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Qaseem A, Obley AJ, Shamliyan T, Hicks LA, Harrod CS, Crandall CJ, Balk EM, Cooney TG, Cross JT, Fitterman N, Lin JS, Maroto M, Miller MC, Shekelle P, Tice JA, Tufte JE, Etxeandia-Ikobaltzeta I, Yost J. Newer Pharmacologic Treatments in Adults With Type 2 Diabetes: A Clinical Guideline From the American College of Physicians. Ann Intern Med 2024; 177:658-666. [PMID: 38639546 DOI: 10.7326/m23-2788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 04/20/2024] Open
Abstract
DESCRIPTION The American College of Physicians (ACP) developed this clinical guideline to update recommendations on newer pharmacologic treatments of type 2 diabetes. This clinical guideline is based on the best available evidence for effectiveness, comparative benefits and harms, consideration of patients' values and preferences, and costs. METHODS This clinical guideline is based on a systematic review of the effectiveness and harms of newer pharmacologic treatments of type 2 diabetes, including glucagon-like peptide-1 (GLP-1) agonists, a GLP-1 agonist and glucose-dependent insulinotropic polypeptide agonist, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, and long-acting insulins, used either as monotherapy or in combination with other medications. The Clinical Guidelines Committee prioritized the following outcomes, which were evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach: all-cause mortality, major adverse cardiovascular events, myocardial infarction, stroke, hospitalization for congestive heart failure, progression of chronic kidney disease, serious adverse events, and severe hypoglycemia. Weight loss, as measured by percentage of participants who achieved at least 10% total body weight loss, was a prioritized outcome, but data were insufficient for network meta-analysis and were not rated with GRADE. AUDIENCE AND PATIENT POPULATION The audience for this clinical guideline is physicians and other clinicians. The population is nonpregnant adults with type 2 diabetes. RECOMMENDATION 1 ACP recommends adding a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or glucagon-like peptide-1 (GLP-1) agonist to metformin and lifestyle modifications in adults with type 2 diabetes and inadequate glycemic control (strong recommendation; high-certainty evidence). • Use an SGLT-2 inhibitor to reduce the risk for all-cause mortality, major adverse cardiovascular events, progression of chronic kidney disease, and hospitalization due to congestive heart failure. • Use a GLP-1 agonist to reduce the risk for all-cause mortality, major adverse cardiovascular events, and stroke. RECOMMENDATION 2 ACP recommends against adding a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin and lifestyle modifications in adults with type 2 diabetes and inadequate glycemic control to reduce morbidity and all-cause mortality (strong recommendation; high-certainty evidence).
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., T.S., C.H.S.)
| | - Adam J Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O.)
| | - Tatyana Shamliyan
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., T.S., C.H.S.)
| | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.A.H.)
| | - Curtis S Harrod
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., T.S., C.H.S.)
| | - Carolyn J Crandall
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California (C.J.C.)
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2
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Qaseem A, Owens DK, Etxeandia-Ikobaltzeta I, Tufte JE, Cross JT, Wilt TJ, Crandall CJ, Hicks LA, Balk EM, Cooney TG, Fitterman N, Lin JS, Maroto M, Miller MC, Obley AJ, Owens DK, Shekelle PG, Harrod CS, Yost J. Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians (Version 1, Update Alert). Ann Intern Med 2024; 177:eL230440. [PMID: 38498880 DOI: 10.7326/l23-0440] [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] [Indexed: 03/20/2024] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania
| | - Douglas K Owens
- Stanford Health Policy, Stanford University, Stanford, California
| | | | | | | | - Timothy J Wilt
- Minneapolis VA Center for Care Delivery and Outcomes Research, Minneapolis, Minnesota
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3
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Yohanna S, Naylor KL, Sontrop JM, Ribic CM, Clase CM, Miller MC, Madan S, Hae R, Ho J, Roushani J, Parfeniuk S, Jansen M, Shavel S, Richter M, Young K, Cowell B, Lambe S, Margetts P, Piercey K, Tandon V, Boylan C, Wang C, McKenzie S, Longo B, Garg AX. Implementation of a One-Day Living Kidney Donor Assessment Clinic to Improve the Efficiency of the Living Kidney Donor Evaluation: Program Report. Can J Kidney Health Dis 2024; 11:20543581241231462. [PMID: 38410167 PMCID: PMC10896046 DOI: 10.1177/20543581241231462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/22/2023] [Indexed: 02/28/2024] Open
Abstract
Purpose of program A key barrier to becoming a living kidney donor is an inefficient evaluation process, requiring more than 30 tests (eg, laboratory and diagnostic tests), questionnaires, and specialist consultations. Donor candidates make several trips to hospitals and clinics, and often spend months waiting for appointments and test results. The median evaluation time for a donor candidate in Ontario, Canada, is nearly 1 year. Longer wait times are associated with poorer outcomes for the kidney transplant recipient and higher health care costs. A shorter, more efficient donor evaluation process may help more patients with kidney failure receive a transplant, including a pre-emptive kidney transplant (ie, avoiding the need for dialysis). In this report, we describe the development of a quality improvement intervention to improve the efficiency, effectiveness, and patient-centeredness of the donor candidate evaluation process. We developed a One-Day Living Kidney Donor Assessment Clinic, a condensed clinic where interested donor candidates complete all testing and consultations within 1 day. Sources of information The One-Day Living Kidney Donor Assessment Clinic was developed after performing a comprehensive review of the literature, receiving feedback from patients who have successfully donated, and meetings with transplant program leadership from St. Joseph's Healthcare Hamilton. A multistakeholder team was formed that included health care staff from nephrology, transplant surgery, radiology, cardiology, social work, nuclear medicine, and patients with the prior lived experience of kidney donation. In the planning stages, the team met regularly to determine the objectives of the clinic, criteria for participation, clinic schedule, patient flow, and clinic metrics. Methods Donor candidates entered the One-Day Clinic if they completed initial laboratory testing and agreed to an expedited process. If additional testing was required, it was completed on a different day. Donor candidates were reviewed by the nephrologist, transplant surgeon, and donor coordinator approximately 2 weeks after the clinic for final approval. The team continues to meet regularly to review donor feedback, discuss challenges, and brainstorm solutions. Key findings The One-Day Clinic was implemented in March 2019, and has now been running for 4 years, making iterative improvements through continuous patient and provider feedback. To date, we have evaluated more than 150 donor candidates in this clinic. Feedback from donors has been uniformly positive (98% of donors stated they were very satisfied with the clinic), with most noting that the clinic was efficient and minimally impacted work and family obligations. Hospital leadership, including the health care professionals from each participating department, continue to show support and collaborate to create a seamless experience for donor candidates attending the One-Day Clinic. Limitations Clinic spots are limited, meaning some interested donor candidates may not be able to enter a One-Day Clinic the same month they come forward. Implications This patient-centered quality improvement intervention is designed to improve the efficiency and experience of the living kidney donor evaluation, result in better outcomes for kidney transplant recipients, and potentially increase living donation. Our next step is to conduct a formal evaluation of the clinic, measuring qualitative feedback from health care professionals working in the clinic and donor candidates attending the clinic, and measuring key process and outcome measures in donor candidates who completed the one-day assessment compared with those who underwent the usual care assessment. This program evaluation will provide reliable, regionally relevant evidence that will inform transplant centers across the country as they consider incorporating a similar one-day assessment model.
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Affiliation(s)
- Seychelle Yohanna
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
| | - Kyla L Naylor
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Jessica M Sontrop
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Christine M Ribic
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
| | - Catherine M Clase
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
| | - Matthew C Miller
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
| | - Sunchit Madan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard Hae
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jasper Ho
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jian Roushani
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | | | - Shahid Lambe
- St. Joseph's Healthcare Hamilton, ON, Canada
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Peter Margetts
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
| | - Kevin Piercey
- St. Joseph's Healthcare Hamilton, ON, Canada
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Vikas Tandon
- Division of Cardiology, McMaster University, Hamilton, ON, Canada
| | - Colm Boylan
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Carol Wang
- Department of Medicine, Western University, London, ON, Canada
| | | | - Barb Longo
- Transplant Ambassador Program, Toronto, ON, Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
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Qaseem A, Yost J, Abraham GM, Andrews R, Jokela JA, Miller MC, Humphrey LL, Dunn A, Haeme R, Lee R, Saini SD, Tschanz CMP, Etxeandia-Ikobaltzeta I, Harrod C, Shamliyan T, Umana K. Outpatient Treatment of Confirmed COVID-19: Living, Rapid Practice Points From the American College of Physicians (Version 2). Ann Intern Med 2023; 176:1396-1404. [PMID: 37722112 PMCID: PMC10620951 DOI: 10.7326/m23-1636] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
DESCRIPTION Evidence for the use of outpatient treatments in adults with confirmed COVID-19 continues to evolve with new data. This is version 2 of the American College of Physicians (ACP) living, rapid practice points focusing on 22 outpatient treatments for COVID-19, specifically addressing the dominant SARS-CoV-2 Omicron variant. METHODS The Population Health and Medical Science Committee (formerly the Scientific Medical Policy Committee) developed this version of the living, rapid practice points on the basis of a living, rapid review done by the ACP Center for Evidence Reviews at Cochrane Austria at the University for Continuing Education Krems (Danube University Krems). This topic will be maintained as living and rapid by continually monitoring and assessing the impact of new evidence. PRACTICE POINT 1 Consider molnupiravir to treat symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease. PRACTICE POINT 2 Consider nirmatrelvir-ritonavir combination therapy to treat symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease. PRACTICE POINT 3 Do not use ivermectin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 4 Do not use sotrovimab to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | | | - Janet A Jokela
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (J.A.J.)
| | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (L.L.H.)
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Qaseem A, Yost J, Miller MC, Andrews R, Jokela JA, Forciea MA, Abraham GM, Humphrey LL, Lee RA, Tschanz MP, Etxeandia-Ikobaltzeta I, Harrod C, Shamliyan T, Umana K. Outpatient Treatment of Confirmed COVID-19: Living, Rapid Practice Points From the American College of Physicians (Version 1). Ann Intern Med 2023; 176:115-124. [PMID: 36442061 PMCID: PMC9707698 DOI: 10.7326/m22-2249] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
DESCRIPTION Strategies to manage COVID-19 in the outpatient setting continue to evolve as new data emerge on SARS-CoV-2 variants and the availability of newer treatments. The Scientific Medical Policy Committee (SMPC) of the American College of Physicians (ACP) developed these living, rapid practice points to summarize the best available evidence on the treatment of adults with confirmed COVID-19 in an outpatient setting. These practice points do not evaluate COVID-19 treatments in the inpatient setting or adjunctive COVID-19 treatments in the outpatient setting. METHODS The SMPC developed these living, rapid practice points on the basis of a living, rapid review done by the ACP Center for Evidence Reviews at Cochrane Austria at the University for Continuing Education Krems (Danube University Krems). The SMPC will maintain these practice points as living by monitoring and assessing the impact of new evidence. PRACTICE POINT 1 Consider molnupiravir to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 to 7 days of the onset of symptoms and at high risk for progressing to severe disease. PRACTICE POINT 2 Consider nirmatrelvir-ritonavir combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at high risk for progressing to severe disease. PRACTICE POINT 3 Consider remdesivir to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 7 days of the onset of symptoms and at high risk for progressing to severe disease. PRACTICE POINT 4 Do not use azithromycin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 5 Do not use chloroquine or hydroxychloroquine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 6 Do not use ivermectin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 7 Do not use nitazoxanide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 8 Do not use lopinavir-ritonavir combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 9 Do not use casirivimab-imdevimab combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation. PRACTICE POINT 10 Do not use regdanvimab to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation. PRACTICE POINT 11 Do not use sotrovimab to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation. PRACTICE POINT 12 Do not use convalescent plasma to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 13 Do not use ciclesonide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. PRACTICE POINT 14 Do not use fluvoxamine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | | | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (L.L.H.)
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6
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Nolan GS, Dunne JA, Lee AE, Wade RG, Kiely AL, Pritchard Jones RO, Gardiner MD, Abbassi O, Abdelaty M, Ahmed F, Ahmed R, Ali S, Allan A, Allen L, Anderson I, Bakir A, Berwick D, Sarala BBN, Bhat W, Bloom O, Bolton L, Brady N, Campbell E, Capitelli-McMahon H, Cassell O, Chalhoub X, Chalmers R, Chan J, Chu HO, Collin T, Cooper K, Curran TA, Cussons D, Daruwalla M, Dearden A, Delikonstantinou I, Dobbs T, Dunlop R, El-Muttardi N, Eleftheriadou A, Elamin SE, Eriksson S, Exton R, Fourie LR, Freethy A, Gardner E, Geh JL, Georgiou A, Georgiou M, Gilbert P, Gkorila A, Green D, Haeney J, Hamilton S, Harper F, Harrison C, Heinze Z, Hemington-Gorse S, Hever P, Hili S, Holmes W, Hughes W, Ibrahim N, Ismail A, Jallali N, James NK, Jemec B, Jica R, Kaur A, Kazzazi D, Khan M, Khan N, Khashaba H, Khera B, Khoury A, Kiely J, Kumar S, Patel PK, Kumbasar DE, Kundasamy P, Kyle D, Langridge B, Liu C, Lo M, Macdonald C, Anandan SM, Mahdi M, Mandal A, Manning A, Markeson D, Matteucci P, McClymont L, Mikhail M, Miller MC, Munro S, Musajee A, Nasrallah F, Ng L, Nicholas R, Nicola A, Nikkhah D, O'Hara N, Odili J, Oudit D, Patel A, Patel C, Patel N, Patel P, Peach H, Phillips B, Pinder R, Pinto-Lopes R, Plonczak A, Quinnen N, Rafiq S, Rahman K, Ramjeeawon A, Rinkoff S, Sainsbury D, Schumacher K, Segaren N, Shahzad F, Shariff Z, Siddiqui A, Singh P, Sludden E, Smith JRO, Song M, Stodell M, Tanos G, Taylor K, Taylor L, Thomson D, Tiernan E, Totty JP, Vaingankar N, Toh V, Wensley K, Whitehead C, Whittam A, Wiener M, Wilson A, Wong KY, Wood S, Yeoh T, Yii NW, Yim G, Young R, Zberea D, Jain A. National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK. Br J Surg 2022; 109:1040-1043. [DOI: 10.1093/bjs/znac232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022]
Abstract
A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.
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Affiliation(s)
- Grant S Nolan
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Jonathan A Dunne
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Alice E Lee
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds , Leeds , UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Ailbhe L Kiely
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Rowan O Pritchard Jones
- Department of Plastic and Reconstructive Surgery, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust , Prescot , UK
| | - Matthew D Gardiner
- Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham , Slough , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
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- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
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Miller MC. Complementary and Integrative Medicine: Origins and Expanding Horizons. Otolaryngol Clin North Am 2022; 55:891-898. [PMID: 36088152 DOI: 10.1016/j.otc.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article is an introduction to the concepts of complementary, alternative, and integrative medicine. It discusses the scope and prevalence of complementary and integrative medicine (CIM) use among otolaryngology patients. Specific types of CIM are characterized in the context of their origins, philosophic and historical bases, scientific evidence, and applicability to the practice of otolaryngology. The author's intent is to provide a framework for discussing CIM with patients and integrate into treatment paradigms in an evidence-based manner.
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Affiliation(s)
- Matthew C Miller
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY 14642, USA.
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Abraham GM, Jokela JA, Forciea MA, Miller MC, Humphrey LL. Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2, Update Alert 3). Ann Intern Med 2022; 175:W55-W57. [PMID: 35226518 PMCID: PMC8900283 DOI: 10.7326/m21-4810] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania
| | - Jennifer Yost
- American College of Physicians, Philadelphia, Pennsylvania, and Villanova University, Villanova, Pennsylvania
| | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts
| | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois
| | | | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon
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9
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Forciea MA, Abraham GM, Miller MC, Obley AJ, Humphrey LL, Akl EA, Andrews R, Dunn A, Haeme R, Kansagara DL, Tschanz MP. What Is the Antibody Response and Role in Conferring Natural Immunity After SARS-CoV-2 Infection? Rapid, Living Practice Points From the American College of Physicians (Version 2). Ann Intern Med 2022; 175:556-565. [PMID: 35073153 PMCID: PMC8803138 DOI: 10.7326/m21-3272] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The Scientific Medical Policy Committee (SMPC) of the American College of Physicians (ACP) developed these living, rapid practice points to summarize the current best available evidence on the antibody response to SARS-CoV-2 infection and protection against reinfection with SARS-CoV-2. This is version 2 of the ACP practice points, which serves to update version 1, published on 16 March 2021. These practice points do not evaluate vaccine-acquired immunity or cellular immunity. METHODS The SMPC developed this version of the living, rapid practice points based on an updated living, rapid, systematic review conducted by the Portland VA Research Foundation and funded by the Agency for Healthcare Research and Quality. PRACTICE POINT 1 Do not use SARS-CoV-2 antibody tests for the diagnosis of SARS-CoV-2 infection. PRACTICE POINT 2 Do not use SARS-CoV-2 antibody tests to predict the degree or duration of natural immunity conferred by antibodies against reinfection, including natural immunity against different variants. RETIREMENT FROM LIVING STATUS Although natural immunity remains a topic of scientific interest, this topic is being retired from living status given the availability of effective vaccines for SARS-CoV-2 and widespread recommendations for and prevalence of their use. Currently, vaccination is the best clinical recommendation for preventing infection, reinfection, and serious illness from SARS-CoV-2 and its variants.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | | | - George M Abraham
- University of Massachusetts Medical School/Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | | | - Adam J Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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11
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Abraham GM, Jokela JA, Miller MC, Forciea MA, Humphrey LL. Update Alert 2: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2). Ann Intern Med 2021; 174:W116-W117. [PMID: 34606308 PMCID: PMC8496689 DOI: 10.7326/l21-0607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania
| | | | | | - George M Abraham
- Saint Vincent Hospital-Worcester Medical Center, Worcester, Massachusetts
| | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois
| | | | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon
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12
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Abraham GM, Jokela JA, Miller MC, Forciea MA, Humphrey LL, Dunn A, Andrews R, Haeme R, Tschanz MP. Update Alert: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2). Ann Intern Med 2021; 174:W66-W67. [PMID: 34251904 PMCID: PMC8297419 DOI: 10.7326/l21-0389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania
| | | | | | - George M Abraham
- Saint Vincent Hospital-Worcester Medical Center, Worcester, Massachusetts
| | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois
| | | | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon
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13
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Qaseem A, Yost J, Forciea MA, Jokela JA, Miller MC, Obley A, Humphrey LL, Centor RM, Andrews R, Bledsoe TA, Haeme R, Kansagara DL, Marcucci M. The Development of Living, Rapid Practice Points: Summary of Methods From the Scientific Medical Policy Committee of the American College of Physicians. Ann Intern Med 2021; 174:1126-1132. [PMID: 34029483 PMCID: PMC8252088 DOI: 10.7326/m20-7641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In response to the COVID-19 pandemic, the Scientific Medical Policy Committee (SMPC) of the American College of Physicians (ACP) began developing "practice points" to provide clinical advice based on the best available evidence for the public, patients, clinicians, and public health professionals. As one of the first organizations in the United States to develop evidence-based clinical guidelines, ACP continues to lead and advance the science of evidence-based medicine by implementing new methods to rapidly publish practice points and maintain them as living advice that regularly assesses and incorporates new evidence. The overarching aim of practice points is to answer targeted key questions for which there is a timely need to synthesize evidence for decision making. The SMPC believes these methods can potentially be adapted to address various clinical and public health topics beyond the COVID-19 pandemic. This article presents an overview of the SMPC's living, rapid practice points development process, which includes a rapid systematic review, use of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method, use of stringent policies on the disclosure of interests and management of conflicts of interest, incorporating a public (nonclinician) perspective, and maintenance of the documents as living through ongoing surveillance and synthesis of new evidence as it emerges.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | | | - Adam Obley
- Portland VA Medical Center, Portland, Oregon (A.O.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (L.L.H.)
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14
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Forciea MA, Abraham GM, Miller MC, Obley AJ, Humphrey LL, Centor RM, Akl EA, Andrews R, Bledsoe TA, Haeme R, Kansagara DL. What Is the Antibody Response and Role in Conferring Natural Immunity After SARS-CoV-2 Infection? Rapid, Living Practice Points From the American College of Physicians (Version 1). Ann Intern Med 2021; 174:828-835. [PMID: 33721518 PMCID: PMC8017476 DOI: 10.7326/m20-7569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The widespread availability of SARS-CoV-2 antibody tests raises important questions for clinicians, patients, and public health professionals related to the appropriate use and interpretation of these tests. The Scientific Medical Policy Committee (SMPC) of the American College of Physicians developed these rapid, living practice points to summarize the current and best available evidence on the antibody response to SARS-CoV-2 infection, antibody durability after initial infection with SARS-CoV-2, and antibody protection against reinfection with SARS-CoV-2. METHODS The SMPC developed these rapid, living practice points based on a rapid and living systematic evidence review done by the Portland VA Research Foundation and funded by the Agency for Healthcare Research and Quality. Ongoing literature surveillance is planned through December 2021. When new studies are identified and a full update of the evidence review is published, the SMPC will assess the new evidence and any effect on the practice points. PRACTICE POINT 1 Do not use SARS-CoV-2 antibody tests for the diagnosis of SARS-CoV-2 infection. PRACTICE POINT 2 Antibody tests can be useful for the purpose of estimating community prevalence of SARS-CoV-2 infection. PRACTICE POINT 3 Current evidence is uncertain to predict presence, level, or durability of natural immunity conferred by SARS-CoV-2 antibodies against reinfection (after SARS-CoV-2 infection).
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | | | - Adam J Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
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15
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Lee RA, Centor RM, Humphrey LL, Jokela JA, Andrews R, Qaseem A, Akl EA, Bledsoe TA, Forciea MA, Haeme R, Kansagara DL, Marcucci M, Miller MC, Obley AJ. Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians. Ann Intern Med 2021; 174:822-827. [PMID: 33819054 DOI: 10.7326/m20-7355] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION Antimicrobial overuse is a major health care issue that contributes to antibiotic resistance. Such overuse includes unnecessarily long durations of antibiotic therapy in patients with common bacterial infections, such as acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia (CAP), urinary tract infections (UTIs), and cellulitis. This article describes best practices for prescribing appropriate and short-duration antibiotic therapy for patients presenting with these infections. METHODS The authors conducted a narrative literature review of published clinical guidelines, systematic reviews, and individual studies that addressed bronchitis with COPD exacerbations, CAP, UTIs, and cellulitis. This article is based on the best available evidence but was not a formal systematic review. Guidance was prioritized to the highest available level of synthesized evidence. BEST PRACTICE ADVICE 1 Clinicians should limit antibiotic treatment duration to 5 days when managing patients with COPD exacerbations and acute uncomplicated bronchitis who have clinical signs of a bacterial infection (presence of increased sputum purulence in addition to increased dyspnea, and/or increased sputum volume). BEST PRACTICE ADVICE 2 Clinicians should prescribe antibiotics for community-acquired pneumonia for a minimum of 5 days. Extension of therapy after 5 days of antibiotics should be guided by validated measures of clinical stability, which include resolution of vital sign abnormalities, ability to eat, and normal mentation. BEST PRACTICE ADVICE 3 In women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days, or fosfomycin as a single dose. In men and women with uncomplicated pyelonephritis, clinicians should prescribe short-course therapy either with fluoroquinolones (5 to 7 days) or TMP-SMZ (14 days) based on antibiotic susceptibility. BEST PRACTICE ADVICE 4 In patients with nonpurulent cellulitis, clinicians should use a 5- to 6-day course of antibiotics active against streptococci, particularly for patients able to self-monitor and who have close follow-up with primary care.
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Affiliation(s)
- Rachael A Lee
- University of Alabama at Birmingham, Birmingham, Alabama (R.A.L.)
| | - Robert M Centor
- Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama (R.M.C.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (L.L.H.)
| | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Urbana, Illinois (J.A.J.)
| | - Rebecca Andrews
- University of Connecticut Health Center, Farmington, Connecticut (R.A.)
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
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16
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Abraham GM, Jokela JA, Forciea MA, Miller MC, Humphrey LL, Centor RM, Andrews R, Haeme R. Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2). Ann Intern Med 2021; 174:673-679. [PMID: 33560862 PMCID: PMC7983309 DOI: 10.7326/m20-8101] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Clinicians must have access to the best available evidence to inform point-of-care decisions about the use of remdesivir in patients with COVID-19. This article provides updated advice from the American College of Physicians for clinicians based on an updated rapid review.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | | | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (L.L.H.)
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17
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Ellens NR, Miller MC, Shafiq I, Williams ZR, Vates GE. Nonabsorbable intrasellar stent placement for recurrent Rathke cleft cyst: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 1:CASE2117. [PMID: 36046794 PMCID: PMC9394677 DOI: 10.3171/case2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUNDRathke cleft cyst (RCC) has a recurrence rate of 10% to 22%, and preventing recurrence is challenging. For patients who experience persistent recurrence of RCC, placement of steroid-eluting bioabsorbable intrasellar stents has been rarely described. However, recurrences are often delayed, suggesting that dissolvable stents may not be successful long-term. The release of steroids in close proximity to the pituitary gland may also unintentionally influence the hypothalamic-adrenal-pituitary axis.OBSERVATIONSThe authors present a case of a 66-year-old woman with a persistently recurrent RCC who underwent drainage of her cyst with placement of a nonabsorbable intrasellar stent in the form of a tympanostomy tube. After repeat transsphenoidal drainage of her cyst, a tympanostomy T-tube was placed to stent open the dural aperture. Postoperatively, the patient’s condition showed improvement clinically and radiographically.LESSONSPlacement of an intrasellar stent for recurrent RCC has rarely been described. Steroid-eluting bioabsorbable stents may dissolve before RCC recurrence and may have an unintentional effect on the hypothalamic-pituitary-adrenal axis. The authors present the first case of nonabsorbable stent placement in the form of a tympanostomy tube for recurrence of RCC. Additional studies and longer follow-up are necessary to evaluate the long-term efficacy of both absorbable and nonabsorbable stent placement.
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Affiliation(s)
| | | | | | - Zoe R. Williams
- Departments of Neurosurgery,
- Ophthalmology, and
- Neurology, University of Rochester, Rochester, New York
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18
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Abraham GM, Jokela JA, Forciea MA, Miller MC, Humphrey LL, Centor RM, Andrews R, Haeme R, Kansagara DL, Marcucci M. Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 1). Ann Intern Med 2021; 174:229-236. [PMID: 33017175 PMCID: PMC7556654 DOI: 10.7326/m20-5831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
These rapid and living practice points from the American College of Physicians address the effectiveness and harms of remdesivir treatment in patients with COVID-19.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | | | | | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (L.L.H.)
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19
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Qaseem A, Etxeandia-Ikobaltzeta I, Yost J, Miller MC, Abraham GM, Obley AJ, Forciea MA, Jokela JA, Humphrey LL, Centor RM, Andrews R, Bledsoe TA, Haeme R, Kansagara DL, Marcucci M. Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1). Ann Intern Med 2020; 173:642-649. [PMID: 32551813 PMCID: PMC7357230 DOI: 10.7326/m20-3234] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Controversy exists around the appropriate types of masks and the situations in which they should be used in community and health care settings for the prevention of SARS-CoV-2 infection. In this article, the American College of Physicians (ACP) provides recommendations based on the best available evidence through 14 April 2020 on the effectiveness of N95 respirators, surgical masks, and cloth masks in reducing transmission of infection. The ACP plans periodic updates of these recommendations on the basis of ongoing surveillance of the literature for 1 year from the initial search date.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | | | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Adam J Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | | | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
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20
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Lippa SM, Werner JK, Miller MC, Gill JM, Diaz-Arrastia R, Kenney K. Recent Advances in Blood-Based Biomarkers of Remote Combat-Related Traumatic Brain Injury. Curr Neurol Neurosci Rep 2020; 20:54. [PMID: 32984931 DOI: 10.1007/s11910-020-01076-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) is highly prevalent among service members and Veterans (SMVs) and associated with changes in blood-based biomarkers. This manuscript reviews candidate biomarkers months/years following military-associated TBI. RECENT FINDINGS Several blood-based biomarkers have been investigated for diagnostic or prognostic use to inform care years after military-associated TBI. The most promising include increased levels of plasma/serum and exosomal proteins reflecting neuronal, axonal and/or vascular injury, and inflammation, as well as altered microRNA expression and auto-antibodies of central nervous system markers. Diagnostic and prognostic biomarkers of remote TBI outcomes remain in the discovery phase. Current evidence does not yet support single or combination biomarkers for clinical diagnostic use remotely after injury, but there are promising candidates that require validation in larger, longitudinal studies. The use of prognostic biomarkers of future neurodegeneration, however, holds much promise and could improve treatments and/or preventive measures for serious TBI outcomes.
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Affiliation(s)
- Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - J Kent Werner
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Sleep Medicine, WRNMMC, Bethesda, MD, USA.,CNRM, USUHS, Bethesda, MD, USA
| | - Matthew C Miller
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jessica M Gill
- CNRM, USUHS, Bethesda, MD, USA.,Brain Tissue Injury, NINR, NIH, Bethesda, MD, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA. .,Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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21
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Miller MC, Abraham GM, Obley AJ, Forciea MA, Jokela JA, Humphrey LL, Centor RM, Andrews R, Bledsoe TA, Haeme R, Kansagara DL, Marcucci M. Should Clinicians Use Chloroquine or Hydroxychloroquine Alone or in Combination With Azithromycin for the Prophylaxis or Treatment of COVID-19? Living Practice Points From the American College of Physicians (Version 1). Ann Intern Med 2020; 173:137-142. [PMID: 32422063 PMCID: PMC7281715 DOI: 10.7326/m20-1998] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | | | - George M Abraham
- University of Massachusetts Medical School/Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Adam Jacob Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | - Mary Ann Forciea
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (M.A.F.)
| | - Janet A Jokela
- University of Illinois at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
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22
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Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, Miller MC, Abraham GM, Obley AJ, Forciea MA, Jokela JA, Humphrey LL. Update Alert: Should Clinicians Use Chloroquine or Hydroxychloroquine Alone or in Combination With Azithromycin for the Prophylaxis or Treatment of COVID-19? Living Practice Points From the American College of Physicians. Ann Intern Med 2020; 173:W48-W51. [PMID: 32551892 PMCID: PMC7322813 DOI: 10.7326/m20-3862] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Jennifer Yost
- Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | | | - George M Abraham
- Saint Vincent Hospital-Worcester Medical Center, Worcester, Massachusetts (G.M.A.)
| | - Adam J Obley
- Portland Veterans Affairs Medical Center, Portland, Oregon (A.J.O.)
| | | | - Janet A Jokela
- University of Illinois College of Medicine, Urbana, Illinois (J.A.J.)
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Fadle AA, Campbell BC, Willett JF, Williams L, Conti SF, Miller MC. A simple foot pedal device in a horizontal bore imaging facility replicates weightbearing outcomes for Hallux Valgus patients. Foot Ankle Surg 2020; 26:320-324. [PMID: 31079958 DOI: 10.1016/j.fas.2019.04.011] [Citation(s) in RCA: 4] [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: 04/12/2018] [Revised: 03/08/2019] [Accepted: 04/09/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Weightbearing images are important to the diagnosis of foot pathologies as are the three dimensional views available from CT and MRI. Standard three-dimensional imaging hardware, however, does not have a simple tool to obtain weightbearing images. The current research aimed to design, build and test a simple device to apply load in a horizontal bore imaging facility. METHODS With the immediate need in hallux valgus studies, hallux valgus subjects were imaged using the new loading device, which could be easily transported and had no additional electronics. RESULTS Testing showed that the usual angular measures of the foot (intermetatarsal and hallux valgus) replicated the results from the standard of care standing plain film results. With application of load, HV angle changed from 29.9° non-weightbearing to 32.2° weightbearing, while IM angle changed from nonweightbearing 15.8° to weightbearing 16.5°. CONCLUSION The pedal-like device can provide weightbearing images in a horizontal bore MRI facility.
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Affiliation(s)
- Amr A Fadle
- Assiut University, Orthpaedic Department, Assiut, Egypt
| | - B C Campbell
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - J F Willett
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - L Williams
- Department of Radiology, Passavant Hospital, Pittsburgh PA, USA
| | - S F Conti
- Orthopedic Partners, Pittsburgh PA, USA
| | - M C Miller
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Orthopaedic Biomechanics Laboratory, Allegheny General Hospital, Pittsburgh, PA, USA.
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Cognetti DM, Villaflor VM, Fakhry C, Miller MC, Malloy KM. Survivorship support in head and neck cancer: American Head and Neck Society survey. Head Neck 2020; 42:939-944. [DOI: 10.1002/hed.26066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/24/2019] [Accepted: 12/17/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- David M. Cognetti
- Department of Otolaryngology, Sydney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania
| | - Victoria M. Villaflor
- Department of Medical Oncology, Robert H Lurie Comprehensive Cancer Center of Northwestern University Chicago Illinois
| | - Carole Fakhry
- Department of Otolaryngology, Johns Hopkins University School of Medicine Baltimore Maryland
| | - Matthew C. Miller
- Department of Otolaryngology, University of Rochester School of Medicine Rochester New York
| | - Kelly M. Malloy
- Department of Otolaryngology, University of Michigan Medical School Ann Arbor Michigan
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Miller MC, Fink PW, Macdermid PW, Allen D, Stannard SR. Braking and performance characteristics of experienced and inexperienced mountain bikers navigating an isolated off-road turn using a brake power meter. INT J PERF ANAL SPOR 2018. [DOI: 10.1080/24748668.2018.1496383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Matthew C Miller
- School of Sport & Exercise, Massey University, Palmerston North, New Zealand
| | - Philip W Fink
- School of Sport & Exercise, Massey University, Palmerston North, New Zealand
| | - Paul W Macdermid
- School of Sport & Exercise, Massey University, Palmerston North, New Zealand
| | - Daniel Allen
- School of Sport & Exercise, Massey University, Palmerston North, New Zealand
| | - Stephen R Stannard
- School of Sport & Exercise, Massey University, Palmerston North, New Zealand
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Rieth KKS, Gill SR, Lott-Limbach AA, Merkley MA, Botero N, Allen PD, Miller MC. Prevalence of High-Risk Human Papillomavirus in Tonsil Tissue in Healthy Adults and Colocalization in Biofilm of Tonsillar Crypts. JAMA Otolaryngol Head Neck Surg 2018; 144:231-237. [PMID: 29372248 PMCID: PMC5885877 DOI: 10.1001/jamaoto.2017.2916] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/05/2017] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The pathogenesis of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma is currently an important topic of elucidation. The presence of latent HPV infection in tonsil tissue of healthy adults may provide an explanation for a component of this process and contribute to the understanding of HPV-associated squamous cell carcinoma oncogenesis of the oropharynx. OBJECTIVE To determine the prevalence of oropharyngeal HPV and to determine the spatial relationship between the virus and crypt biofilm in tonsil tissue. DESIGN, SETTING, AND PARTICIPANTS A retrospective, cross-sectional study was carried out using samples obtained from tonsils that were archived at a university hospital following elective nononcologic tonsillectomy from 2012 to 2015. Samples consisted of formalin-fixed paraffin embedded samples of tumor-free tonsil tissue from 102 adults between the ages of 20 and 39 years. EXPOSURES Human papillomavirus status was assessed by polymerase chain reaction, and high-risk subtypes 16 and 18 were assessed with quantitative polymerase chain reaction assay. Samples that demonstrated presence of HPV were then analyzed by in situ hybridization to localize the viral capsid protein. These samples were then stained with concanavalin A to establish biofilm presence and morphology. These samples were also stained with diamidino-phenylindole (DAPI) to visualize location of the virus in relation to cell nuclei. These data were then assembled for aggregate analysis to colocalize HPV in the biofilm of the tonsillar crypts. MAIN OUTCOMES AND MEASURES Outcome measurements were determined prior to data collection and include prevalence of high-risk HPV types 16 and 18 in tonsil tissue of otherwise healthy adults, as well as demonstration with immunohistochemistry of HPV in tonsillar crypt biofilm. RESULTS In 102 otherwise healthy adults (55 [53.9%] female; age range, 20-39 years), the overall prevalence of HPV in tonsils was 4.9% (n = 5); and high-risk type 16 or 18, 3.9% (n = 4). In this sample population, in situ hybridization colocalized HPV virus to the biofilm of the tonsillar crypts. CONCLUSIONS AND RELEVANCE Biofilm is present in the tonsillar crypts in a considerable proportion of tonsil tissues and may be reproducibly identified. Human papillomavirus is demonstrated to colocalize to the crypt biofilm. This has important implications with respect to the determination of HPV prevalence rates in the oropharynx. It may also play a role in the pathogenesis of HPV-related oropharyngeal carcinoma.
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Affiliation(s)
- Katherine K. S. Rieth
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
| | - Steven R. Gill
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York
| | | | - Mark A. Merkley
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
| | | | - Paul D. Allen
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
| | - Matthew C. Miller
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
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Miller MC, Fink PW, Macdermid PW, Stannard SR. Quantification of brake data acquired with a brake power meter during simulated cross-country mountain bike racing. Sports Biomech 2018; 18:343-353. [PMID: 29343172 DOI: 10.1080/14763141.2017.1409257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There is currently a dearth of information describing cycling performance outside of propulsive and physiological variables. The aim of the present study was to utilise a brake power meter to quantify braking during a multi-lap cross-country mountain bike time trial and to determine how braking affects performance. A significant negative association was determined between lap time and brake power (800.8 ± 216.4 W, mean ± SD; r = -0.446; p < 0.05), while the time spent braking (28.0 ± 6.4 s) was positively associated with lap time (314.3 ± 37.9 s; r = 0.477; p < 0.05). Despite propulsive power decreasing after the first lap (p < 0.05), lap time remained unchanged (p > 0.05) which was attributed to decreased brake work (p < 0.05) and brake time (p < 0.05) in both the front and rear brakes by the final lap. A multiple regression model incorporating braking and propulsion was able to explain more of the variance in lap time (r2 = 0.935) than propulsion alone (r2 = 0.826). The present study highlights that riders' braking contributes to mountain bike performance. As riders repeat a cross-country mountain bike track, they are able to change braking, which in turn can counterbalance a reduction in power output. Further research is required to understand braking better.
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Affiliation(s)
- Matthew C Miller
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | - Philip W Fink
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | - Paul W Macdermid
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | - Stephen R Stannard
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
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Abstract
Real-world cycling performance depends not only on exercise capacities, but also on efficiently traversing the bicycle through the terrain. The aim of this study was to determine if it was possible to quantify the braking done by a cyclist in the field. One cyclist performed 408 braking trials (348 on a flat road; 60 on a flat dirt path) over 5 days on a bicycle fitted with brake torque and angular velocity sensors to measure brake power. Based on Newtonian physics, the sum of brake work, aerodynamic drag and rolling resistance was compared with the change in kinetic energy in each braking event. Strong linear relationships between the total energy removed from the bicycle-rider system through braking and the change in kinetic energy were observed on the tar-sealed road (r2 = 0.989; p < 0.0001) and the dirt path (r2 = 0.952; p < 0.0001). T-tests revealed no difference between the total energy removed and the change in kinetic energy on the road (p = 0.715) or dirt (p = 0.128). This study highlights that brake torque and angular velocity sensors are valid for calculating brake power on the disc brakes of a bicycle in field conditions. Such a device may be useful for investigating cyclists' ability to traverse through various terrains.
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Affiliation(s)
- Matthew C Miller
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | - Philip W Fink
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | | | - Blake G Perry
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | - Stephen R Stannard
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
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Macdermid PW, Miller MC, Fink PW, Stannard SR. The effectiveness of front fork systems at damping accelerations during isolated aspects specific to cross-country mountain biking. Sports Biomech 2017. [PMID: 28632064 DOI: 10.1080/14763141.2016.1246599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cross-country mountain bike suspension reportedly enhances comfort and performance through reduced vibration and impact exposure. This study analysed the effectiveness of three different front fork systems at damping accelerations during the crossing of three isolated obstacles (stairs, drop, and root). One participant completed three trials on six separate occasions in a randomised order using rigid, air-sprung, and carbon leaf-sprung forks. Performance was determined by time to cross obstacles, while triaxial accelerometers quantified impact exposure and damping response. Results identified significant main effect of fork type for performance time (p < 0.05). The air-sprung and leaf-sprung forks were significantly slower than the rigid forks for the stairs (p < 0.05), while air-sprung suspension was slower than the rigid for the root protocol (p < 0.05). There were no differences for the drop protocol (p < 0.05). Rigid forks reduced overall exposure (p < 0.05), specifically at the handlebars for the stairs and drop trials. More detailed analysis presented smaller vertical accelerations at the handlebar for air-sprung and leaf-sprung forks on the stairs (p < 0.05), and drop (p < 0.05) but not the root. As such, it appears that the suspension systems tested were ineffective at reducing overall impact exposure at the handlebar during isolated aspects of cross-country terrain features which may be influenced to a larger extent by rider technique.
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Affiliation(s)
- Paul W Macdermid
- a School of Sport & Exercise, College of Health , Massey University , Palmerston North , New Zealand
| | - Matthew C Miller
- a School of Sport & Exercise, College of Health , Massey University , Palmerston North , New Zealand
| | - Philip W Fink
- a School of Sport & Exercise, College of Health , Massey University , Palmerston North , New Zealand
| | - Stephen R Stannard
- a School of Sport & Exercise, College of Health , Massey University , Palmerston North , New Zealand
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Campbell B, Schimoler P, Belagaje S, Miller MC, Conti SF. Weight-bearing recommendations after first metatarsophalangeal joint arthrodesis fixation: a biomechanical comparison. J Orthop Surg Res 2017; 12:23. [PMID: 28166805 PMCID: PMC5294903 DOI: 10.1186/s13018-017-0525-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/10/2016] [Accepted: 01/23/2017] [Indexed: 11/25/2022] Open
Abstract
Background This study sought to determine whether several metatarsophalangeal (MTP) fusion techniques require complete immobilization or if some level of weight-bearing could be recommended after surgery. A comparison of synthetic composite to actual bone was included in order to examine the validity of the testing conditions. Methods Four MTP fusion modalities were tested in synthetic composite bone models: unlocked plating, locked plating, crossed lag screws, and an unlocked plate with a single lag screw. Stiffness was calculated and then used to find the two most rigid constructs; the load to failure was recorded. Stiffness and load to failure testing for the two more rigid constructs in paired cadaveric bones were followed. Results The unlocked plate plus screw and crossed screw constructs were stiffest (p < 0.008). Loads to failure of the unlocked plate plus screw and crossed screws in synthetic bone were 131 and 101 N, respectively and in cadaveric bone were 154 and 94 N, respectively, which are less than the estimated 25% body weight required at the MTP joint. The plate plus screws were statistically more stiff than crossed screws (p = 0.008), but there was no statistical difference between synthetic and cadaveric bone in load to failure (p = 0.296). Conclusions The plate plus screw offered the greatest stiffness; the failure test showed that no construct could withstand weight-bearing as tolerated; and, synthetic composite models of the MTP joint did not provide the consistent results in stiffness and failure.
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Affiliation(s)
- Bradley Campbell
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA.
| | - Patrick Schimoler
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA
| | - Sudhir Belagaje
- Department of Orthopaedic Surgery, Orthopaedic Biomechanics Laboratory, Allegheny General Hospital, 320 E. North Ave, Pittsburgh, PA, 15212, USA
| | - M C Miller
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA.,Department of Orthopaedic Surgery, Orthopaedic Biomechanics Laboratory, Allegheny General Hospital, 320 E. North Ave, Pittsburgh, PA, 15212, USA.,Department of Bioengineering, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA
| | - S F Conti
- Orthopaedic Practices, Pittsburgh, PA, 15261, USA
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Miller MC, Goldenberg D. AHNS Series: Do you know your guidelines? Principles of surgery for head and neck cancer: A review of the National Comprehensive Cancer Network guidelines. Head Neck 2016; 39:791-796. [PMID: 27987243 DOI: 10.1002/hed.24654] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 02/05/2023] Open
Abstract
This article continues a series developed by the American Head and Neck Society's Education Committee entitled "Do you know your guidelines?" It is hoped that these features will increase awareness of and adherence to current best practices in head and neck cancer care. In this installment, the National Comprehensive Cancer Network (NCCN) guidelines for surgical therapy are reviewed. © 2016 Wiley Periodicals, Inc. Head Neck 39: 791-796, 2017.
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Affiliation(s)
- Matthew C Miller
- Department of Otolaryngology - Head and Neck Surgery, Strong Memorial Hospital, Rochester, New York
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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Miller MC, Macdermid PW, Fink PW, Stannard SR. Performance and physiological effects of different descending strategies for cross-country mountain biking. Eur J Sport Sci 2016; 17:279-285. [PMID: 27712198 DOI: 10.1080/17461391.2016.1237550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study investigated the performance-related feasibility and physiological benefits of purposefully eliminating propulsive work while descending in mountain biking and compared values to those measured during road descending. Participants cycled uphill on a road at race pace before descending over three conditions (off-road pedalling; off-road coasting; road coasting). Relatively low power output during off-road pedalling was associated with a greater oxygen uptake (p < .01) when compared with off-road coasting despite no difference in vibration exposure (p > .05). Importantly, pedalling did not invoke a performance benefit (p > .05) on the descent used in this study. Significantly greater heart rate and oxygen uptake (both p < .01) were observed between road and off-road descending, likely caused by the increase in terrain-induced vibrations (p < .01) experienced between the bicycle and rider. Results indicate that reducing propulsive work during descending can improve recovery without being disadvantageous to performance. Similarly, the vibrations experienced during road descending are relatively low, and further reduce oxygen cost. In an effort to increase efficiency, it is recommended that mountain bike athletes focus on skills to increase descending speed without the addition of pedalling, and that equipment be used to decrease vibrations nearer to those seen on the road.
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Affiliation(s)
- Matthew C Miller
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | - Paul W Macdermid
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | - Phil W Fink
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | - Stephen R Stannard
- a School of Sport & Exercise , Massey University , Palmerston North , New Zealand
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Affiliation(s)
- Matthew C. Miller
- Department of Otolaryngology–Head and Neck Surgery, James P. Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Andrew G. Shuman
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
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Abstract
PURPOSE Geography is known to affect cost of care in surgical procedures. Understanding the relationship between geography and hospital costs is pertinent in the effort to reduce healthcare costs. We studied the geographic variation in cost for transsphenoidal pituitary surgery in hospitals across New York State. METHODS Using the Healthcare Cost and Utilization Project State Inpatient Database for New York from 2008 to 2011, we analyzed records of patients who underwent elective transsphenoidal pituitary tumor surgery and were discharged to home or self-care. N.Y. State was divided into five geographic regions: Buffalo, Rochester, Syracuse, Albany, and Downstate. These five regions were compared according to median charge and cost per day. RESULTS From 2008 to 2011, 1803 transsphenoidal pituitary tumor surgeries were performed in New York State. Mean patient age was 50.7 years (54 % were female). Adjusting prices for length of stay, there was substantial variation in prices. Median charges per day ranged from $8485 to $13,321 and median costs per day ranged from $2962 to $6837 between the highest and lowest regions from 2008 to 2011. CONCLUSION Within New York State, significant geographic variation exists in the cost for transsphenoidal pituitary surgery. The significance of and contributors to such variation is an important question for patients, providers, and policy makers. Transparency of hospital charges, costs, and average length of stay for procedures to the public provides useful information for informed decision-making, especially for a highly portable disease entity like pituitary tumors.
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Affiliation(s)
- Charles C Lee
- Department of Neurosurgery, School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 670, Rochester, NY, 14642, USA.
- UR Medicine Pituitary Program, University of Rochester Medical Center, 601 Elmwood Ave, Box 670, Rochester, NY, 14642, USA.
| | - Kristopher T Kimmell
- Department of Neurosurgery, School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 670, Rochester, NY, 14642, USA
| | - Amy Lalonde
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, 601 Elmwood Ave, Box 630, Rochester, NY, 14642, USA
| | - Peter Salzman
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, 601 Elmwood Ave, Box 630, Rochester, NY, 14642, USA
| | - Matthew C Miller
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Ave, Box 629, Rochester, NY, 14642, USA
| | - Laura M Calvi
- Division of Endocrine, Diabetes, and Metabolism, University of Rochester Medical Center, 601 Elmwood Ave, Box 693, Rochester, NY, 14642, USA
- UR Medicine Pituitary Program, University of Rochester Medical Center, 601 Elmwood Ave, Box 670, Rochester, NY, 14642, USA
| | - Ekaterina Manuylova
- Division of Endocrine, Diabetes, and Metabolism, University of Rochester Medical Center, 601 Elmwood Ave, Box 693, Rochester, NY, 14642, USA
- UR Medicine Pituitary Program, University of Rochester Medical Center, 601 Elmwood Ave, Box 670, Rochester, NY, 14642, USA
| | - Ismat Shafiq
- Division of Endocrine, Diabetes, and Metabolism, University of Rochester Medical Center, 601 Elmwood Ave, Box 693, Rochester, NY, 14642, USA
- UR Medicine Pituitary Program, University of Rochester Medical Center, 601 Elmwood Ave, Box 670, Rochester, NY, 14642, USA
| | - G Edward Vates
- Department of Neurosurgery, School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 670, Rochester, NY, 14642, USA
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Ave, Box 629, Rochester, NY, 14642, USA
- Division of Endocrine, Diabetes, and Metabolism, University of Rochester Medical Center, 601 Elmwood Ave, Box 693, Rochester, NY, 14642, USA
- UR Medicine Pituitary Program, University of Rochester Medical Center, 601 Elmwood Ave, Box 670, Rochester, NY, 14642, USA
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Mithoowani S, Gregory-Miller K, Goy J, Miller MC, Wang G, Noroozi N, Kelton JG, Arnold DM. High-dose dexamethasone compared with prednisone for previously untreated primary immune thrombocytopenia: a systematic review and meta-analysis. Lancet Haematol 2016; 3:e489-e496. [PMID: 27658982 DOI: 10.1016/s2352-3026(16)30109-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/31/2016] [Accepted: 08/02/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Whether high-dose dexamethasone has long-term efficacy and safety in previously untreated patients with immune thrombocytopenia is unclear. We did a systematic review and a meta-analysis of randomised trials to establish the effect of high-dose dexamethasone compared with prednisone for long-term platelet count response. METHODS We searched MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Library Database for papers published from 1970 to July, 2016, and abstracts from American Society of Hematology annual meetings published from 2004 to 2015 for randomised trials comparing different corticosteroid regimens for patients with previously untreated immune thrombocytopenia who achieved a platelet count response. Trials that compared corticosteroids exclusively with other interventions were excluded. The primary endpoint was overall (platelets >30 × 109/L) and complete (platelets >100 × 109/L) platelet count response at 6 months with high-dose dexamethasone compared with standard-dose prednisone. Children and adults were analysed separately. Estimates of effect were pooled with a random-effects model. FINDINGS Nine randomised trials (n=1138) were included. Of those, five (n=533) compared one to three cycles of dexamethasone (40 mg per day for 4 days) with prednisone (1 mg per kg) for 14-28 days followed by dose tapering in adults. We found no difference in overall platelet count response at 6 months (pooled proportions 54% vs 43%, relative risk [RR] 1·16, 95% CI 0·79-1·71; p=0·44). At 14 days, overall platelet count response was higher with dexamethasone (79% vs 59%, RR 1·22, 95% CI 1·00-1·49; p=0·048). The dexamethasone group had fewer reported toxicities. Long-term response rates were similar when the data were analysed by cumulative corticosteroid dose over the course of treatment. No difference in initial platelet count response was observed with different high-dose corticosteroid regimens in children. INTERPRETATION In adults with previously untreated immune thrombocytopenia, high-dose dexamethasone did not improve durable platelet count responses compared with standard-dose prednisone. High-dose dexamethasone might be preferred over prednisone for patients with severe immune thrombocytopenia who require a rapid rise in platelet count. FUNDING Canadian Institutes of Health Research, and Canadian Blood Services, and Health Canada.
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Affiliation(s)
- Siraj Mithoowani
- Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kathleen Gregory-Miller
- Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jennifer Goy
- Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthew C Miller
- Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Grace Wang
- Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nastaran Noroozi
- Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - John G Kelton
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada; Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Donald M Arnold
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada; Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Canadian Blood Services, Hamilton, ON, Canada.
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Joerger M, von Pawel J, Kraff S, Fischer JR, Eberhardt W, Gauler TC, Mueller L, Reinmuth N, Reck M, Kimmich M, Mayer F, Kopp HG, Behringer DM, Ko YD, Hilger RA, Roessler M, Kloft C, Henrich A, Moritz B, Miller MC, Salamone SJ, Jaehde U. Open-label, randomized study of individualized, pharmacokinetically (PK)-guided dosing of paclitaxel combined with carboplatin or cisplatin in patients with advanced non-small-cell lung cancer (NSCLC). Ann Oncol 2016; 27:1895-902. [PMID: 27502710 DOI: 10.1093/annonc/mdw290] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/14/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Variable chemotherapy exposure may cause toxicity or lack of efficacy. This study was initiated to validate pharmacokinetically (PK)-guided paclitaxel dosing in patients with advanced non-small-cell lung cancer (NSCLC) to avoid supra- or subtherapeutic exposure. PATIENTS AND METHODS Patients with newly diagnosed, advanced NSCLC were randomly assigned to receive up to 6 cycles of 3-weekly carboplatin AUC 6 or cisplatin 80 mg/m(2) either with standard paclitaxel at 200 mg/m(2) (arm A) or PK-guided dosing of paclitaxel (arm B). In arm B, initial paclitaxel dose was adjusted to body surface area, age, sex, and subsequent doses were guided by neutropenia and previous-cycle paclitaxel exposure [time above a plasma concentration of 0.05 µM (Tc>0.05)] determined from a single blood sample on day 2. The primary end point was grade 4 neutropenia; secondary end points included neuropathy, radiological response, progression-free survival (PFS) and overall survival (OS). RESULTS Among 365 patients randomly assigned, grade 4 neutropenia was similar in both arms (19% versus 16%; P = 0.10). Neuropathy grade ≥2 (38% versus 23%, P < 0.001) and grade ≥3 (9% versus 2%, P < 0.001) was significantly lower in arm B, independent of the platinum drug used. The median final paclitaxel dose was significantly lower in arm B (199 versus 150 mg/m(2), P < 0.001). Response rate was similar in arms A and B (31% versus 27%, P = 0.405), as was adjusted median PFS [5.5 versus 4.9 months, hazard ratio (HR) 1.16, 95% confidence interval (CI) 0.91-1.49, P = 0.228] and OS (10.1 versus 9.5 months, HR 1.05, 95% CI 0.81-1.37, P = 0.682). CONCLUSION PK-guided dosing of paclitaxel does not improve severe neutropenia, but reduces paclitaxel-associated neuropathy and thereby improves the benefit-risk profile in patients with advanced NSCLC. CLINICAL TRIAL INFORMATION NCT01326767 (https://clinicaltrials.gov/ct2/show/NCT01326767).
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Affiliation(s)
- M Joerger
- Department of Medical Oncology, Cantonal Hospital, St Gallen, Switzerland
| | - J von Pawel
- Pneumology Clinic, Asklepios Fachkliniken, Gauting
| | - S Kraff
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn
| | - J R Fischer
- Department of Medical Oncology, Klinik Löwenstein, Löwenstein
| | - W Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen
| | - T C Gauler
- Department of Medical Oncology (Cancer Research), West German Cancer Center, University Hospital Essen of University Duisburg-Essen, Essen
| | - L Mueller
- Oncological Practice, Praxis Leer, Leer
| | - N Reinmuth
- Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf
| | - M Reck
- Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf
| | - M Kimmich
- Pulmonology and Oncology, Klinik Schillerhöhe, Gerlingen
| | - F Mayer
- Department of Oncology and Hematology, University Hospital, Medical Center II, Tübingen
| | - H-G Kopp
- Department of Oncology and Hematology, Eberhard Karls University Medical Center, Tübingen
| | | | - Y-D Ko
- Medical Oncology, Johanniter-Krankenhaus Bonn, Bonn
| | - R A Hilger
- Cancer Research, University Hospital Essen, Essen, Germany
| | - M Roessler
- CESAR Central Office (CCO), Vienna CESAR Central European Society for Anticancer Drug Research-EWIV, Vienna, Austria
| | - C Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Free University Berlin, Berlin, Germany
| | - A Henrich
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Free University Berlin, Berlin, Germany
| | - B Moritz
- CESAR Central Office (CCO), Vienna CESAR Central European Society for Anticancer Drug Research-EWIV, Vienna, Austria
| | - M C Miller
- Saladax Biomedical, Inc., Bethlehem, USA
| | | | - U Jaehde
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn
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Macdermid PW, Fink PW, Miller MC, Stannard S. The impact of uphill cycling and bicycle suspension on downhill performance during cross-country mountain biking. J Sports Sci 2016; 35:1355-1363. [PMID: 27484102 DOI: 10.1080/02640414.2016.1215493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Non-propulsive work demand has been linked to reduced energetic economy of cross-country mountain biking. The purpose of this study was to determine mechanical, physiological and performance differences and observe economy while riding a downhill section of a cross-country course prior to and following the metabolic "load" of a climb at race pace under two conditions (hardtail and full suspension) expected to alter vibration damping mechanics. Participants completed 1 lap of the track incorporating the same downhill section twice, under two conditions (hardtail and full suspension). Performance was determined by time to complete overall lap and specific terrain sections. Power, cadence, heart rate and oxygen consumption were sampled and logged every second while triaxial accelerometers recorded accelerations (128 Hz) to quantify vibration. No differences between performance times (P = 0.65) or power outputs (P = 0.61) were observed while physiological demand of loaded downhill riding was significantly greater (P < 0.0001) than unloaded. Full suspension decreased total vibrations experienced (P < 0.01) but had no effect on performance (P = 0.97) or physiological (P > 0.05) measures. This study showed minimal advantage of a full suspension bike in our trial, with further investigations over a full race distance warranted.
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Affiliation(s)
- Paul W Macdermid
- a College of Health, School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | - Philip W Fink
- a College of Health, School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | - Matthew C Miller
- a College of Health, School of Sport & Exercise , Massey University , Palmerston North , New Zealand
| | - Stephen Stannard
- a College of Health, School of Sport & Exercise , Massey University , Palmerston North , New Zealand
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Vates E, Lalonde A, Lee C, Kimmell KT, Calvi L, Love T, Miller MC. 151 Race and Insurance Status Are Associated With Higher Charges in Patients Having Pituitary Tumor Surgery in New York State. Neurosurgery 2016. [DOI: 10.1227/01.neu.0000489720.59949.f2] [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: 11/19/2022] Open
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Gross ND, Holsinger FC, Magnuson JS, Duvvuri U, Genden EM, Ghanem TA, Yaremchuk KL, Goldenberg D, Miller MC, Moore EJ, Morris LG, Netterville J, Weinstein GS, Richmon J. Robotics in otolaryngology and head and neck surgery: Recommendations for training and credentialing: A report of the 2015 AHNS education committee, AAO-HNS robotic task force and AAO-HNS sleep disorders committee. Head Neck 2016; 38 Suppl 1:E151-8. [PMID: 26950771 DOI: 10.1002/hed.24207] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/09/2015] [Indexed: 01/08/2023] Open
Abstract
Training and credentialing for robotic surgery in otolaryngology - head and neck surgery is currently not standardized, but rather relies heavily on industry guidance. This manuscript represents a comprehensive review of this increasingly important topic and outlines clear recommendations to better standardize the practice. The recommendations provided can be used as a reference by individuals and institutions alike, and are expected to evolve over time. © 2016 Wiley Periodicals, Inc. Head Neck 38: E151-E158.
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Affiliation(s)
- Neil D Gross
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, California
| | - J Scott Magnuson
- Department of Otolaryngology - Head and Neck Surgery, Division of Surgery, Florida Hospital Group, Celebration, Florida
| | - Umamaheswar Duvvuri
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Veterans Administration Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Eric M Genden
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Tamer Ah Ghanem
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Kathleen L Yaremchuk
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan
| | - David Goldenberg
- Division of Otolaryngology - Head and Neck Surgery, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Matthew C Miller
- Department of Otolaryngology - Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Luc Gt Morris
- Department of Head and Neck Surgery, Division of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - James Netterville
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Ingram Cancer Center, Nashville, Tennessee
| | - Gregory S Weinstein
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy Richmon
- Department of Otolaryngology - Head and Neck Surgery, Division of Surgery, Johns Hopkins University, Baltimore, Maryland
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Miller MC, Goldenberg D. Do you know your guidelines? An initiative of the American Head and Neck Society's Education Committee. Head Neck 2016; 38:165-7. [DOI: 10.1002/hed.24104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Matthew C. Miller
- The Education Committee of American Head and Neck Society (AHNS); University of Rochester Medical Center; Rochester New York
| | - David Goldenberg
- The Education Committee of American Head and Neck Society (AHNS), Department of Surgery, Division of Otolaryngology; The Pennsylvania State University, College of Medicine; Hershey Pennsylvania
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Bice TC, Tran V, Merkley MA, Newlands SD, van der Sloot PG, Wu S, Miller MC. Disease-Specific Survival with Spindle Cell Carcinoma of the Head and Neck. Otolaryngol Head Neck Surg 2015. [DOI: 10.1177/0194599815594360] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives (1) Determine factors influencing survival in patients diagnosed with spindle cell carcinoma (SpCC), a rare variant of head and neck squamous cell carcinoma (SCC). (2) Compare survival of patients with SpCC to those with conventional SCC. Study Design Retrospective cohort study. Setting Surveillance, Epidemiology, and End Results 18 database (years 2004-2009). Subjects and Methods Among patients receiving treatment for a single primary in the oral cavity, oropharynx, hypopharynx, or larynx, 118 subjects with SpCC and 18,298 subjects with SCC were identified with complete data for the variables of age, sex, grade, tumor size, stage group, and TNM stage. Disease-specific survival curves were compared. Univariate and multivariate analyses were used to examine the effects of each factor on survival over all sites and within each of 3 sites. Results Univariate analysis of the combination of the 3 anatomic subsites showed survival with SpCC was worse than with conventional SCC ( P < .001). Three-year disease-specific survival with SpCC was 49.5%, and 5-year disease-specific survival was 40.2%. Compared with conventional SCC, survival was worse for SpCC of the oral cavity ( P < .001) and oropharynx ( P < .001) but no different for the larynx and hypopharynx site ( P = .15). Multivariate analysis identified age ( P = .02), tumor size ( P = .006), and M stage ( P < .001) as the only variables significantly affecting survival with SpCC. All variables significantly affected survival with conventional SCC. Conclusions Spindle cell carcinoma carries a worse prognosis than SCC. Larger tumor size, older age, and metastatic disease portend worse survival with SpCC of the head and neck.
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Affiliation(s)
- Tristan C. Bice
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Van Tran
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Mark A. Merkley
- Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Shawn D. Newlands
- Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul G. van der Sloot
- Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Shuang Wu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Matthew C. Miller
- Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
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Bice TC, Merkley MA, van der Sloot PG, Newlands SD, Miller MC. Survival with Spindle Cell Carcinoma Compared to Conventional Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: (1) Compare survival of patients with spindle cell carcinoma variant (SpCC) to survival of patients with conventional squamous cell carcinoma (SCC). (2) Describe the impact of patient demographics and tumor characteristics on survival with SpCC. Methods: A retrospective cohort study was conducted with 18,416 cases entered into the Surveillance, Epidemiology, and End Results Program database between 2004 and 2009. Variables including age, sex, race, tumor grade, size, stage group, TNM stage, and treatment modality of 18,298 SCC patients and 118 SpCC patients were extracted and combined into oral cavity, oropharynx, and larynx sites. Characteristics and survival of SpCC and SCC patients were compared in total and at each site. The effect of variables on survival with SpCC was assessed. Results: In total, SpCC patients experienced worse survival than conventional SCC patients ( P < .05). Overall, SpCC patient mortality was worse than SCC patients within the first 3 years ( P < .05) but was not different at 5 or 10 years. Of the 3 sites, survival was only significantly worse for SpCC patients within the oropharynx site ( P < .05). Survival of SpCC patients was worse with higher stage group and TNM stage (both P < .05), but did not differ by sex, race, or tumor grade. Conclusions: SpCC carries a worse prognosis than conventional SCC when located in the oropharynx. Survival with SpCC was associated with stage group and TNM stage, but was unaffected by sex, race, or grade.
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Sauers EJ, Miller MC, Sina B, Muth BJ, Snyder BW, Davis SE. Effects Of Full-fat And Fat-free Chocolate Milk On Recovery Following Endurance Running. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000495383.35647.1e] [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: 11/21/2022]
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Miller MC, Witmer CA, Moir GL, Davis SE. The Predictive Validity of Critical Power and Functional Threshold Power for Mountain Bike Race Performance. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000496310.18611.5f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
This article is an introduction to the concepts of complementary, alternative, and integrative medicine. It discusses the scope and prevalence of complementary and integrative medicine (CIM) use among otolaryngology patients. Specific types of CIM are characterized in the context of their origins, philosophic and historical bases, scientific evidence, and applicability to the practice of otolaryngology. The author's intent is to provide a framework for discussing CIM with patients and integrating it into treatment paradigms in an evidence-based manner.
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Affiliation(s)
- Matthew C Miller
- Department of Otolaryngology-Head and Neck Surgery, Rochester, NY 14642, USA.
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Aggarwal C, Meropol NJ, Punt CJ, Iannotti N, Saidman BH, Sabbath KD, Gabrail NY, Picus J, Morse MA, Mitchell E, Miller MC, Cohen SJ. Relationship among circulating tumor cells, CEA and overall survival in patients with metastatic colorectal cancer. Ann Oncol 2013; 24:420-428. [PMID: 23028040 DOI: 10.1093/annonc/mds336] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We previously reported results of a prospective trial evaluating the significance of circulating tumor cells (CTCs) in patients with metastatic colorectal cancer (mCRC). This secondary analysis assessed the relationship of the CTC number with carcinoembryonic antigen (CEA) and overall survival. PATIENTS AND METHODS Patients with mCRC had CTCs measured at baseline and specific time points after the initiation of new therapy. Patients with a baseline CEA value ≥ 10 ng/ml and CEA measurements within ± 30 days of the CTC collection were included. RESULTS We included 217 patients with mCRC who had a CEA value of ≥ 10 ng/ml. Increased baseline CEA was associated with shorter survival (15.8 versus 20.7 months, P = 0.012). Among all patients with a baseline CEA value of ≥ 25 ng/ml, patients with low baseline CTCs (<3, n = 99) had longer survival than those with high CTCs (≥ 3, n = 58; 20.8 versus 11.7 months, P = 0.001). CTCs added prognostic information at the 3-5- and 6-12-week time points regardless of CEA. In a multivariate analysis, CTCs at baseline but not CEA independently predicted survival and both CTCs and CEA independently predicted survival at 6-12 weeks. CONCLUSIONS This study demonstrates that both CEA and CTCs contribute prognostic information for patients with mCRC.
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Affiliation(s)
- C Aggarwal
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia.
| | - N J Meropol
- Department of Medicine, Division of Hematology-Oncology, Case Western Reserve University, Cleveland, USA
| | - C J Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - N Iannotti
- Hematology Oncology Associates, Port Saint Lucie
| | | | - K D Sabbath
- Medical Oncology and Hematology, PC, New Haven
| | | | - J Picus
- Department of Medical Oncology, Washington University, St Louis
| | - M A Morse
- Department of Medical Oncology, Duke University Medical Center, Durham
| | - E Mitchell
- Department of Medicine, Division of Hematology-Oncology, Thomas Jefferson University, Philadelphia
| | | | - S J Cohen
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, USA
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Miller MC, Hanson JD, Hartwell GJ, Knowlton SF, Maurer DA, Stevenson BA. Design and implementation of a multichannel millimeter wave interferometer for the Compact Toroidal Hybrid experiment. Rev Sci Instrum 2012; 83:10E332. [PMID: 23126990 DOI: 10.1063/1.4732056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A three-channel 1 mm wave interferometer has been designed, assembled, and installed on the Compact Toroidal Hybrid torsatron (CTH). The interferometer design makes novel use of a subharmonic mixer for detection, which simplifies alignment. It employs a single electronically tunable source that is repetitively chirped using a sawtooth waveform of frequency up to 1 MHz. The 15.25 GHz drive oscillator is multiplied in two stages to 122 GHz before a final doubler stage brings it to 244 GHz. Local oscillator (LO) power at 122 GHz is directed through waveguide to the LO input of the subharmonic mixer of each viewing chord, simplifying alignment. Phase detection is performed by directly digitizing the amplified mixer outputs at 50 MHz and processing them with a software algorithm. Initial measurements made with the central chord of the new interferometer agree with those from the existing 4 mm system at low densities. The 1 mm system performs well in current-driven discharges reaching densities over 10(19) m(-3), whereas the lower frequency interferometer is found to be less reliable due to loss of fringes. This is a critical improvement for experiments studying the onset, avoidance, and vacuum magnetic transform dependence of disruptions in the CTH device.
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Affiliation(s)
- M C Miller
- Physics Department, Auburn University, Auburn, Alabama 36849, USA.
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Moravan MJ, Petraglia AL, Almast J, Yeaney GA, Miller MC, Edward Vates G. Intraosseous hemangioma of the clivus: a case report and review of the literature. J Neurosurg Sci 2012; 56:255-259. [PMID: 22854594] [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: 06/01/2023]
Abstract
Intraosseous hemangiomas are benign vascular tumors that are encountered most commonly in vertebrae and rarely in the skull. When presenting in the skull, they are commonly found in the calvarium in frontal and parietal bones and seldom in the skull base. We encountered a patient with an incidental finding on magnetic resonance imaging (MRI) of an enhancing lesion in the clivus. Here we report an unusual location of a clival intraosseous hemangioma. A 62 year old man worked up for carpal tunnel syndrome had imaging of his cervical spine that revealed an enhancing clival lesion, which extended into the left occipital condyle. Endoscopic endonasal biopsy was performed on the abnormality revealing a capillary hemangioma. Patient tolerated the biopsy well and no further surgical intervention is indicated at this time. Patient will be followed at six month intervals. Primary intraosseus hemangiomas of the skull are extremely rare and usually occur in the calvarium. This is one of the few reported case of an intraosseus hemangioma in the clivus. We present this case in part because it is unusual, but more importantly, with the wider use of MRI, it is likely that these lesions will be discovered more frequently, and conceivably confused for more dangerous lesions.
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Affiliation(s)
- M J Moravan
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
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