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Smith O, MacLeod T, Lim P, Chitsabesan P, Chintapatla S. A structured pathway for developing your complex abdominal hernia service: our York pathway. Hernia 2021; 25:267-275. [PMID: 33599900 PMCID: PMC7890783 DOI: 10.1007/s10029-020-02354-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors' knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented. METHODS A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time. RESULTS We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit. CONCLUSION A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.
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Guillet H, Gallet R, Pham V, D'Humières T, Huguet R, Lim P, Michel M, Khellaf M. Clinical spectrum of ischaemic arterial diseases associated with COVID-19: a series of four illustrative cases. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 5:ytaa488. [PMID: 33542975 PMCID: PMC7799310 DOI: 10.1093/ehjcr/ytaa488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/15/2020] [Accepted: 11/07/2020] [Indexed: 12/13/2022]
Abstract
Background Severe coronavirus-induced disease 2019 (COVID-19) leads to acute respiratory distress syndrome with an increased risk of venous thrombo-embolic events. To a much lesser extent, arterial thrombo-embolic events have also been reported in this setting. Case summary Here, we describe four different cases of COVID-19 infection with ischaemic arterial events, such as a myocardial infarction with high thrombus load, ischaemic stroke on spontaneous thrombosis of the aortic valve, floating thrombus with mesenteric, splenic and renal infarction, and acute limb ischaemia. Discussion Cardiovascular risk factors such as hypertension, obesity, and diabetes are comorbidities most frequently found in patients with a severe COVID-19 infection and are associated with a higher death rate. Our goal is to provide an overview of the clinical spectrum of ischaemic arterial events that may either reveal or complicate COVID-19. Several suspected pathophysiological mechanisms could explain the association between cardiovascular events and COVID-19 (role of systemic inflammatory response syndrome, endothelial dysfunction, activation of coagulation cascade leading to a hypercoagulability state, virus-induced secondary antiphospholipid syndrome). We need additional studies of larger size, to estimate the incidence of these arterial events and to assess the efficacy of anticoagulation therapy.
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Sifaoui I, Oliver L, Tacher V, Fiore A, Lepeule R, Moussafeur A, Huguet R, Teiger E, Audureau E, Derbel H, Luciani A, Kobeiter H, Lim P, Ternacle J, Deux JF. Diagnostic Performance of Transesophageal Echocardiography and Cardiac Computed Tomography in Infective Endocarditis. J Am Soc Echocardiogr 2020; 33:1442-1453. [PMID: 32981789 DOI: 10.1016/j.echo.2020.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
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Fard D, Huguet R, Koutsoukis A, Deguillard C, Tuffreau AS, Deux JF, Lim P, Teiger E. [SARS-COV-2 myocarditis. An update]. Ann Cardiol Angeiol (Paris) 2020; 69:349-354. [PMID: 33069383 PMCID: PMC7543970 DOI: 10.1016/j.ancard.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/04/2020] [Indexed: 01/08/2023]
Abstract
The outbreak of the SARS-CoV-2 virus responsible for the COVID-19 disease has given rise to a new disease whose boundaries are still to be discovered. While the first data suggested a purely respiratory infection, the most recent publications highlight a large pleomorphism of the disease, responsible for multiple organ damage, of which cardiac injury seems to be the most represented. This cardiac injury can present as acute myocarditis. Our aim was to discuss the pathophysiological rationale underlying the existence of SARS-CoV-2 myocarditis and to analyze the literature data regarding the diagnosis and treatment of this particular entity.
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Hamon D, Courty B, Leenhardt A, Lim P, Elbaz N, Rouffiac S, Varlet E, Algalarrondo V, Messali A, Audureau E, Extramiana F, Lellouche N. Predictive value of premature atrial complex characteristics in pulmonary vein isolation for patients with paroxysmal atrial fibrillation. Arch Cardiovasc Dis 2020; 114:122-131. [PMID: 33153949 DOI: 10.1016/j.acvd.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/23/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Premature atrial complexes from pulmonary veins are the main triggers for atrial fibrillation in the early stages. Thus, pulmonary vein isolation is the cornerstone of catheter ablation for paroxysmal atrial fibrillation. However, the success rate remains perfectible. AIM To assess whether premature atrial complex characteristics before catheter ablation can predict pulmonary vein isolation success in paroxysmal atrial fibrillation. METHODS We investigated consecutive patients who underwent catheter ablation for paroxysmal atrial fibrillation from January 2013 to April 2017 in two French centres. Patients were included if they were treated with pulmonary vein isolation alone, and had 24-hour Holter electrocardiogram data before catheter ablation available and a follow-up of≥6 months. Catheter ablation success was defined as freedom from any sustained atrial arrhythmia recurrence after a 3-month blanking period following catheter ablation. RESULTS One hundred and three patients were included; all had an acute successful pulmonary vein isolation procedure, and 34 (33%) had atrial arrhythmia recurrences during a mean follow-up of 30±15 months (group 1). Patients in group 1 presented a longer history of atrial fibrillation (71.9±65.8 vs. 42.9±48.4 months; P=0.008) compared with those who were "free from arrhythmia" (group 2). Importantly, the daily number of premature atrial complexes before catheter ablation was significantly lower in group 1 (498±1413 vs. 1493±3366 in group 2; P=0.028). A daily premature atrial complex cut-off number of<670 predicted recurrences after pulmonary vein isolation (41.1% vs. 13.3%; sensitivity 88.2%; specificity 37.7%; area under the curve 0.635; P=0.017), and was the only independent predictive criterion in the multivariable analysis (4-fold increased risk). CONCLUSION Preprocedural premature atrial complex analysis on 24-hour Holter electrocardiogram in paroxysmal atrial fibrillation may improve patient selection for pulmonary vein isolation.
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Bouabdallaoui N, Tardif JC, Waters DD, Pinto FJ, Maggioni AP, Diaz R, Berry C, Koenig W, Lopez-Sendon J, Gamra H, Kiwan GS, Blondeau L, Orfanos A, Ibrahim R, Grégoire JC, Dubé MP, Samuel M, Morel O, Lim P, Bertrand OF, Kouz S, Guertin MC, L’Allier PL, Roubille F. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J 2020; 41:4092-4099. [PMID: 32860034 PMCID: PMC7700755 DOI: 10.1093/eurheartj/ehaa659] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS The COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated the benefits of targeting inflammation after myocardial infarction (MI). We aimed to determine whether time-to-treatment initiation (TTI) influences the beneficial impact of colchicine. METHODS AND RESULTS In COLCOT, patients were randomly assigned to receive colchicine or placebo within 30 days post-MI. Time-to-treatment initiation was defined as the length of time between the index MI and the initiation of study medication. The primary efficacy endpoint was a composite of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization. The relationship between endpoints and various TTI (<3, 4-7 and >8 days) was examined using multivariable Cox regression models. Amongst the 4661 patients included in this analysis, there were 1193, 720, and 2748 patients, respectively, in the three TTI strata. After a median follow-up of 22.7 months, there was a significant reduction in the incidence of the primary endpoint for patients in whom colchicine was initiated < Day 3 compared with placebo [hazard ratios (HR) = 0.52, 95% confidence intervals (CI) 0.32-0.84], in contrast to patients in whom colchicine was initiated between Days 4 and 7 (HR = 0.96, 95% CI 0.53-1.75) or > Day 8 (HR = 0.82, 95% CI 0.61-1.11). The beneficial effects of early initiation of colchicine were also demonstrated for urgent hospitalization for angina requiring revascularization (HR = 0.35), all coronary revascularization (HR = 0.63), and the composite of cardiovascular death, resuscitated cardiac arrest, MI, or stroke (HR = 0.55, all P < 0.05). CONCLUSION Patients benefit from early, in-hospital initiation of colchicine after MI. TRIAL REGISTRATION COLCOT ClinicalTrials.gov number, NCT02551094.
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Dillinger J, Achkouty G, Albert F, Labeque J, Morelle J, Cottin Y, Lim P, Schiele F, Ferrieres J, Henry P, Puymirat E, Simon T, Danchin N. Correlates and prognostic impact of acute heart failure at the acute stage of ST-elevation and non-ST-elevation myocardial infarction according to diabetic status: the FAST-MI registries. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Diabetes mellitus (DM) predisposes to cardiovascular diseases including acute myocardial infarction (AMI) and acute heart failure (AHF).
Purpose
Analysing the French Registries of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 and 2010, we assessed correlates of AHF occurring at the acute stage of ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI), as well as the prognostic impact of AHF on 5-year mortality according to diabetic status.
Methods
The FAST-MI 2005 and 2010 registries included 7,839 consecutive patients admitted for AMI (4,250 STEMI and 3,589 NSTEMI). Vital status at 5 years was available in >96% of the patients. Binary logistic regression analysis was used to determine independent correlates of AHF and Cox multivariate analysis was used to determine independent correlates of 5-year mortality. Long-term survival curves were estimated using the Kaplan Meier method and comparisons were made using log-rank tests.
Results
2,151 patients presented with DM (27,4%) and 629 patients (8,0%) were treated by insulin (DMi). DM patients were older (70.0 vs. 64.6 years; p<0.001), with more comorbidities and more severe coronary artery disease. AHF (pulmonary edema or cardiogenic shock) was the most frequent in-hospital complication (12.5%) and was twice as frequent in DM patients (20.2% vs. 9.6%; adjusted OR=1.66; 95% confidence interval: 1.43–1.94; P<0.001). AHF was more frequently observed in DM patients on insulin therapy compared with DM patients not receiving insulin (29.1% vs 16.6%; adjusted OR=1.53; 95% CI: 1.20–1.96; P=0.001). The significant difference in AHF between DM patients and patients without DM was found in both STEMI (18.8% vs 8.0%; P=0.001) and in NSTEMI (21.3% vs 11.9%; P=0.001) patients.
After multivariate analysis on confounders (risk factors, previous medical history, type of AMI, year of survey and medications used before the index AMI), compared with patients without DM nor AHF, those with AHF without DM and those with DM without AHF had a 50% increase in 5-year mortality (adjusted HR=1.50; 95% CI: 1.32–1.69; P<0.001 and adjusted HR=1.46; 95% CI: 1.23–1.74; P<0.001) while the risk of 5-year death was doubled in those with both DM and AHF (adjusted HR=1.97; 95% CI: 1.66–2.34; P<0.0001).
Conclusion
AHF is the most frequent complication of AMI and is twice as common in DM patients. It is associated with reduced 5-year survival in non-diabetic and DM patients, with the worst outcomes in patients with both conditions (AHF and DM). In AMI, new management strategies are needed to prevent AHF and improve survival in DM patients with AHF.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The FAST-MI 2005 and 2010 registries are the propriety of the French Society of Cardiology and were funded by grants from the following companies: Amgen, AstraZeneca, Bayer, BMS, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, and Servier, and by a grant from the French National Health Insurance body (CNAM-TS).
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Asarbakhsh M, Smith O, Chitsabesan P, MacLeod T, Lim P, Chintapatla S. A multistage process leading to the development of a structured consent form and patient information leaflet for complex abdominal wall reconstruction (CAWR). Hernia 2020; 25:277-285. [PMID: 32638242 DOI: 10.1007/s10029-020-02260-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Informed consent is vital in surgery. The General Medical Council, UK and Royal College of Surgeons of England provide clear guidance on what constitutes the process of informed patient consent. Despite this, evidence suggests that the consent process may not be performed well in surgery. We utilised a staged patient-centred approach and rigorous methodology to develop a standardised patient information leaflet (PIL) and pre-written structured consent form for complex abdominal wall reconstruction (CAWR). METHODS We utilised the principles of Deming's Plan-Do-Study-Act (PDSA) cycles to approach the process. Buzan's mind maps were used to identify the stakeholders and deficiencies in the consent process ('Plan' phase). The content of the PIL and pre-written consent form was then developed in collaboration with stakeholders ('Do' phase). Multidisciplinary and multidepartmental feedback was obtained on the proposed content and amendments were made ('Study' and 'Act' phases). RESULTS We successfully produced a clear, focused PIL and structured consent form, in Plain English, presenting accurate, relevant and detailed information in a highly understandable way. The PIL had a Flesch Reading Ease score of > 80, demonstrating a high level of readability and comprehensibility, with positive implications for informed patient decision making and preparedness for surgery. CONCLUSION Through sharing the process that we undertook, we aim to support other abdominal wall units who wish to develop and improve their own consent process.
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Koutsoukis A, Fard D, Gallet R, Boukantar M, Teiger E, Nguyen A, Huguet R, Lim P. MitraClip Implantation for Functional Mitral Regurgitation With Coaptation Gap Facilitated by Levosimendan Treatment. JACC Case Rep 2020; 2:862-865. [PMID: 34317368 PMCID: PMC8302007 DOI: 10.1016/j.jaccas.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/05/2022]
Abstract
A patient with severe, symptomatic functional mitral regurgitation was initially considered not suitable for MitraClip (Abbott Vascular, Abbott Park, Illinois) implantation because of non-coapting mitral leaflets. Repeated levosimendan infusions in combination with intensive diuresis induced sufficient valve coaptation, thus allowing MitraClip implantation to be performed. (Level of Difficulty: Intermediate.)
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Takahashi M, Mouillet G, Khaled A, Boukantar M, Gallet R, Rubimbura V, Lim P, Dubois-Rande JL, Teiger E. Perioperative Outcomes of Adjunctive Hypnotherapy Compared with Conscious Sedation Alone for Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation. Int Heart J 2020; 61:60-66. [DOI: 10.1536/ihj.19-296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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San R, Lim P, Itti E. How to differentiate infective from physiologic 18F-Fluorodeoxyglucose positron emission tomography uptake pattern in left prosthetic heart valve? ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2020. [DOI: 10.1016/j.acvdsp.2019.09.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Juguet W, Faivre L, Deguillard C, Fard D, Pelletier V, Oliver L, Damy T, Mongardon N, Mekontso-Dessap A, Dubois Randé J, Gallet R, Huguet R, Lim P. Levosimendan added to dobutamine in acute decompensated heart failure refractory to dobutamine. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2020. [DOI: 10.1016/j.acvdsp.2019.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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San S, Lim P, Itti E. Characterization of 18-Fluorodeoxyglucose uptake pattern in infective endocarditis after transcatheter aortic valve implantation. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2020. [DOI: 10.1016/j.acvdsp.2019.09.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lim P, Barber J, Sykes J. Evaluation of dual energy CT and iterative metal artefact reduction (iMAR) for artefact reduction in radiation therapy. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:1025-1032. [PMID: 31602593 DOI: 10.1007/s13246-019-00801-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/19/2019] [Accepted: 09/16/2019] [Indexed: 11/27/2022]
Abstract
Metal artefacts pose a common problem in single energy computed tomography (SECT) images used for radiotherapy. Virtual monoenergetic (VME) images constructed with dual energy computed tomography (DECT) scans can be used to reduce beam hardening artefacts. Dual energy metal artefact reduction is compared and combined with iterative metal artefact reduction (iMAR) to determine optimal imaging strategies for patients with metal prostheses. SECT and DECT scans were performed on a Siemens Somatom AS-64 Slice CT scanner. Images were acquired of a modified CIRS pelvis phantom with 6, 12, 20 mm diameter stainless steel rods and VME images reconstructed at 100, 120, 140 and 190 keV. These were post-reconstructed with and without the iMAR algorithm. Artefact reduction was measured using: (1) the change in Hounsfield Unit (HU) with and without metal artefact reduction (MAR) for 4 regions of interest; (2) the total number of artefact pixels, defined as pixels with a difference (between images with metal rod and without) exceeding a threshold; (3) the difference in the mean pixel intensity of the artefact pixels. DECT, SECT + iMAR and DECT + iMAR were compared. Both SECT + iMAR and DECT + iMAR offer successful MAR for phantom simulating unilateral hip prosthesis. DECT gives minimal artefact reduction over iMAR alone. Quantitative metrics are advantageous for MAR analysis but have limitations that leave room for metric development.
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Moore K, Oza A, Colombo N, Oaknin A, Scambia G, Lorusso D, Farias-Eisner R, Banerjee S, Murphy C, Tanyi J, Hirte H, Konner J, Lim P, Hayes MP, Monk B, Kim S, Wang J, Pautier P, Vergote I, Birrer M. FORWARD I (GOG 3011): A phase III study of mirvetuximab soravtansine, a folate receptor alpha (FRa)-targeting antibody-drug conjugate (ADC), versus chemotherapy in patients (pts) with platinum-resistant ovarian cancer (PROC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Smith SCL, Saltzman J, Shivaji UN, Lethebe BC, Cannatelli R, Ghosh S, Iacucci M, Bannaga A, Fowler H, Geh D, Gupta T, Harvey PR, Khan S, Kumar A, Lim P, McCulloch A, O'Rourke J, Polewiczowska B, Qurashi M, Tahir F, Widlak MM. Randomized controlled study of the prediction of diminutive/small colorectal polyp histology using didactic versus computer-based self-learning module in gastroenterology trainees. Dig Endosc 2019; 31:535-543. [PMID: 30844114 DOI: 10.1111/den.13389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/03/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM The aim of this randomized trial was to evaluate the performance of self-training versus didactic training in order to increase the diagnostic accuracy of diminutive/small colonic polyp histological prediction by trainees. METHODS Sixteen trainees reviewed 78 videos (48 iSCAN-OE and 30 NBI) of diminutive/small polyps in a pretraining assessment. Trainees were randomized to receive computer-based self-learning (n = 8) or didactic training (n = 8) using identical teaching materials and videos. The same 78 videos, in a different randomized order, were assessed. The NICE (NBI International Colorectal Endoscopic) and SIMPLE (Simplified Identification Method for Polyp Labeling during Endoscopy) classification systems were used to classify diminutive/small polyps. RESULTS A higher proportion of high-confidence predictions of polyps was made by the self-training group versus the didactic group using both the SIMPLE classification (77.1% [95% CI 73.4-80.3] vs 69.9% [95% CI 66.1-73.5%] [P = 0.005]) and the NICE classification (77% [95% CI 73.2-80.4%] vs 69.8% [95% CI 66-73.4%] [P = 0.006]). When using NICE, sensitivity of the self-training group compared with the didactic group was 72% versus 83% (P = 0.0005), and the accuracy was 66.1% versus 69.1%. The training improved the confidence of participants and SIMPLE was preferred over NICE. CONCLUSION Self-learning for the prediction of diminutive/small polyp histology is a method of training that can achieve results similar to didactic training. Availability of adequate self-learning teaching modules could enable widespread implementation of optical diagnosis in clinical practice.
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de Roux Q, Maghrebi S, Fiore A, Arminot-Fremaux M, Dessalle T, Lim P, Folliguet T, Bartolucci P, Langeron O, Mongardon N. Venoarterial Extracorporeal Membrane Oxygenation in Sickle Cell Disease for Urgent Cardiac Surgery. Ann Thorac Surg 2019; 109:e161-e162. [PMID: 31362014 DOI: 10.1016/j.athoracsur.2019.05.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
Sickle cell disease (SCD) is among the most common genetic diseases, with a recent increase in life expectancy. Patients may therefore need similar surgical procedures as does the general population, including cardiac surgery. Cardiopulmonary bypass is a homeostasis challenge for SCD patients, with high risk of vasoocclusive crisis. In the most severe cases of cardiogenic shock, venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be required, with prolonged exposure to extreme nonphysiological conditions. We report a case of postcardiotomy shock in an SCD patient successfully managed with VA-ECMO. This highlights that SCD should not be a counterindication to VA-ECMO, pending multidisciplinary management.
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Royer G, Melloul E, Roisin L, Courbin V, Jacquier H, Lepeule R, Coutte L, Darty M, Fihman V, Lim P, Decousser JW, Rodriguez C, Woerther PL. Complete genome sequencing of Enterococcus faecalis strains suggests role of Ebp deletion in infective endocarditis relapse. Clin Microbiol Infect 2019; 25:1565-1567. [PMID: 31306792 DOI: 10.1016/j.cmi.2019.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/01/2019] [Accepted: 07/04/2019] [Indexed: 12/16/2022]
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Huguet R, Fard D, D’humières T, Brault-Meslin O, Nahory L, Faivre L, Dubois-Randé J, Ternacle J, Oliver L, Lim P. Three-Dimensional inferior vena cava for assessing central venous pressure in patients with cardiogenic shock. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2019. [DOI: 10.1016/j.acvdsp.2019.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fard D, Huguet R, Doan H, San S, Faivre L, D’humières T, Dubois-Randé J, Oliver L, Ternacle J, Lim P. Is functional tricuspid regurgitation decrease under diuretic correlated with outcome? ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2019. [DOI: 10.1016/j.acvdsp.2018.10.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nguyen A, Gallet R, Riant E, Deux JF, Boukantar M, Mouillet G, Dubois-Randé JL, Lellouche N, Teiger E, Lim P, Ternacle J. Peridevice Leak After Left Atrial Appendage Closure: Incidence, Risk Factors, and Clinical Impact. Can J Cardiol 2018; 35:405-412. [PMID: 30935631 DOI: 10.1016/j.cjca.2018.12.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/25/2018] [Accepted: 12/13/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Limited studies reported the rate and clinical impact of peridevice leaks (PDL) after percutaneous left atrial appendage closure (LAAC). METHODS All consecutive patients with a nonvalvular atrial fibrillation admitted for LAAC between November 2011 and October 2016 were prospectively enrolled. The follow-up included clinical, transesophageal echocardiography, and/or cardiac computed tomography angiogram (CCTA). PDL was defined by the presence of contrast within the left atrial appendage on CCTA, and Major Adverse Cardiac Event (MACE) included stroke, device-related thrombosis, and cardiovascular death. RESULTS Overall, 77 patients (mean CHA2DS2-VASc score = 4.4 ± 1.5 and mean HAS-BLED = 3.4 ± 1.1) were implanted using Amplatzer Cardiac Plug (n = 24), Amulet (n = 37), or Watchman devices (n = 16). Indications were stroke recurrence despite adequate oral anticoagulation (OAC, n = 6) or contraindication to long-term OAC (n = 71). From 3-month to 12-month CCTA follow-up, the PDL rate decreased from 68.5% to 56.7% (P = 0.02), without any difference between the various devices. Patients with PDL were more often in permanent atrial fibrillation, and had a larger landing zone diameter, a lower ratio of device compression, and a more frequent off-axis position of the device. A device compression ratio < 10% was the only parameter associated with PDL occurrence. During follow-up (median 236 days) the MACE rate was 9.1%, with no statistically significant difference between patients with vs without PDL (12% vs 4.3%, P = 0.3). CONCLUSIONS The PDL rate detected by CCTA after LAAC was high, especially in cases with a low device compression ratio (< 10%), but decreased over time. The incidence of MACE was quantitatively greater with PDL, but the difference was not statistically significant. Larger studies are needed to determine the clinical importance of PDL.
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Jonveaux M, Gallet R, Mouillet G, Lim P, Teiger E, Ternacle J. Acute haemolysis after transcatheter mitral valve implantation. Eur Heart J 2018; 40:488-490. [DOI: 10.1093/eurheartj/ehy793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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d'Humières T, Faivre L, Chammous E, Deux JF, Bergoënd E, Fiore A, Radu C, Couetil JP, Benhaiem N, Derumeaux G, Dubois-Randé JL, Ternacle J, Fard D, Lim P. A New Three-Dimensional Echocardiography Method to Quantify Aortic Valve Calcification. J Am Soc Echocardiogr 2018; 31:1073-1079. [DOI: 10.1016/j.echo.2018.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Indexed: 11/30/2022]
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d’Humières T, Fard D, Damy T, Roubille F, Galat A, Doan HL, Oliver L, Dubois-Randé JL, Squara P, Lim P, Ternacle J. Outcome of patients with cardiac amyloidosis admitted to an intensive care unit for acute heart failure. Arch Cardiovasc Dis 2018; 111:582-590. [DOI: 10.1016/j.acvd.2018.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/22/2018] [Accepted: 03/03/2018] [Indexed: 01/22/2023]
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Nahory L, Bodez D, Galat A, Oliver L, Lim P, Dubois-Rande JL, Logeart D, Damy T. P1792Prevalence, causes and consequences of interatrial dyssynchrony in cardiac amyloidosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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