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Amiri N, De Vera M, Choi HK, Sayre EC, Avina-Zubieta JA. Corrigendum to: Increased risk of cardiovascular disease in giant cell arteritis: a general population-based study. Rheumatology (Oxford) 2021; 60:5882. [PMID: 34672332 DOI: 10.1093/rheumatology/keab299] [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: 11/14/2022] Open
Affiliation(s)
- Neda Amiri
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver
| | - Mary De Vera
- Arthritis Research Canada, Richmond.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyon K Choi
- Arthritis Research Canada, Richmond.,Department of Rheumatology, Division of Rheumatology, Allergy and Immunology, Harvard Medical School, Boston, MA, USA
| | | | - J Antonio Avina-Zubieta
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver.,Arthritis Research Canada, Richmond
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Jorge A, McCormick N, Lu N, Zheng Y, Esdaile J, Vera MD, Choi H, Avina-Zubieta JA. Hydroxychloroquine and Mortality Among Patients With Systemic Lupus Erythematosus in the General Population. Arthritis Care Res (Hoboken) 2021; 73:1219-1223. [PMID: 32407570 PMCID: PMC7665987 DOI: 10.1002/acr.24255] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 05/05/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Hydroxychloroquine (HCQ) has been associated with improved survival among patients with systemic lupus erythematosus (SLE) from tertiary referral centers. We aimed to determine the potential impact of HCQ use on the risk of mortality among SLE patients in the general population. METHODS We conducted a nested case-control study within an incident SLE cohort from the entire population of British Columbia, Canada. Deceased patients were matched with up to 3 living controls by age, sex, and SLE disease duration. HCQ exposure was categorized by the time between the last HCQ prescription date covered (i.e., end of supply) and the index date (i.e., death date) as current (<30 days), recent (30-365 days), remote (>365 days), or never used. We used conditional logistic regression to assess the risk of all-cause mortality associated with current or recent HCQ exposure compared with remote HCQ users. RESULTS Among 6,241 patients with incident SLE, we identified 290 deceased patients and 502 matched SLE controls. Adjusted odd ratios for all-cause mortality were 0.50 (95% confidence interval [95% CI] 0.30-0.82) for current users and 2.47 (95% CI 1.21-5.05) for recent users compared with remote users. Associations were similar in subgroups according to SLE duration (≤5 years versus >5 years). CONCLUSION Our general population data support a substantial survival benefit associated with current HCQ use. Increased mortality among patients who had discontinued HCQ recently could be due to a sick stopper effect or the loss of actual HCQ benefits.
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Affiliation(s)
- April Jorge
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital
| | - Natalie McCormick
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital
- Arthritis Research Canada, Richmond, BC, Canada
| | - Na Lu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital
- Arthritis Research Canada, Richmond, BC, Canada
| | - Yufei Zheng
- Arthritis Research Canada, Richmond, BC, Canada
| | | | - Mary De Vera
- Arthritis Research Canada, Richmond, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hyon Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital
| | - J. Antonio Avina-Zubieta
- Arthritis Research Canada, Richmond, BC, Canada
- Medicine, University of British Columbia, Department of Medicine, Division of Rheumatology, Vancouver, BC, Canada
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Kelly A, Tymms K, Wit M, Bartlett SJ, Cross M, Dawson T, De Vera M, Evans V, Gill M, Hassett G, Lim I, Manera K, Major G, March L, O’Neill S, Scholte-Voshaar M, Sinnathurai P, Sumpton D, Teixeira‐Pinto A, Tugwell P, Bemt B, Tong A. Patient and Caregiver Priorities for Medication Adherence in Gout, Osteoporosis, and Rheumatoid Arthritis: Nominal Group Technique. Arthritis Care Res (Hoboken) 2020; 72:1410-1419. [DOI: 10.1002/acr.24032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Ayano Kelly
- Australian National University and Canberra Rheumatology, Canberra, Australian Capital Territory, Australia, and Children’s Hospital at Westmead Sydney New South Wales Australia
| | - Kathleen Tymms
- Australian National University, Canberra Rheumatology, and Canberra Hospital Canberra Australian Capital Territory Australia
| | - Maarten Wit
- Amsterdam University Medical Centre Amsterdam The Netherlands
| | - Susan J. Bartlett
- McGill University, Montreal, Quebec, Canada, and Johns Hopkins School of Medicine Baltimore Maryland
| | - Marita Cross
- Institute of Bone and Joint Research Kolling Institute of Medical Research Sydney New South Wales Australia
| | - Therese Dawson
- Lord Street Specialist Centre, Port Macquarie, New South Wales, Australia, and Mayo Hospital Specialist Centre Taree New South Wales Australia
| | - Mary De Vera
- University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada Richmond British Columbia Canada
| | - Vicki Evans
- Clear Vision Consulting and University of Canberra, Canberra, Australian Capital Territory, Australia, and Outcome Measures in Rheumatology
| | - Michael Gill
- Dragon Claw, Sydney, New South Wales, Australia, and Outcome Measures in Rheumatology
| | - Geraldine Hassett
- Liverpool Hospital and Ingham Institute of Applied Medical Research Sydney New South Wales Australia
| | - Irwin Lim
- BJC Health Sydney New South Wales Australia
| | - Karine Manera
- Children’s Hospital at Westmead and University of Sydney Sydney New South Wales Australia
| | - Gabor Major
- John Hunter Hospital and University of Newcastle Newcastle New South Wales Australia
| | - Lyn March
- Institute of Bone and Joint Research Kolling Institute of Medical Research Royal North Shore Hospital, and Northern Clinical School Sydney University Sydney New South Wales Australia
| | - Sean O’Neill
- Liverpool Hospital and Ingham Institute of Applied Medical Research Sydney New South Wales Australia
| | - Marieke Scholte-Voshaar
- University of Twente, Enschede, The Netherlands, and Outcome Measures in Rheumatology Netherlands
| | - Premarani Sinnathurai
- Institute of Bone and Joint Research Kolling Institute of Medical Research Royal North Shore Hospital, and Northern Clinical School Sydney University Sydney New South Wales Australia
| | - Daniel Sumpton
- Children’s Hospital at Westmead University of Sydney, and Concord Hospital Sydney New South Wales Australia
| | - Armando Teixeira‐Pinto
- Children’s Hospital at Westmead and University of Sydney Sydney New South Wales Australia
| | | | - Bart Bemt
- Sint Maartenskliniek, Ubbergen, The Netherlands, and Radboud University Medical Centre Nijmegen The Netherlands
| | - Allison Tong
- Children’s Hospital at Westmead and University of Sydney Sydney New South Wales Australia
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Aviña-Zubieta JA, Chan J, De Vera M, Sayre EC, Choi H, Esdaile J. Risk of venous thromboembolism in ankylosing spondylitis: a general population-based study. Ann Rheum Dis 2019; 78:480-485. [DOI: 10.1136/annrheumdis-2018-214388] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/04/2019] [Accepted: 01/21/2019] [Indexed: 12/22/2022]
Abstract
BackgroundVenous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), can be life threatening. An increased frequency of VTE has been found in inflammatory conditions. To date, evidence assessing whether this risk is also greater in patients with ankylosing spondylitis (AS) is scarce.MethodsUsing the provincial British Columbia, Canada healthcare database that encompasses all residents within the province, we conducted matched cohort analyses of incident PE, DVT and overall VTE among incident cases of AS and compared them with individuals randomly selected from the general population without AS. We calculated incidence rates (IRs) of VTE and multivariable analyses after adjusting for traditional risk factors using Cox models.ResultsAmong 7190 incident cases of AS, 35 developed PE and 47 developed DVT. IRs of PE, DVT and overall VTE per 1000 person-years for patients with AS were 0.79, 1.06, 1.56 compared with 0.40, 0.50, 0.77 in the control cohort. Corresponding fully adjusted HRs (95% CI) of PE, DVT and VTE were 1.36 (0.92 to 1.99), 1.62 (1.16 to 2.26) and 1.53 (1.16 to 2.01), respectively. The risks of PE, DVT and VTE were highest in the first year of diagnosis with HR (95% CI) of 2.88 (0.87 to 9.62), 2.20 (0.80 to 6.03) and 2.10 (0.88 to 4.99), respectively.ConclusionsThese findings demonstrate an increased risk of VTE in the general AS population. This risk appears the most prominent in the first year after diagnosis.
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Park JYE, Li J, Howren A, Tsao NW, De Vera M. Mobile Phone Apps Targeting Medication Adherence: Quality Assessment and Content Analysis of User Reviews. JMIR Mhealth Uhealth 2019; 7:e11919. [PMID: 30702435 PMCID: PMC6374723 DOI: 10.2196/11919] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 01/20/2023] Open
Abstract
Background With the accessibility and widespread use of mobile phones, mobile phone apps targeting medication adherence may be useful tools to help patients take medications as prescribed. Objective Our objectives were to (1) characterize and assess mobile phone medication adherence apps guided by a conceptual framework on the focus of adherence interventions and (2) conduct a content analysis of Web-based reviews to explore users’ perspectives and experiences with mobile phone medication adherence apps. Methods We searched for mobile phone medication adherence apps using keyword searches in Apple and Android operating systems. We characterized all apps in terms of number of downloads, ratings, languages, cost, and disease target. We categorized apps according to 4 key features of (1) alerting to take medication, (2) tracking medication taking, (3) reminding to refill or indicating amount of medication left, and (4) storing medication information. We then selected representative apps from each operating system for detailed quality assessment and user testing. We also downloaded Web-based reviews for these selected apps and conducted a qualitative content analysis using an inductive approach involving steps of initial open coding, construction of categories, and abstraction into themes. Results We identified 704 apps (443 from Apple and 261 from Android). The majority of apps across both operating systems had 1 or 2 features—specifically, 37.2% (165/443) and 38.1% (169/443) of Apple apps, respectively, and 41.4% (108/261) and 31.4% (108/261) of Android apps, respectively. Quality assessment and user testing of 20 selected apps revealed apps varied in quality and commonly focused on behavioral strategies to enhance medication adherence through alerts, reminders, and logs. A total of 1323 eligible Web-based reviews from these 20 selected apps were analyzed, and the following themes emerged: (1) features and functions appreciated by users, which included the ability to set up customized medication regimen details and reminders, monitor other health information (eg, vitals, supplements, and manage multiple people or pets), support health care visits (eg, having a list of medications and necessary health information in 1 app); (2) negative user experiences that captured technical difficulties (glitches, confusing app navigation, and poor interoperability), dosage schedule, and reminder setup inflexibility; and (3) desired functions and features related to optimization of information input, improvement of reminders, and upgrading app performance (better synchronization or backup of data and interoperability). Conclusions A large number of mobile phone medication adherence apps are currently available. The majority of apps have features representing a behavioral approach to intervention. Findings of the content analysis offer mostly positive feedback as well as insights into current limitations and improvements that could be addressed in current and future medication adherence apps.
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Affiliation(s)
- Jamie Yea Eun Park
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Jenny Li
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Alyssa Howren
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.,Arthritis Research Canada, Vancouver, BC, Canada
| | - Nicole Wen Tsao
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.,Arthritis Research Canada, Vancouver, BC, Canada
| | - Mary De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.,Arthritis Research Canada, Vancouver, BC, Canada
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Kelly A, Tong A, Tymms K, March L, Craig JC, De Vera M, Evans V, Hassett G, Toupin-April K, van den Bemt B, Teixeira-Pinto A, Alten R, Bartlett SJ, Campbell W, Dawson T, Gill M, Hebing R, Meara A, Nieuwlaat R, Shaw Y, Singh JA, Suarez-Almazor M, Sumpton D, Wong P, Christensen R, Beaton D, de Wit M, Tugwell P. Outcome Measures in Rheumatology - Interventions for medication Adherence (OMERACT-Adherence) Core Domain Set for Trials of Interventions for Medication Adherence in Rheumatology: 5 Phase Study Protocol. Trials 2018; 19:204. [PMID: 29587864 PMCID: PMC5870260 DOI: 10.1186/s13063-018-2565-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Over the last 20 years, there have been marked improvements in the availability of effective medications for rheumatic conditions such as gout, osteoporosis and rheumatoid arthritis (RA), which have led to a reduction in disease flares and the risk of re-fracture in osteoporosis, and the slowing of disease progression in RA. However, medication adherence remains suboptimal, as treatment regimens can be complex and difficult to continue long term. Many trials have been conducted to improve adherence to medication. Core domains, which are the outcomes of most relevance to patients and clinicians, are a pivotal component of any trial. These core domains should be measured consistently, so that all relevant trials can be combined in systematic reviews and meta-analyses to reach conclusions that are more valid. Failure to do this severely limits the potential for trial-based evidence to inform decisions on how to support medication adherence. The Outcome Measures in Rheumatology (OMERACT) - Interventions for Medication Adherence study by the OMERACT-Adherence Group aims to develop a core domain set for interventions that aim to support medication adherence in rheumatology. METHODS/DESIGN This OMERACT-Adherence study has five phases: (1) a systematic review to identify outcome domains that have been reported in interventions focused on supporting medication adherence in rheumatology; (2) semi-structured stakeholder interviews with patients and caregivers to determine their views on the core domains; (3) focus groups using the nominal group technique with patients and caregivers to identify and rank domains that are relevant to them, including the reasons for their choices; (4) an international three-round modified Delphi survey involving patients with diverse rheumatic conditions, caregivers, health professionals, researchers and other stakeholders to develop a preliminary core domain set; and (5) a stakeholder workshop with OMERACT members to review, vote on and reach a consensus on the core domain set for interventions to support medication adherence in rheumatology. DISCUSSION Establishing a core domain set to be reported in all intervention studies undertaken to support patients with medication adherence will enhance the relevance and the impact of these results and improve the lives of people with rheumatic conditions.
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Affiliation(s)
- Ayano Kelly
- Canberra Rheumatology, Level 9, 40 Marcus Clarke St, Canberra City, ACT, 2606, Australia. .,Department of Rheumatology, Canberra Hospital, Canberra, ACT, Australia. .,College of Health and Medicine, Australian National University, Canberra, ACT, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kathleen Tymms
- Canberra Rheumatology, Level 9, 40 Marcus Clarke St, Canberra City, ACT, 2606, Australia.,Department of Rheumatology, Canberra Hospital, Canberra, ACT, Australia.,College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Lyn March
- Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.,Institute of Bone and Joint Research, Kolling Institute of Medical Research, Sydney, NSW, Australia.,Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Mary De Vera
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - Vicki Evans
- Patient Research Partner, Clear Vision Consulting, Canberra, ACT, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Karine Toupin-April
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Bart van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, Netherlands.,Radboud University Medical Centre, Nijmegen, Netherlands
| | - Armando Teixeira-Pinto
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Rieke Alten
- Department of Rheumatology, Clinical Immunology, Osteology, Physical therapy and Sports Medicine, Schlosspark Klinik, Charité University Medicine, Berlin, Germany
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Canada.,Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Willemina Campbell
- Patient Research Partner, Toronto Western Hospital, Toronto, Ottawa, Canada
| | - Therese Dawson
- Lord Street Specialist Centre, Port Macquarie, NSW, Australia.,Mayo Hospital Specialist Centre, Taree, NSW, Australia
| | - Michael Gill
- Patient Research Partner, Dragon Claw, Sydney, NSW, Australia
| | - Renske Hebing
- Amsterdam Rheumatology and Immunology Centre, Amsterdam, Netherlands
| | - Alexa Meara
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Robby Nieuwlaat
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Yomei Shaw
- National Data Bank for Rheumatic Diseases, Wichita, KS, USA
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, USA.,Department of Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA.,Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL, USA
| | - Maria Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel Sumpton
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Concord Hospital, Sydney, NSW, Australia
| | - Peter Wong
- Mid-North Coast Arthritis Clinic, Coffs Harbour, NSW, Australia.,University of New South Wales Rural Clinical School, Coffs Harbour, NSW, Australia
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Dorcas Beaton
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute for Work & Health, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy and the Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Maarten de Wit
- Metamedica, VU Medical Centre, Amsterdam, The Netherlands
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Aviña-Zubieta JA, To F, Vostretsova K, De Vera M, Sayre EC, Esdaile JM. Risk of Myocardial Infarction and Stroke in Newly Diagnosed Systemic Lupus Erythematosus: A General Population-Based Study. Arthritis Care Res (Hoboken) 2017; 69:849-856. [DOI: 10.1002/acr.23018] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 07/11/2016] [Accepted: 08/16/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | - Fergus To
- University of British Columbia; Vancouver British Columbia Canada
| | | | - Mary De Vera
- Arthritis Research Canada and University of British Columbia; Vancouver British Columbia Canada
| | - Eric C. Sayre
- Arthritis Research Canada and University of British Columbia; Vancouver British Columbia Canada
| | - John M. Esdaile
- Arthritis Research Canada and University of British Columbia; Vancouver British Columbia Canada
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8
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Amiri N, De Vera M, Choi HK, Sayre EC, Avina-Zubieta JA. Increased risk of cardiovascular disease in giant cell arteritis: a general population–based study. Rheumatology (Oxford) 2015; 55:33-40. [DOI: 10.1093/rheumatology/kev262] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Indexed: 11/13/2022] Open
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Singh C, De Vera M, Campbell KL. The effect of prospective monitoring and early physiotherapy intervention on arm morbidity following surgery for breast cancer: a pilot study. Physiother Can 2014; 65:183-91. [PMID: 24403683 DOI: 10.3138/ptc.2012-23o] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Significant arm morbidity is reported following surgery for breast cancer, yet physiotherapy is not commonly part of usual care. This study compared the effect on arm morbidity after surgery for breast cancer of a clinical care pathway including preoperative education, prospective monitoring, and early physiotherapy (experimental group) to that of preoperative education alone (comparison group). METHODS A prospective quasi-experimental pretest-posttest, non-equivalent group design compared two clinical sites; Site A (n=41) received the experimental intervention, and Site B (n=31) received the comparison intervention. At baseline (preoperative) and 7 months postoperative, shoulder range of motion (ROM), upper-extremity (UE) strength, UE circumference, pain, UE function, and quality of life were assessed. RESULTS The experimental group maintained shoulder flexion ROM at 7 months, whereas the comparison group saw a decrease (mean 1° [SD 9°] vs. -6° [SD 15°], p=0.03). A lower incidence of arm morbidity and better quality of life were observed in the experimental group, but these findings were not statistically significant. Baseline characteristics and surgical approaches differed between the two sites, which may have had an impact on the findings. CONCLUSION Initial results are promising and support the feasibility of integrating a surveillance approach into follow-up care. This pilot study provides the foundation for a larger, more definitive trial.
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Affiliation(s)
| | | | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver B.C
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Abstract
OBJECTIVE Several studies have suggested that higher serum uric acid levels lead to a lower risk of Parkinson's disease (PD) because uric acid exerts antioxidant effects on neurons. Our objective was to examine the relationship between gout and the risk of PD in persons age > or = 65 years. METHODS We conducted a population-based cohort study using the British Columbia Linked Health Database and PharmaCare data (i.e., prescription drug data for those age > or = 65 years). We compared incidence rates of PD between 11,258 gout patients and 56,199 controls matched on age, sex, date of gout diagnosis, and length of medical record. Cox proportional hazards models were used to estimate the relative risk (RR) of PD, adjusting for age, sex, prior comorbid conditions, and use of diuretics and nonsteroidal antiinflammatory drugs. RESULTS Over an 8-year median followup, we identified 1,182 new cases of PD. Compared with individuals without gout, the multivariate RR of PD among those with gout was 0.70 (95% confidence interval [95% CI] 0.59-0.83). In subgroup analyses, the inverse association was similarly present in both sexes and was evident among those who did not use diuretics (RR 0.66, 95% CI 0.54-0.81), but not among diuretic users (RR 0.80, 95% CI 0.58-1.10, P for interaction 0.35). CONCLUSION Our population-based data provide evidence for a protective effect of gout on the risk of PD and support the purported protective role of uric acid.
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Affiliation(s)
- Mary De Vera
- Arthritis Research Centre of Canada and University of British Columbia, Vancouver, British Columbia, Canada
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Alvarez C, De Vera M, Chhina H, Black A. Normative data for the dynamic pedobarographic profiles of children. Gait Posture 2008; 28:309-15. [PMID: 18417345 DOI: 10.1016/j.gaitpost.2008.01.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 01/17/2008] [Accepted: 01/17/2008] [Indexed: 02/02/2023]
Abstract
In order to establish the clinical utility of pedobarography in the treatment of childhood foot pathology, a reliable set of pedobarograph data describing non-pathologic feet is required. The purpose of this study was to describe the pedobarographic profiles of normal children across all ages, with specific focus on young children and explore age-related differences in foot pressure patterns. The Tekscan HR Mat pressure measurement system was used in a protocol involving a dynamic test at self-selected speed and walking pattern of 146 normal children (age range 1.6-14.9 years). Relative force and timing data were obtained across five foot segments (heel, lateral midfoot, medial midfoot, lateral forefoot, and medial forefoot). Analysis of variance (ANOVA) techniques were applied to determine if there were any age-related differences in foot pressure profiles in children across four a priori pedobarograph variables: % of stance at initiation at the heel, % of stance at initiation at the medial midfoot, maximum % force at the heel, maximum % force at the medial midfoot. Differences in foot pressure profiles were distinguished across three age groups: (1) Group 1: <2 years; (2) Group 2: 2-5 years; and (3) Group 3: >5 years. Age-related differences in initiation patterns, force transmission, and the amount of time spent on each foot segment provide evidence for maturation of children's foot pressure profiles from a flatfoot pattern in the young child to a curvilinear pattern in the older child.
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Affiliation(s)
- Christine Alvarez
- University of British Columbia, Faculty of Medicine, Department of Orthopaedics, BC Children's Hospital, A203 - 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
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Alvarez C, De Vera M, Varghese R. Review of current methods used in the treatment of clubfoot at initial presentation and at recurrence. J Surg Orthop Adv 2008; 17:107-114. [PMID: 18549743] [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: 05/26/2023]
Abstract
Idiopathic clubfoot is a common condition seen by orthopaedic surgeons and is characterized by complex three-dimensional deformity of the foot. It is recognized that clubfoot treatment is a challenging issue in orthopaedics because it is an ongoing process, beginning in early infancy and continuing until the patient has reached skeletal maturity. This review article summarizes two important stages of clubfoot treatment. First, methods of initial correction-including nonoperative, semi-operative, and operative techniques-that have been used in the last 20 years are described. Second, the management of the recurrent clubfoot is discussed in terms of methods used to address specific deformities.
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Affiliation(s)
- Christine Alvarez
- Department of Orthopaedics, BC Children's Hospital, Room A203, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
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Alvarez C, De Vera M, Beauchamp R, Ward V, Black A. Classification of idiopathic toe walking based on gait analysis: development and application of the ITW severity classification. Gait Posture 2007; 26:428-35. [PMID: 17161602 DOI: 10.1016/j.gaitpost.2006.10.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [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: 06/22/2006] [Revised: 10/24/2006] [Accepted: 10/29/2006] [Indexed: 02/02/2023]
Abstract
Idiopathic toe walking (ITW), considered abnormal after the age of 3 years, is a common complaint seen by medical professionals, especially orthopaedic surgeons and physiotherapists. A classification for idiopathic toe walking would be helpful to better understand the condition, delineate true idiopathic toe walkers from patients with other conditions, and allow for assignment of a severity gradation, thereby directing management of ITW. The purpose of this study was to describe idiopathic toe walking and develop a toe walking classification scheme in a large sample of children. Three primary criteria, presence of a first ankle rocker, presence of an early third ankle rocker, and predominant early ankle moment, were used to classify idiopathic toe walking into three severity groups: Type 1 mild; Type 2 moderate; and Type 3 severe. Supporting data, based on ankle range of motion, sagittal joint powers, knee kinematics, and EMG data were also analyzed. Prospectively collected gait analysis data of 133 children (266 feet) with idiopathic toe walking were analyzed. Subjects' age range was from 4.19 to 15.96 years with a mean age of 8.80 years. Pooling right and left foot data, 40 feet were classified as Type 1, 129 were classified as Type 2, and 90 were classified as Type 3. Seven feet were unclassifiable. Statistical analysis of continuous variables comprising the primary criteria showed that the toe walking severity classification was able to differentiate between three levels of toe walking severity. This classification allowed for the quantitative description of the idiopathic toe walking pattern as well as the delineation of three distinct types of ITW patients (mild, moderate, and severe).
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Affiliation(s)
- Christine Alvarez
- UBC, Faculty of Medicine, Department of Orthopaedics, BC Children's Hospital, A203-4480 Oak Street, Vancouver, BC V6H 3V4, Canada.
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Abstract
The synthesis of four benzophenone-containing analogues of the antiproliferative natural product didemnin B is presented. In vitro protein biosynthesis inhibition potency and antitumor activity were evaluated. The results indicate that all four analogues are biologically active and could serve as photoaffinity reagents for the study of receptor-binding interactions of didemnins. These analogues could also be useful in studying antitumor effects of didemnins.
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Affiliation(s)
- M D Vera
- Department of Chemistry, University of Pennsylvania, 19104-6323, Philadelphia, PA, USA
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15
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Abstract
The total synthesis of a didemnin B analogue containing a conformationally constrained replacement for the isostatine moiety is reported. Synthetic highlights include an improved preparation of 2-hydroxy-3-cyclohexenecarboxylic acid and a new strategy for accessing the macrocycle.
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Affiliation(s)
- D Xiao
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street, Philadelphia, PA 19104-6323, USA
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16
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Abstract
The synthesis and antitumor activity of a novel didemnin B analogue containing a psi[CH2NH] amide bond surrogate between N-Me-D-Leu7 and Pro8 are reported. The analogue shows activity (GI50 = 4 nM) comparable to that of didemnin B (GI50 = 13 nM) in the NCI-60 tumor cell screen. This result, along with new data from previously reported synthetic didemnin analogues, is discussed within the context of the side-chain SAR for didemnins.
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Affiliation(s)
- X Ding
- Department of Chemistry, University of Pennsylvania, Philadelphia 19104-6323, USA
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17
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Abstract
The synthesis and biological activity of N(epsilon)-Z-[Lys3]didemnin B are reported. This novel analogue retains antiproliferative, cytotoxic, and protein biosynthesis inhibition activities, but at reduced levels. This result suggests the use of [Lys3]didemnin derivatives as potential affinity probes for studying the molecular target(s) of the didemnin class of natural products.
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Affiliation(s)
- M D Vera
- Department of Chemistry, University of Pennsylvania, Philadelphia 19104-6323, USA
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Ahuja D, Geiger A, Ramanjulu JM, Vera MD, SirDeshpande B, Pfizenmayer A, Abazeed M, Krosky DJ, Beidler D, Joullié MM, Toogood PL. Inhibition of protein synthesis by didemnins: cell potency and SAR. J Med Chem 2000; 43:4212-8. [PMID: 11063617 DOI: 10.1021/jm000168v] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Synthetic and naturally occurring didemnins are potent and specific inhibitors of protein synthesis in vitro. Structure-activity analysis indicates a requirement for the intact macrocycle; however, the smaller ring size represented by the didemnin analogue, tamandarin A, is equipotent to didemnin B. Replacement of the N,O-dimethyltyrosine by a N-methylphenylalanine or N-methylleucine residue is also well-tolerated. The rank order for inhibition of protein synthesis in vitro appears to be retained in MCF-7 cells, albeit at much higher potency. This increase in potency is explained for the first time by data indicating that MCF-7 cells can accumulate didemnin B up to 2-3 orders of magnitude compared to the growth medium.
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Affiliation(s)
- D Ahuja
- Willard H. Dow Laboratory, Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109-1055, USA
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Affiliation(s)
- B Liang
- Department of Chemistry, University of Pennsylvania, Philadelphia 19104-6323, USA
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Ahuja D, Vera MD, SirDeshpande BV, Morimoto H, Williams PG, Joullié MM, Toogood PL. Inhibition of protein synthesis by didemnin B: how EF-1alpha mediates inhibition of translocation. Biochemistry 2000; 39:4339-46. [PMID: 10757982 DOI: 10.1021/bi992202h] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [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] [Indexed: 11/28/2022]
Abstract
The antineoplastic cyclic depsipeptide didemnin B (DB) inhibits protein synthesis in cells and in vitro. The stage at which DB inhibits protein synthesis in cells is not known, although dehydrodidemnin B arrests translation at the stage of polypeptide elongation. Inhibition of protein synthesis by DB in vitro also occurs at the elongation stage, and it was shown previously that DB prevents EF-2-dependent translocation in partial reaction models of protein synthesis. This inhibition of translocation displays an absolute requirement for EF-1alpha; however, the dependence upon EF-1alpha was previously unexplained. It is shown here that DB binds only weakly to EF-1alpha/GTP in solution, but binds to ribosome. EF-1alpha complexes with a dissociation constant K(d) = 4 microM. Thus, the inhibition of protein synthesis by DB appears to involve an interaction with both EF-1alpha and ribosomes in which all three components are required. Using diphtheria toxin-mediated ADP-ribosylation to assay for EF-2, it is demonstrated that DB blocks EF-2 binding to pre-translocative ribosome.EF-1alpha complexes, thus preventing ribosomal translocation. Based on this model for protein synthesis inhibition by DB, and the proposed mechanism of action of fusidic acid, evidence is presented in support of the Grasmuk model for EF-1alpha function in which this elongation factor does not fully depart the ribosome during polypeptide elongation.
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Affiliation(s)
- D Ahuja
- Willard H. Dow Laboratory, Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109-1055, USA
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21
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Abstract
[formula: see text] Tamandarin A (1), a newly isolated natural product similar in structure to didemnin B (2), was shown to be somewhat more active in vitro than 2 against pancreatic carcinoma with an ED50 value 1.5 to 2 ng/mL. We report here the first total synthesis of 1. The key steps include a practical stereoselective synthesis of the Hiv-isostatine unit, high-yielding linear precursor formation, a successful macrocyclization, and coupling of the macrocycle with the side chain to afford tamandarin A (1).
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Affiliation(s)
- B Liang
- Department of Chemistry, University of Pennsylvania, Philadelphia 19104-6323, USA
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Abstract
A didemnin B analog containing a Tic (1,2,3,4-tetrahydroisoquinoline-3-carboxylic acid) as a conformationally restrained replacement for tyrosine has been synthesized and shown to have comparable potency as a protein biosynthesis inhibitor. Synthetic highlights include an oxidation of an alcohol to an acid in the presence of the sensitive Tic heterocycle and a modified Schmidt-type one-pot macrocyclization.
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Affiliation(s)
- A J Pfizenmayer
- Department of Chemistry, University of Pennsylvania, Philadelphia 19104-6323, USA
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