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Sharpe AR, Richardson K, Stanton M, Dang C, Feih J, Brazauskas R, Teng BQ, Feldman R. Lack of Association of Initial Vasopressor Dosing with Survival and Cardiac Re-Arrest Likelihood After Return of Spontaneous Circulation. J Emerg Med 2023; 65:e209-e220. [PMID: 37635036 DOI: 10.1016/j.jemermed.2023.05.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/26/2023] [Accepted: 05/26/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Cardiac arrest occurs in approximately 350,000 patients outside the hospital and approximately 30,000 patients in the emergency department (ED) annually in the United States. When return of spontaneous circulation (ROSC) is achieved, hypotension is a common complication. However, optimal dosing of vasopressors is not clear. OBJECTIVE The objective of this study was to determine if initial vasopressor dosing was associated with cardiac re-arrest in patients after ROSC. METHODS This was a retrospective, single-center analysis of adult patients experiencing cardiac arrest prior to arrival or within the ED. Patients were assigned to one of four groups based on starting dose of vasopressor: low dose (LD; < 0.25 µg/kg/min), medium dose (MD; 0.25-0.49 µg/kg/min), high dose (HD; 0.5-0.99 µg/kg/min), and very high dose (VHD; ≥ 1 µg/kg/min). Data collection was performed primarily via manual chart review of medical records. The primary outcome was incidence of cardiac re-arrest within 1 h of vasopressor initiation. Multivariate logistic regression analysis was conducted to identify any covariates strongly associated with the primary outcome. RESULTS No difference in cardiac re-arrest incidence was noted between groups. The VHD group was significantly more likely to require a second vasopressor (p = 0.003). The HD group had lower survival rates to hospital discharge compared with the LD and MD groups (p = 0.0033 and p = 0.0147). In the multivariate regression, longer duration of pre-vasopressor re-arrests and hyperkalemic cardiac arrest etiology were significant predictors of cardiac re-arrest after vasopressor initiation. CONCLUSIONS Initial vasopressor dosing was not found to be associated with risk of cardiac re-arrest or, conversely, risk of adverse events.
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Affiliation(s)
- Abigail R Sharpe
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kelly Richardson
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew Stanton
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cathyyen Dang
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jessica Feih
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ruta Brazauskas
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bi Qing Teng
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ryan Feldman
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
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O'Brien KM, Badowski ME, Bartoo AS, Peppard WJ, Schwarz K, Sharpe AR, Austin Szwak J. Determining support for and barriers to
pharmacist‐driven
research: Results of a national survey. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kathryn M. O'Brien
- Department of Pharmacy Northwestern Memorial Hospital Chicago Illinois USA
| | - Melissa E. Badowski
- Section of Infectious Diseases Pharmacotherapy, Department of Pharmacy Practice University of Illinois at Chicago, College of Pharmacy Chicago Illinois USA
| | - Anna S. Bartoo
- Department of Pharmacy Services Mayo Clinic Rochester Minnesota USA
| | - William J. Peppard
- Department of Pharmacy, Department of Surgery Froedtert & the Medical College of Wisconsin Milwaukee Wisonsin USA
| | - Kerry Schwarz
- Department of Pharmacy UCHealth University of Colorado Hospital Aurora Colorado USA
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3
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Caldera F, Hillman L, Saha S, Wald A, Grimes I, Zhang Y, Sharpe AR, Reichelderfer M, Hayney MS. Immunogenicity of High Dose Influenza Vaccine for Patients with Inflammatory Bowel Disease on Anti-TNF Monotherapy: A Randomized Clinical Trial. Inflamm Bowel Dis 2020; 26:593-602. [PMID: 31504526 DOI: 10.1093/ibd/izz164] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 04/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) on anti-tumor necrosis factor alpha (TNF) agents may have lower immune response to the influenza vaccine. We aimed to evaluate the immunogenicity of the high dose (HD) vs standard dose (SD) influenza vaccine in patients with IBD on anti-TNF monotherapy. METHODS We performed a randomized clinical trial at a single academic center evaluating the immunogenicity of the HD vs SD influenza vaccine in patients with IBD on anti-TNF monotherapy. Influenza antibody concentration was measured at immunization, at 2 to 4 weeks postimmunization, and at 6 months. RESULTS Sixty-nine patients with IBD were recruited into the study, 40 on anti-TNF monotherapy, and 19 on vedolizumab, along with 20 healthy controls (HC). Patients with IBD receiving the HD influenza vaccine had significantly higher H3N2 postimmunization antibodies compared with those who received the SD influenza vaccine (160 [interquartile range 80 to 320] vs 80 [interquartile range 40 to 160]; P = 0.003). The H1N1 postimmunization levels were not significantly higher in the HD influenza vaccine (320 [interquartile range 150 to 320] vs 160 [interquartile range 80 to 320]; P = 0.18). Patients with IBD receiving the HD influenza vaccine and those on vedolizumab who received SD had equivalent antibody concentrations to HC (H1N1 P = 0.85; H3N2 P = 0.23; B/Victoria P = 0.20 and H1N1 P = 0.46; H3N2 P = 0.21; B/Victoria P = 1.00, respectively). CONCLUSIONS Patients with IBD on anti-TNF monotherapy receiving the HD influenza vaccine had significantly higher postimmunization antibody levels compared with SD vaccine. Clinicaltrials.gov (#NCT02461758).
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Affiliation(s)
- Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, WI, USA
| | - Luke Hillman
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, WI, USA
| | - Sumona Saha
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, WI, USA
| | - Arnold Wald
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, WI, USA
| | - Ian Grimes
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, WI, USA
| | - Youqi Zhang
- School of Pharmacy, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, WI, USA
| | - Abigail R Sharpe
- School of Pharmacy, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, WI, USA
| | - Mark Reichelderfer
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, WI, USA
| | - Mary S Hayney
- School of Pharmacy, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, WI, USA
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5
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Abstract
A 36-year-old woman with hyperthyroidism, elevated blood thyroid-stimulating hormone (TSH) and alpha-subunit levels, amenorrhea, hyperprolactinemia and no evidence of acromegaly, was found to have a pituitary adenoma containing TSH, alpha-subunit and growth hormone by immunohistochemistry. Preoperative testing revealed elevated TSH and alpha-subunit with no response to thyrotropin-releasing hormone (TRH) but a normal response in prolactin to TRH. Culture of the pituitary cells showed release of TSH, alpha-subunit and prolactin. In vitro, TRH failed to cause TSH discharge; however, it increased prolactin concentrations in the culture medium. Triiodothyronine, added to the pituitary cell culture, resulted in no inhibition of TSH and prolactin discharge. By electron microscopy, the adenoma cells showed features of thyrotrophs. However, some adenoma cells contained fibrous bodies characteristic of some growth hormone cell tumors and acidophil stem cell adenomas, suggesting that the adenoma originated in a common progenitor cell.
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Affiliation(s)
- J N Clore
- Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond
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Abstract
The use of postoperative radioiodine thyroid scanning has questioned whether total thyroidectomy is surgically possible. Similar to earlier studies, we have found functioning iodine 131 (131I)-avid thyroid tissue in our patients following total thyroidectomy for thyroid cancer. Preoperative and postoperative thyroid scans were compared in 24 patients to study the cervical location of postthyroidectomy residual thyroid tissue. Thyroid scanning detected 44 distinct sites of uptake. Thirty-eight of these foci were located either at the extremes of the upper poles of the thyroid gland (24) or along the embryonic thyroid descent tract (14). We conclude that these foci of 131I uptake represent incomplete resection of normal thyroid tissue, and that surgical attention to these areas should result more frequently in extirpation of the entire thyroid gland.
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Tatum JL, Burke TS, Fratkin MJ, Sharpe AR, Goodrich JK. Relative decreased splenic uptake of Tc-99m-sulfur colloid in patients with pancreatic carcinoma. Clin Nucl Med 1982; 7:1-4. [PMID: 7060290 DOI: 10.1097/00003072-198201000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Relative spleen/liver activity ratio was determined from posterior projection images using a photodensitometric method. Ratios from scans of 22 patients with proven pancreatic carcinoma (12 from rectilinear scans and 10 from scintillation camera images) were determined and compared to studies from patients documented as normal and to randomly selected liver/spleen imaging studies which had been previously interpreted as normal. The mean ratio from the pancreatic carcinoma group was significantly lower than the means of the respective normal groups (p[t] less than .0001 for rectilinear scans and p[t] less than .001 for scintigrams). There was no significant difference between the means of the proven normal and randomly selected normal groups or between the two pancreatic carcinoma groups. Splenic vascular alteration is discussed as a possible reason for decreased splenic distribution of Tc-99m-sulfur colloid in this patient group.
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Chan JC, Sharpe AR. Glomerular filtration rate in children with advanced chronic renal failure: methods of determination and clinical applications. Am J Nephrol 1982; 2:46-55. [PMID: 6758581 DOI: 10.1159/000166584] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The rationale, significance and pitfalls of currently available methods for the determination of glomerular filtration rates in children with advanced chronic renal diseases are reviewed. Normal renal clearances in infants and children from birth to adulthood are presented. Methods of serial measurements of renal function, especially by the reciprocals of serum creatinine concentrations, are evaluated. They are applied clinically to monitor the effectiveness of conservative and new modalities of treatment, such as dietary supplementation with essential amino acids plus their keto analogues, and to determine that 1,25-dihydroxyvitamin-D3 treatment of renal osteodystrophy does not accelerate the deterioration of renal function in children with chronic renal insufficiency.
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Coyne SS, Walsh JW, Tisnado J, Brewer WH, Sharpe AR, Amendola MA, Mendez-Picon G, Lee HM. Surgically correctable renal transplant complications: an integrated clinical and radiologic approach. AJR Am J Roentgenol 1981; 136:1113-9. [PMID: 6786023 DOI: 10.2214/ajr.136.6.1113] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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10
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Sugerman HJ, Hirsch JI, Strash AM, Kan PT, Sharpe AR, Stoneburner J, Greenfield LJ. Preliminary report. Gamma camera detection of oleic acid alveolar-capillary albumin leak. J Surg Res 1980; 29:93-9. [PMID: 6903226 DOI: 10.1016/0022-4804(80)90013-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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11
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Fratkin MJ, Sharpe AR. Irradiation and thyroid cancer: evaluating, treating the patient at risk. Va Med 1977; 104:307-11. [PMID: 860594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Hietala SO, Stinnett RG, Faunce HF, Sharpe AR, Scoggins WG, Smith RH. Pulmonary artery narrowing in sarcoidosis. JAMA 1977; 237:572-3. [PMID: 576286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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13
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Fratkin MJ, Hirsch JI, Sharpe AR. Ga-67 staging of Hodgkin's disease. Va Med Mon (1918) 1976; 103:257-60, 265-6. [PMID: 1258540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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14
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15
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Tinglestad JB, Howell TR, Sharpe AR. Diagnosis of omphalocele and diaphragmatic hernia and hepatopericardium using 99mTc-sulfur colloid. J Nucl Med 1974; 15:42-4. [PMID: 4808678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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16
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17
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Fratkin MJ, Sharpe AR. Nontuberculous psoas abscess: localization using 67 Ga. J Nucl Med 1973; 14:499-501. [PMID: 4711266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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18
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Walton PW, Sharpe AR. An electronic marking device for a gamma scintillation camera. J Nucl Med 1971; 12:257-61. [PMID: 5580841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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19
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Williams JP, Pribram HF, Lynde RH, Sharpe AR. Isotope cisternography in the evaluation of patients with subarachnoid hemorrhage. J Nucl Med 1970; 11:592-6. [PMID: 5506342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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21
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Sharpe AR, Gardner CT, Cassida WA, Blackburn E. Thyroid uptake and scan using technetium-99m pertechnetate. J Nucl Med 1967; 8:337. [PMID: 6032623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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22
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23
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Sharpe AR, Magee JH, Richardson DW. Unilateral renal disease and hypertension. Arch Intern Med 1966; 118:546-52. [PMID: 5925441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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24
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25
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