.33 CI 0.08 to 1.33). However, fewer people in the DBT group displayed indicators of parasuicidal behaviour (n=24, RR 0.13 CI 0.02 to 0.85, NNT 2 CI 2 to 11). There were no differences for outcomes of anxiety and depression (n=24, 1 RCT, RR anxiety BAI >/=10 0.60 CI 0.32 to 1.12; RR depression HDRS >/=10 0.43 CI 0.14 to 1.28) but people who received DBT had less general psychiatric severity than those in the control (MD BPRS at 6 months -7.41 CI -13.72 to -1.10). Finally this one relevant study reports skewed data for suicidal ideation with considerably lower scores for people allocated to DBT. When psychoanalytically oriented partial hospitalization was compared with general psychiatric care the former tended to come off best. People who received treatment in a psychoanalytic orientated day hospital were less likely to be admitted into inpatient care when measured at different time points (e.g. n=44, RR admitted to inpatient 24 hour care >18 to 24 months 0.05 CI 0.00 to 0.77, NNT 3 CI 3 to 10) Fewer people in psychoanalytically oriented partial hospitalization needed day hospital intervention in the 18 months after discharge (n=44, 1 RCT, RR 0.04 CI 0.00 to 0.59, NNT 2 CI 2 to 8). More people in the control group took psychotropic medication by the 30 to 36 month follow-up, than those receiving psychoanalytic treatment (n=44, 1 RCT, RR 0.44 CI 0.25 to 0.80, NNT 3 CI 2 to 7). Anxiety and depression scores were generally lower in the psychoanalytically oriented partial hospitalization group (n=44, 1 RCT, RR >/=14 on BDI 0.52 CI 0.34 to 0.80, NNT 3 CI 3 to 6), as are global severity scores. People receiving psychoanalytic care in a day hospital had better social improvement in social adjustment using the SAS-SR at 6 to 12 months compared with people in general psychiatric care (MD -0.70 CI -1.08 to -0.32). Rates of attrition were the same (n=44, 1 RCT, RR leaving the study early 1.00 CI 0.23 to 4.42). AUTHORS' CONCLUSIONS This review suggests that some of the problems frequently encountered by people with borderline personality disorder may be amenable to talking/behavioural treatments but all therapies remain experimental and the studies are too few and small to inspire full confidence in their results. These findings require replication in larger 'real-world' studies.
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Affiliation(s)
- C A Binks
- University of Bristol, 8 Priory, Bristol, UK, BS8 1TZ.
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Abstract
BACKGROUND Borderline Personality Disorder (BPD) is prevalent (2% in the general population, 20% among psychiatry in-patients) and has a major impact on health facilities as those affected often present in crisis but then make poor use of further attempts to help them. OBJECTIVES To evaluate the effects of pharmacological interventions for people with borderline personality disorder. SEARCH STRATEGY We conducted a systematic search of 26 specialist and general bibliographic databases (October 2002) and searched relevant reference lists for further trials. SELECTION CRITERIA We included all randomised clinical trials comparing any psychoactive drugs with any other treatment for people with borderline personality disorder. DATA COLLECTION AND ANALYSIS We independently selected, quality assessed and data extracted studies. For binary outcomes we calculated a standard estimation of the risk ratio (RR), its 95% confidence interval (CI), and where possible the number need to help/harm (NNT/H). For continuous outcomes, endpoint data were preferred to change data. Non-skewed data from valid scales were synthesised using a weighted mean difference (WMD). MAIN RESULTS We found ten small (total n=554), short, randomised studies involving eight comparisons from which we could extract usable data. Studies comparing antidepressants with placebo were small (total n=79, 2 RCTs) but for ratings of anger fluoxetine may offer some improvement for those on antidepressant therapy over placebo (n=22, 1 RCT, RR anger not improved 0.30 CI 0.10 to 0.85, NNT 2 CI 2 to 9). The one small study investigating the important outcome of attempted suicide found no difference between mianserin and placebo (n=38, 1 RCT, RR 0.82 CI 0.44 to 1.54). Haloperidol may be better than antidepressants for symptoms of hostility and psychotism. There were few differences between MAOIs and placebo except that people given MAOIs were less hostile (n=62, 1 RCT, MD -9.19 CI -16.12 to -2.26). Although some ratings were statistically significant the comparison of MAOIs with antipsychotics did not show convincing differences. Antipsychotics may effect some mental state symptoms more effectively than placebo but results are difficult to interpret clinically and there is little evidence of advantage of one antipsychotic over another. Finally mood stabilisers such as divalporex may help mental state (n=16, 1 RCT, RR no improvement in mental state 0.58 CI 0.36 to 0.94, NNT 3 CI 2 to 17) but data are far from conclusive. AUTHORS' CONCLUSIONS Pharmacological treatment of people with BPD is not based on good evidence from trials and it is arguable that future use of medication should be from within randomised trials. Current trials suggest that the positive effect of antidepressants, in particular, could be considerable. Well designed, conducted and reported clinically meaningful trials are possible and needed with, perhaps, the question of antidepressant versus placebo being addressed first.
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Affiliation(s)
- C A Binks
- University of Bristol, 8 Priory, Bristol, UK, BS8 1TZ.
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Frasier M, Walzer M, McCarthy L, Magnuson D, Lee JM, Haas C, Kahle P, Wolozin B. Tau phosphorylation increases in symptomatic mice overexpressing A30P alpha-synuclein. Exp Neurol 2005; 192:274-87. [PMID: 15755545 DOI: 10.1016/j.expneurol.2004.07.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Revised: 07/02/2004] [Accepted: 07/21/2004] [Indexed: 11/25/2022]
Abstract
Mice overexpressing mutant alpha-synuclein develop a progressive loss of motor function associated with the accumulation of aggregated alpha-synuclein in neurons of the brainstem. Recent reports suggest that tau pathology might also be associated with Parkinson disease (PD) and aggregation of alpha-synuclein. We now report that mice overexpressing A30P alpha-synuclein develop abnormally phosphorylated tau in parallel with the accumulation of aggregated alpha-synuclein. Enhanced phosphorylation of tau occurs only in symptomatic mice that also harbor abundant aggregated alpha-synuclein. The increased phosphorylation of tau occurs at S396/404 and S202 as shown by immunoblotting and immunocytochemical studies with the antibodies PHF-1 and AT8. Neurons that accumulated alpha-synuclein occurred in the dorsal brainstem and did not show strong colocalization with neurons that showed abnormal tau phosphorylation, which largely occurred in the ventral brainstem. Aggregation of alpha-synuclein and phosphorylation of tau are associated with increased levels of phosphorylated c-jun kinase (JNK), which is a stress kinase known to phosphorylate tau protein. These results suggest that alpha-synuclein pathology can stimulate early pathological changes in tau.
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Affiliation(s)
- M Frasier
- Department of Pharmacology, Loyola University Medical Center, Maywood, IL 60153, USA
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Mehta PB, Jenkins BL, McCarthy L, Thilak L, Robson CN, Neal DE, Leung HY. MEK5 overexpression is associated with metastatic prostate cancer, and stimulates proliferation, MMP-9 expression and invasion. Oncogene 2003; 22:1381-9. [PMID: 12618764 DOI: 10.1038/sj.onc.1206154] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The novel mitogen/extracellular-signal-regulated kinase kinase 5/extracellular signal-regulated kinase-5 (MEK5/ERK5) pathway has been implicated in the regulation of cellular proliferation. MEK5 expression has been detected in prostate cancer cells, although the significance of the MEK5/ERK5 pathway in human prostate cancer has not been tested. We examined MEK5 expression in 127 cases of prostate cancer and 20 cases of benign prostatic hypertrophy (BPH) by immunohistochemistry and compared the results to clinical parameters. We demonstrated that MEK5 expression is increased in prostate cancer as compared to benign prostatic tissue. Strong MEK5 expression correlates with the presence of bony metastases and less favourable disease-specific survival. Furthermore, among the patients with high Gleason score of 8-10, MEK5 overexpression has an additional prognostic value in survival. MEK5 transfection experiments confirm its ability to induce proliferation (P < 0.0001), motility (P = 0.0001) and invasion in prostate cancer cells (P = 0.0001). MEK5 expression drastically increased MMP-9, but not MMP-2 mRNA expression. Luciferase report assays suggest that the -670/MMP-9 promoter is upregulated by MEK5 and electromobility shift assay further suggests the involvement of activator protein-I (AP-1), but not the NF-kappa B, binding site in the MMP-9 promoter. Using an AP-1 luciferase construct, activation of MEK5 was confirmed to enhance AP-1 activities up to twofold. Taken together, our results establish MEK5 as a key signalling molecule associated with prostate carcinogenesis. As the MEK5/ERK5 interaction is highly specific, it represents a potential target of therapy.
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Affiliation(s)
- P B Mehta
- Prostate Research Group, Department of Surgery, The Medical School, University of Newcastle-upon-Tyne, Framlington Place, UK
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Szabo I, Wetzel M, McCarthy L, Steele A, Henderson EE, Howard MZ, Oppenheim JJ, Rogers TJ. Interactions of opioid receptors, chemokines, and chemokine receptors. Adv Exp Med Biol 2002; 493:69-74. [PMID: 11727782 DOI: 10.1007/0-306-47611-8_8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- I Szabo
- Department of Microbiology and Immunology, Center for Substance Abuse Research, and the Fels Institute for Cancer Research and Molecular Biology, Temple University School of Medicine, Philadelphia, PA 19140, USA
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41
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Abstract
It is now clear that opioid receptors participate in the function of the cells of the immune system, and evidence suggests that opioids modulate both innate and acquired immune responses. We review literature here which establishes that mu-, kappa-, and delta-opioid compounds alter resistance to a variety of infectious agents, including the Human Immunodeficiency Virus (HIV). The nature of the immunomodulatory activity of the opioids has been the subject of a great deal of research over the last ten years. There is increasing evidence that effects of opioids on the immune response are mediated at several levels. Modulation of the inflammatory response appears to be a target of these compounds, including effects on phagocytic activity, as well as the response of cells to various chemoattractant molecules. Moreover, findings from several laboratories have demonstrated the impact of opioid treatment on antibody responses, and the molecular basis for this effect is likely due, at least in part, to the modulation of both cytokine and cytokine receptor expression. Future research should provide a clearer understanding of the cellular and molecular targets of opioid action within the immune system.
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Affiliation(s)
- L McCarthy
- Department of Microbiology and Immunology, Temple University School of Medicine, 3400 N. Broad Street, Philadelphia, PA 19140, USA
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42
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Abstract
We have examined the chemotactic responsiveness of thymocytes to selective mu-, kappa-, and delta-opioid agonists. Our results show that developing T cells migrate in response to mu-, but not kappa- or delta-opioids. The mu-opioid response appears to be dependent on the classical mu-opioid receptor (MOR-1) since the chemotactic response is blocked by a selective mu-opioid antagonist, and is absent in thymocytes from MOR-1-deficient mice. Flow cytometric analysis of the mu-opioid responsive cells shows that these cells consist predominantly of highly immature CD4- CD8- T cells. These results represent the first demonstration of the functional expression of mu-opioid receptors by developing T cells.
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MESH Headings
- 3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cyclohexyl)-benzeneacetamide, (trans)-Isomer/pharmacology
- Analgesics, Non-Narcotic/pharmacology
- Analgesics, Opioid/pharmacology
- Animals
- Cell Differentiation/immunology
- Cells, Cultured
- Chemotaxis, Leukocyte/drug effects
- Chemotaxis, Leukocyte/immunology
- Enkephalin, Ala(2)-MePhe(4)-Gly(5)-/pharmacology
- Enkephalin, D-Penicillamine (2,5)-/pharmacology
- Gene Expression/immunology
- Male
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Knockout
- Receptors, Opioid, mu/genetics
- Receptors, Opioid, mu/immunology
- Specific Pathogen-Free Organisms
- T-Lymphocytes/cytology
- T-Lymphocytes/physiology
- Thymus Gland/cytology
- Thymus Gland/growth & development
- Thymus Gland/immunology
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Affiliation(s)
- L McCarthy
- Department of Microbiology and Immunology, The Fels Institute for Cancer Research and Molecular Biology, Temple University School of Medicine, 3400 North Broad Street, Philadelphia, PA 19140, USA
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Abstract
OBJECTIVES Children waiting for organ transplants continue to die because of the shortage of available organs. Studies of organ donation in children are scarce. The evaluation of the organ donation experience in a pediatric tertiary care hospital may identify factors that influence actual organ donation rates and lead to strategies to improve pediatric organ donation. DESIGN Retrospective study. SETTING Pediatric intensive care unit in a Canadian pediatric referral center. PATIENTS All children with brain death over an 8-yr period (1990-1997). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 199 children who fulfilled the criteria for brain death, 153 were medically suitable for organ donation. Families were approached for consent to organ donation in 128 (84%) of the 153 suitable cases. Consent was obtained in 63% (81/128) of those asked. Brain death caused by acute neurosurgical lesions was highly correlated to medical suitability and consent. Families identified as ethnic minorities were significantly more likely to refuse. After consent was granted, organs were procured from 63 (78%) of 81 donors, for an average of 3.6 organs transplanted per donor. There was a failure to procure organs in 22% (18/81) of cases after consent had been granted, primarily as a result of cardiocirculatory instability while in the intensive care unit. CONCLUSIONS Despite an encouraging 63% consent rate for organ donation when families are approached, only 41% of potential donors proceeded to actual donation. Strategies for a prospective pediatric study should focus on mandatory request, multicultural issues, and aggressive postconsent medical management and procurement. The pivotal role of the pediatric intensive care unit practitioner should be emphasized.
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Affiliation(s)
- E Tsai
- Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Ontario, Canada
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Abstract
BACKGROUND OK-432, a lyophilised incubation mixture of group A Streptococcus pyogenes of human origin, was used as a sclerosant for the involution of a giant cervical cystic hygroma in a newborn. RESULTS There were no systemic side effects. Blood tests and double immune diffusion tests showed no systemic infection or generalised inflammatory response, or antibody production. Cellular and cytokine-induced localised inflammatory reaction within the cystic hygroma, was observed on analysis of the intracystic fluid. CONCLUSIONS The leucocytosis induced and activated by OK-432 probably increases the endothelial permeability of the lymphatics. This probably accelerated lymph drainage leading to involution of the cystic hygroma. Intralesional injection of OK-432 was safe and effective therapy for cystic hygroma in this newborn as its inflammatory reaction was localised.
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Affiliation(s)
- M Samuel
- Department of Pediatric Surgery, St George's Hospital, London, UK
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Abstract
Many believe that lesbian identity is predicated upon the availability of opportunities in urban life to find information, support, and like others (Bell and Valentine 1995a). Indeed, exploring one's lesbian sense of self often involves identifying with a visible reference group, seeking out social arenas where there are other gays and lesbians, connecting with a local community, and taking part in gay and lesbian oriented activities. For rural residents, these opportunities are mostly unavailable, and the lack of access to information, to a public meeting space, and to connections with other lesbians further hinders the development of social group identity. Given that gay and lesbian identity has as its basis a social reference group, how might rural lesbians develop and sustain their sense of personal and group lesbian identity? With few exceptions (D'Augelli 1989; D'Augelli et al. 1987; Kramer 1995; Krieger 1982) the empirical research conducted on the lives of gays and lesbians has utilized urban and suburban samples. Likewise, research on rural life has omitted the experiences of gay and lesbian residents. Either way, information about rural lesbian life remains mostly uncovered. This pilot study attempts to provide new information about the experiences of rural lesbians. Utilizing focus group interviews, the challenges of sustaining lesbian identity in a rural setting are explored. The data show that for this sample, although rural lesbians initially felt isolated and unsure of how to develop a sense of group identity, the opportunity to connect with a small informal network of friends and acquaintances helped alleviate these problems. Further, because these women have little access to information, public gathering space, or to local gay culture, this network was said to be crucial. Without it, the women feel invisible and isolated, that is, their identity remains unseen.
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Affiliation(s)
- L McCarthy
- Social Justice Education, School of Education, University of Massachusetts at Amherst, 01002, USA
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Moore A, McCarthy L, Mills KH. The adjuvant combination monophosphoryl lipid A and QS21 switches T cell responses induced with a soluble recombinant HIV protein from Th2 to Th1. Vaccine 1999; 17:2517-27. [PMID: 10418898 DOI: 10.1016/s0264-410x(99)00062-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The induction of protective immunity with recombinant vaccines is dependent on the identification of adjuvant or delivery systems that can augment immune responses, especially cellular immune responses, to soluble protein antigen. In this study we demonstrate that an adjuvant formulation comprising QS21, a purified form of saponin and 3D-monophosphoryl lipid A (MPL), a nontoxic derivative of lipopolysaccharide (LPS), enhances cellular and humoral immune responses to a recombinant HIV protein. Analysis of cytokine secretion by antigen-specific T-cells from the spleen demonstrated that QS21 augmented Th1 and Th2 responses, whereas addition of 3D-MPL resulted in preferential induction of type 1 T-cells. Furthermore, analysis of the subclass of the IgG antibody in the serum in mice immunized with gp120 with the combined adjuvant formulation confirmed the selective activation of Th1 cells in vivo. 3D-MPL was found to enhance B7-1 expression and IL-12 production by macrophages, which are known to be involved in the LPS-induced enhancement of Th1 responses. Thus 3D-MPL appears to act as an adjuvant, without the toxicity associated with LPS, by controlled and selective potentiating effects on antigen presentation and T-cell activation.
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Affiliation(s)
- A Moore
- Department of Biology, National University of Ireland, Maynooth, Co. Kildare
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Kwok C, Korn RM, Davis ME, Burt DW, Critcher R, McCarthy L, Paw BH, Zon LI, Goodfellow PN, Schmitt K. Characterization of whole genome radiation hybrid mapping resources for non-mammalian vertebrates. Nucleic Acids Res 1998; 26:3562-6. [PMID: 9671819 PMCID: PMC147736 DOI: 10.1093/nar/26.15.3562] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Radiation hybrid panels are already available for genome mapping in human and mouse. In this study we have used two model organisms (chicken and zebrafish) to show that hybrid panels that contain a full complement of the donor genome can be generated by fusion to hamster cells. The quality of the resulting hybrids has been assessed using PCR and FISH. We confirmed the utility of our panels by establishing the percentage of donor DNA present in the hybrids. Our hybrid resources will allow inexpensive gene mapping and we expect that this technology can be transferred to many other species. Such successes are providing the basis for a new era of mapping tools, in the form of whole genome radiation hybrid panels, and are opening new possibilities for systematic genome analysis in the animal genetics community.
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Affiliation(s)
- C Kwok
- Department of Genetics, University of Cambridge, Downing Street, Cambridge CB2 3EH, UK.
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Ryan M, McCarthy L, Rappuoli R, Mahon BP, Mills KH. Pertussis toxin potentiates Th1 and Th2 responses to co-injected antigen: adjuvant action is associated with enhanced regulatory cytokine production and expression of the co-stimulatory molecules B7-1, B7-2 and CD28. Int Immunol 1998; 10:651-62. [PMID: 9645613 DOI: 10.1093/intimm/10.5.651] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pertussis toxin (PT) is a major virulence factor of Bordetella pertussis which exerts a range of effects on the immune system, including the enhancement of IgE, IgA and IgG production, delayed-type hypersensitivity reactions, and the induction of experimental autoimmune diseases. However, the mechanism by which PT mediates adjuvanticity remains to be defined. In this investigation we have shown that PT can potentiate antigen-specific T cell proliferation and the secretion of IFN-gamma, IL-2, IL-4 and IL-5 when injected with foreign antigens. A chemically detoxified PT and a genetic mutant with substitutions/deletions in the S-1 and B oligomer components that abrogate enzymatic and binding activity displayed no adjuvant properties. In contrast, a non-toxic S-1 mutant devoid of enzymatic activity but still capable of receptor binding retained its adjuvanticity, augmenting the activation of both Th1 and Th2 subpopulations of T cells. In an attempt to address the mechanism of T cell activation, we found that PT stimulated the production of IFN-gamma and IL-2 by naive T cells and IL-1 by macrophages. Therefore potentiation of distinct T cell subpopulations may have resulted in part from the positive influence of IFN-gamma on the development of Th1 cells and the co-stimulatory role of IL-1 for Th2 cells. Furthermore, PT augmented expression of the co-stimulatory molecules B7-1 and B7-2 on macrophages and B cells, and CD28 on T cells, suggesting that the adjuvant effect may also be associated with facilitation of the second signal required for maximal T cell activation. This study demonstrates that the immunopotentiating properties of PT are largely independent of ADP-ribosyltransferase activity, but are dependent on receptor binding activity and appear to involve enhanced activation of T cells.
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Affiliation(s)
- M Ryan
- Department of Biology, National University of Ireland, Maynooth, Co. Kildare
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McCarthy L. Safe handling of patients on cervical traction. Nurs Times 1998; 94:57-9. [PMID: 9615644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- L McCarthy
- Spinal Injuries Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex
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Keenan SP, Busche KD, Chen LM, McCarthy L, Inman KJ, Sibbald WJ. A retrospective review of a large cohort of patients undergoing the process of withholding or withdrawal of life support. Crit Care Med 1997; 25:1324-31. [PMID: 9267945 DOI: 10.1097/00003246-199708000-00019] [Citation(s) in RCA: 155] [Impact Index Per Article: 5.7] [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] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine the proportion of patients who died as a result of the withdrawal or withholding of life support (WD/WHLS) in the intensive care units (ICUs) of three teaching hospitals and to describe the process involved by determining: a) why the decision was made to withdraw support (WDLS); b) when WDLS took place; and c) how the WDLS process was conducted. DESIGN Retrospective cohort study. SETTING Three university-affiliated ICUs. PATIENTS Four hundred nineteen patients who died in one of three academic, tertiary care ICUs over a 1-yr period. INTERVENTIONS Retrospective chart review. Data collected included age, gender, admitting diagnoses, comorbid disease, Acute Physiology and Chronic Health Evaluation II score, and mode of death (brain death, death due to withholding of life support, death due to WDLS, or death despite ongoing therapy). For those patients dying due to WDLS, the reason for WDLS, person initiating discussion, timing of WDLS, degree of organ dysfunction, order of withdrawal of life support modalities, and the use of sedatives and analgesics were recorded. MEASUREMENTS AND MAIN RESULTS Seventy percent of patients died by WD/WHLS and 8.4% were brain dead. Patients undergoing WD/WHLS were older and had a longer length of stay than patients dying from other causes. Poor prognosis was the most common reason given for WDLS, reflected by significant organ dysfunction at the time of WDLS. Future quality of life was a less frequently cited reason. Most patients undergoing WDLS did so early in their ICU stay, although time to WDLS appeared to reflect diagnostic group. Few meetings occurred before WDLS and death occurred soon after initiating WDLS. There was a preference of withdrawing mechanical ventilation last and large amounts of morphine (mean 21 +/- 33 [SD] mg/hr) and benzodiazepines (mean 8.6 +/- 11 mg/hr) were used. Little variability in practice was apparent among the studied ICUs. CONCLUSIONS Similar to other studies, WD/WHLS was the most common cause of death in academic ICUs and poor patient prognosis was considered the most important factor in deciding on WDLS. However, in contrast to other studies, future quality of life was not as frequently cited a reason for WDLS and larger amounts of morphine were used during WDLS. These discrepancies suggest areas for potential future research.
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Affiliation(s)
- S P Keenan
- Richard Ivey Critical Care Trauma Center, Victoria Hospital, London, ON, Canada
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