1
|
Papaioannou A, McCloskey E, Bell A, Ngui D, Mehan U, Tan M, Goldin L, Langer A. Use of an electronic medical record dashboard to identify gaps in osteoporosis care. Arch Osteoporos 2021; 16:76. [PMID: 33893868 PMCID: PMC8068625 DOI: 10.1007/s11657-021-00919-4] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/17/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Using an electronic medical record (EMR)-based dashboard, this study explored osteoporosis care gaps in primary care. Eighty-four physicians shared their practice activities related to bone mineral density testing, 10-year fracture risk calculation and treatment for those at high risk. Significant gaps in fracture risk calculation and osteoporosis management were identified. PURPOSE To identify care gaps in osteoporosis management focusing on Canadian clinical practice guidelines (CPG) related to bone mineral density (BMD) testing, 10-year fracture risk calculation and treatment for those at high risk. METHODS The ADVANTAGE OP EMR tool consists of an interactive algorithm to facilitate assessment and management of fracture risk using CPG. The FRAX® and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools were embedded to facilitate 10-year fracture risk calculation. Physicians managed patients as clinically indicated but with EMR reminders of guideline recommendations; participants shared practice level data on management activities after 18-month use of the tool. RESULTS Eighty-four physicians (54%) of 154 who agreed to participate in this study shared their aggregate practice activities. Across all practices, there were 171,310 adult patients, 40 years of age and older, of whom 17,214 (10%) were at elevated risk for fracture. Sixty-two percent of patients potentially at elevated risk for fractures did not have BMD testing completed; most common reasons for this were intention to order BMD later (48%), physician belief that BMD was not required (15%) and patient refusal (20%). For patients with BMD completed, fracture risk was calculated in 29%; 19% were at high risk, of whom 37% were not treated with osteoporosis medications as recommended by CPG. CONCLUSION Despite access to CPG and fracture risk calculators through the ADVANTAGE OP EMR tool, significant gaps remain in fracture risk calculation and osteoporosis management. Additional strategies are needed to address this clinical inertia among family physicians.
Collapse
Affiliation(s)
- A. Papaioannou
- McMaster University, Hamilton, Ontario Canada ,GERAS Centre for Aging Research, St. Peter’s Hospital, Hamilton Health Sciences, 88 Maplewood Ave, Hamilton, Ontario L8M 1W9 Canada
| | - E. McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - A. Bell
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - D. Ngui
- University of British Columbia, Vancouver, British Columbia Canada
| | - U. Mehan
- McMaster University, Hamilton, Ontario Canada ,Centre for Family Medicine Family Health Team, Kitchener, Ontario Canada
| | - M. Tan
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
| | - L. Goldin
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
| | - A. Langer
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
| |
Collapse
|
2
|
Bolonhezi B, Matsumura L, Turke K, Silva L, Langer A, Feder D, Carvalho A. EP.57Duchenne muscular dystrophy and stroke: systematic review of literature and two cases reports. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.463] [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: 11/27/2022]
|
3
|
Langer A, Wills C, Tan M, Spindler C, Goodman S, Lin P, Mancini G, Dufour R, Gregoire J, Leiter L. GUIDELINES ORIENTED APPROACH TO LIPID LOWERING (GOAL) MEDICAL PRACTICE ACTIVITY (MPA) TO ACHIEVE LOW DENSITY LIPOPROTEIN CHOLESTEROL (LDL-C) TARGETS. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
4
|
Genin A, De Rycke Y, Stevens D, Donnadieu A, Langer A, Rouzier R, Lerebours F. Association with pregnancy increases the risk of local recurrence but does not impact overall survival in breast cancer: A case–control study of 87 cases. Breast 2016; 30:222-227. [DOI: 10.1016/j.breast.2015.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/02/2015] [Accepted: 09/12/2015] [Indexed: 10/23/2022] Open
|
5
|
Holt K, Janiak E, McCormick MC, Lieberman E, Dehlendorf C, Kajeepeta S, Caglia JM, Langer A. Predictors of pregnancy options counseling and abortion referrals or dissuasion among United States primary care physicians: results from a national survey. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
6
|
Alla JA, Langer A, Quitterer U. Down-regulation of the chemokine (c-c motif) receptor 9 (Ccr9) contributes to the atherosclerosis-lowering activity of the angiotensin-converting enzyme inhibitor captopril. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
7
|
Kearns AD, Caglia JM, Ten Hoope-Bender P, Langer A. Antenatal and postnatal care: a review of innovative models for improving availability, accessibility, acceptability and quality of services in low-resource settings. BJOG 2015; 123:540-8. [PMID: 26694075 DOI: 10.1111/1471-0528.13818] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 10/13/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED Key lessons can be drawn from innovative approaches that have been implemented to ensure access to better antenatal care (ANC) and postnatal care (PNC). This paper examines the successes and challenges of ANC and PNC delivery models in several settings around the world; discusses the lessons to be learned from them; and makes recommendations for future programmes. Based on this review, we conclude that close monitoring of ANC and PNC quality and delivery models, health workforce support, appropriate use of electronic technologies, integrated care, a woman-friendly perspective, and adequate infrastructure are key elements of successful programmes that benefit the health and wellbeing of women, their newborns and families. However, a full evaluation of care delivery models is needed to establish their acceptability, accessibility, availability and quality. TWEETABLE ABSTRACT New paper examines global innovations in antenatal/postnatal care @MHTF @ICS_Integrare #MNCH #healthsystems.
Collapse
Affiliation(s)
- A D Kearns
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - J M Caglia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - A Langer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
8
|
Langer A, Mohallem M, Berment H, Ferreira F, Gog A, Khalifa D, Nekka I, Chérel P. Breast lumps in pregnant women. Diagn Interv Imaging 2015; 96:1077-87. [PMID: 26341843 DOI: 10.1016/j.diii.2015.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 03/31/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
Abstract
Breast lumps detected during pregnancy are generally benign and reflect fibroadenoma, lactating adenoma, cysts, infarction of the breast or galactocele. Although rare, the possibility of breast cancer must also be considered to avoid any delays in diagnosis. After patient questioning and clinical examination, the first imaging modality to use is ultrasound. No further assessment is called for if lesions are categorized as BI-RADS 2 and no suspicious clinical signs are observed. Depending on the clinical setting, lesions classified BI-RADS 3 require monitoring and mammographic assessment (which can be helpful in diagnosing cancer and incurs no risk to the embryo or fetus). If the clinical signs are unclear and/or the lesion(s) are categorized as ≥ BI-RADS 4a, then mammography and often biopsy should be performed. Strict BI-RADS scoring (American College of Radiology) should be applied, bearing in mind that benign lesions can appear suspicious during pregnancy, and some cancers can exhibit what seem to be reassuring characteristics.
Collapse
Affiliation(s)
- A Langer
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France.
| | - M Mohallem
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - H Berment
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - F Ferreira
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - A Gog
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - D Khalifa
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - I Nekka
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - P Chérel
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| |
Collapse
|
9
|
Caresta E, Tortorolo L, Viola L, Polidori G, Piastra M, Chiaretti A, Langer A. Pseudoseizures simulating status epilepticus: two cases of over-treatment in the emergency department and pediatric intensive care unit. J Pediatr Neurol 2015. [DOI: 10.1055/s-0035-1557243] [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: 10/23/2022]
Affiliation(s)
- Elena Caresta
- Pediatric Intensive Care Unit, Department of Pediatrics, Catholic University, Rome, Italy
| | - Luca Tortorolo
- Pediatric Intensive Care Unit, Department of Pediatrics, Catholic University, Rome, Italy
| | - Luigi Viola
- Pediatric Intensive Care Unit, Department of Pediatrics, Catholic University, Rome, Italy
| | - Giancarlo Polidori
- Pediatric Intensive Care Unit, Department of Pediatrics, Catholic University, Rome, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit, Department of Pediatrics, Catholic University, Rome, Italy
| | - Antonio Chiaretti
- Pediatric Intensive Care Unit, Department of Pediatrics, Catholic University, Rome, Italy
| | - Arianna Langer
- Pediatric Intensive Care Unit, Department of Pediatrics, Catholic University, Rome, Italy
| |
Collapse
|
10
|
Khanna D, Tan M, Furst DE, Hill NS, McLaughlin VV, Silver RM, Steen VD, Langer A, Seibold JR. Recognition of pulmonary hypertension in the rheumatology community: lessons from a Quality Enhancement Research Initiative. Clin Exp Rheumatol 2014; 32:S-21-7. [PMID: 24295227] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 09/09/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The aim of this study was to utilise the Quality Enhancement Research Initiative in Systemic Sclerosis (QuERI-SSc) to measure and reduce a perceived gap in the diagnosis of pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc). METHODS Rheumatologists enrolled patients with SSc (aged ≥ 18 years) and provided data on a panel of diagnostic tests over 3 years. Pulmonary function testing, echocardiography, 6-minute walk distance, N-terminal pro-brain natriuretic peptide assays, high-resolution computed tomography of the lungs, and ventilation/perfusion scan plus right heart catheterisation (RHC; when appropriate) were emphasised. Exclusion criteria included previously documented PAH, interstitial lung disease, and SSc overlapping with other connective tissue disease. RESULTS Participating rheumatologists enrolled 207 patients with SSc (90% female; 80% white), with a median age of 57 years and median disease duration of 5 years. A total of 82% of patients were classified as New York Heart Association functional class I and II; of these patients, 177 had an echocardiogram at enrolment and 191 at any time during the study. Of those who met study-specified criteria for RHC at enrolment, only 3 of 7 patients underwent RHC. CONCLUSIONS The screening algorithm was successful in identifying patients with mild impairment. Although specific tools were recommended for screening PAH in patients with SSc, results indicate that significant diagnostic care gaps still exist in the general rheumatology community. Better understanding and adherence to guidelines could improve the care and, ideally, outcomes of these high-risk patients.
Collapse
Affiliation(s)
- D Khanna
- Department of Internal Medicine, University of Michigan Scleroderma Program, Ann Arbor, MI, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Wang J, Leiter L, Langer A, Tan M, Goldin L, Teoh H, Cheng A, Connelly K, Goodman S, Yan A. GLYCEMIC CONTROL AND CARDIOVASCULAR RISK FACTOR MANAGEMENT IN PATIENTS WITH DIABETES WITH AND WITHOUT CORONARY ARTERY DISEASE: INSIGHTS FROM THE DIABETES MELLITUS STATUS IN CANADA (DM-SCAN) SURVEY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
12
|
Tan N, Goodman S, Yan R, Tan M, Fox K, Gore J, Brieger D, Steg P, Langer A, Yan A. PROGNOSTIC SIGNIFICANCE OF LOW QRS VOLTAGE ON THE ADMISSION ELECTROCARDIOGRAM IN ACUTE CORONARY SYNDROMES. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
13
|
Pfeil A, Langer H, Reinhardt L, Langer A, Werner S, Boettcher J, Oelzner P, Wolf G. THU0227 Early Rheumatoid Arthritis is Associated with Periarticular Demineralisation of the Metcarpal Bones. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3678] [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: 11/04/2022]
|
14
|
Langer A, Mohallem M, Stevens D, Rouzier R, Lerebours F, Chérel P. A single-institution study of 117 pregnancy-associated breast cancers (PABC): Presentation, imaging, clinicopathological data and outcome. Diagn Interv Imaging 2014; 95:435-41. [DOI: 10.1016/j.diii.2013.12.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
15
|
Langer A, Kaiser W, Svejda M, Schwertler P, Rant U. Molecular Dynamics of DNA–Protein Conjugates on Electrified Surfaces: Solutions to the Drift-Diffusion Equation. J Phys Chem B 2014; 118:597-607. [DOI: 10.1021/jp410640z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- A. Langer
- Walter Schottky Institute and Chemistry Department, Technische Universität München, 85748 Garching, Germany
- Dynamic
Biosensors
GmbH, 82152 Munich, Germany
| | - W. Kaiser
- Walter Schottky Institute and Chemistry Department, Technische Universität München, 85748 Garching, Germany
- Dynamic
Biosensors
GmbH, 82152 Munich, Germany
| | - M. Svejda
- Walter Schottky Institute and Chemistry Department, Technische Universität München, 85748 Garching, Germany
| | - P. Schwertler
- Walter Schottky Institute and Chemistry Department, Technische Universität München, 85748 Garching, Germany
| | - U. Rant
- Walter Schottky Institute and Chemistry Department, Technische Universität München, 85748 Garching, Germany
- Dynamic
Biosensors
GmbH, 82152 Munich, Germany
| |
Collapse
|
16
|
Teoh H, Després JP, Dufour R, Fitchett DH, Goldin L, Goodman SG, Harris SB, Langer A, Lau DCW, Lonn EM, Mancini GBJ, McFarlane PA, Poirier P, Rabasa-Lhoret R, Tan MK, Leiter LA. A comparison of the assessment and management of cardiometabolic risk in patients with and without type 2 diabetes mellitus in Canadian primary care. Diabetes Obes Metab 2013; 15:1093-100. [PMID: 23683111 DOI: 10.1111/dom.12134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/01/2013] [Accepted: 05/14/2013] [Indexed: 02/05/2023]
Abstract
AIM To investigate the cardiometabolic risk (CMR) assessment and management patterns for individuals with and without type 2 diabetes mellitus (T2DM) in Canadian primary care practices. METHODS Between April 2011 and March 2012, physicians from 9 primary care teams and 88 traditional non-team practices completed a practice assessment on the management of 2461 patients >40 years old with no clinical evidence of cardiovascular disease and diagnosed with at least one of the following risk factor-T2DM, dyslipidaemia or hypertension. RESULTS There were 1304 individuals with T2DM and 1157 without. Pharmacotherapy to manage hyperglycaemia, dyslipidaemia and hypertension was widely prescribed. Fifty-eight percent of individuals with T2DM had a glycated haemoglobin (HbA1c) ≤7.0%. Amongst individuals with dyslipidaemia, median low-density lipoprotein cholesterol (LDL-C) was 1.8 mmol/l for those with T2DM and 2.8 mmol/l for those without. Amongst individuals with hypertension, 30% of those with T2DM achieved the <130/80 mmHg target, whereas 60% of those without met the <140/90 mmHg target. The composite glycaemic, LDL-C and blood pressure (BP) target outcome was achieved by 12% of individuals with T2DM. Only 17% of individuals with T2DM and 11% without were advised to increase their physical activity. Dietary modifications were recommended to 32 and 10% of those with and without T2DM, respectively. CONCLUSIONS Patients at elevated CMR were suboptimally managed in the primary care practices surveyed. There was low attainment of recommended therapeutic glycaemic, lipid and BP targets. Advice on healthy lifestyle changes was infrequently dispensed, representing a missed opportunity to educate patients on the long-term benefits of lifestyle modification.
Collapse
Affiliation(s)
- H Teoh
- Division of Endocrinology & Metabolism, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Division of Cardiac Surgery, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Feller A, Langer A. STRAHLENMESSUNGEN AN MIT RADIOLOGISCHEN ARBEITEN BESCHAFTIGTEM PERSONAL UND EINIGE SCHUTZMASSNAHMEN GEGEN -STRAHLEN. Acta Radiol 2013. [DOI: 10.1177/028418513701800402] [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: 11/17/2022]
|
18
|
Chatfield A, Caglia JM, Dhillon S, Hirst J, Cheikh Ismail L, Abawi K, Kac G, Al Dhaheri AS, Villar J, Kennedy S, Langer A. Translating research into practice: the introduction of the INTERGROWTH-21stpackage of clinical standards, tools and guidelines into policies, programmes and services. BJOG 2013; 120 Suppl 2:139-42, v. [DOI: 10.1111/1471-0528.12416] [Citation(s) in RCA: 20] [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] [Indexed: 11/29/2022]
Affiliation(s)
- A Chatfield
- Maternal Health Task Force at the Women & Health Initiative; Harvard School of Public Health; Boston; MA; USA
| | - JM Caglia
- Maternal Health Task Force at the Women & Health Initiative; Harvard School of Public Health; Boston; MA; USA
| | - S Dhillon
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford; UK
| | | | - L Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford; UK
| | - K Abawi
- Geneva Foundation for Medical Education and Research (GFMER); Geneva; Switzerland
| | - G Kac
- Social and Applied Nutrition Department; Josué de Castro Nutrition Institute; Rio de Janeiro Federal University; Rio de Janeiro; Brazil
| | - AS Al Dhaheri
- Department of Nutrition and Health; College of Food and Agriculture; United Arab Emirates University; Al-Ain; UAE
| | - J Villar
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford; UK
| | - S Kennedy
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford; UK
| | - A Langer
- Maternal Health Task Force at the Women & Health Initiative; Harvard School of Public Health; Boston; MA; USA
| | | |
Collapse
|
19
|
Reinhardt L, Pfeil A, Werner SG, Langer A, Lind-Albrecht G, Mettler S, Wiemann O, Böttcher J, Kerres T, Oelzner P, Wolf G, Langer HE. FRI0072 A risk-tailored strategy enables individualized stratification of care with improved outcome and appropriate allocation of limited resources – long-term results of a managed care model in early arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1199] [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: 11/04/2022]
|
20
|
Langer A. I202 THE WAY FORWARD: IMPLEMENTING THE RESULTS OF THE INTERGROWTH-21ST PROJECT. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
21
|
Tuncalp O, Stanton C, Castro A, Adanu R, Heymann M, Adu-Bonsaffoh K, Lattof S, Langer A. W407 VALIDATING WOMEN'S SELF-REPORT OF EMERGENCY CESAREAN DELIVERY IN GHANA AND THE DOMINICAN REPUBLIC. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)62128-6] [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: 11/17/2022]
|
22
|
Laugel-Haushalter V, Langer A, Marrie J, Fraulob V, Schuhbaur B, Koch-Phillips M, Dollé P, Bloch-Zupan A. From the transcription of genes involved in ectodermal dysplasias to the understanding of associated dental anomalies. Mol Syndromol 2012; 3:158-68. [PMID: 23239958 DOI: 10.1159/000342833] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2012] [Indexed: 01/17/2023] Open
Abstract
Orodental anomalies are one aspect of rare diseases and are increasingly identified as diagnostic and predictive traits. To understand the rationale behind gene expression during tooth or other ectodermal derivative development and the disruption of odontogenesis or hair and salivary gland formation in human syndromes we analyzed the expression patterns of a set of genes (Irf6, Nfkbia, Ercc3, Evc2, Map2k1) involved in human ectodermal dysplasias in mouse by in situ hybridization. The expression patterns of Nfkbia, Ercc3 and Evc2 during odontogenesis had never been reported previously. All genes were indeed transcribed in different tissues/organs of ectodermal origin. However, for Nfkbia, Ercc3, Evc2, and Map2k1, signals were also present in the ectomesenchymal components of the tooth germs. These expression patterns were consistent in timing and localization with the known dental anomalies (tooth agenesis, microdontia, conical shape, enamel hypoplasia) encountered in syndromes resulting from mutations in those genes. They could also explain the similar orodental anomalies encountered in some of the corresponding mutant mouse models. Translational approaches in development and medicine are relevant to gain understanding of the molecular events underlying clinical manifestations.
Collapse
Affiliation(s)
- V Laugel-Haushalter
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Centre National de la Recherche Scientifique (UMR 7104), Institut National de la Santé et de la Recherche Médicale (U 964), Université de Strasbourg, Illkirch, Strasbourg, France
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Teoh H, Després J, Fitchett D, Galluzzi A, Goldin L, Goodman S, Harris S, Langer A, Lonn E, Mancini G, McFarlane P, Poirier P, Rabasa-Lhoret R, Leiter L. 750 Are Lifestyle Modifications Being Appropriately Recommended in the Canadian Primary Care Practice to Manage Elevated Cardiometabolic Risk? Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.677] [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: 11/30/2022] Open
|
24
|
Braga MFB, Casanova A, Teoh H, Gerstein HC, Fitchett DH, Honos G, McFarlane PA, Ur E, Yale JF, Langer A, Goodman SG, Leiter LA. Poor achievement of guidelines-recommended targets in type 2 diabetes: findings from a contemporary prospective cohort study. Int J Clin Pract 2012; 66:457-64. [PMID: 22452524 DOI: 10.1111/j.1742-1241.2012.02894.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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: 11/27/2022] Open
Abstract
AIMS To prospectively evaluate diabetes management in the primary care setting and explore factors related to guideline-recommended triple target achievement [blood pressure (BP) ≤ 130/80 mmHg, A1C ≤ 7% and low-density lipoprotein (LDL)-cholesterol < 2.5 mmol/l]. METHODS Baseline, 6 and 12 month data on clinical and laboratory parameters were measured in 3002 patients with type 2 diabetes enrolled as part of a prospective quality enhancement research initiative in Canada. A generalised estimating equation model was fitted to assess variables associated with triple target achievement. RESULTS At baseline, 54%, 53% and 64% of patients, respectively, had BP, A1C and LDL-cholesterol at target; all three goals were met by 19% of patients. The percentage of individuals achieving these targets significantly increased during the study [60%, 57%, 76% and 26%, respectively, at the final visit, p < 0.0001 except for A1C, p = 0.27]. A much smaller proportion of patients had adequate control during the entire study period [30%, 39%, 53% and 7%, respectively]. In multivariable analysis, women, patients younger than 65 years and patients of Afro-Canadian origin were less likely to achieve the triple target. DISCUSSION As part of a quality enhancement research initiative, we observed important improvements in the attainment of guidelines-recommended targets in patients with type 2 diabetes followed for a 12-month period in the primary care setting; however, many individuals still failed to achieve and especially maintain optimal goals for therapy, particularly the triple target. Results of the multivariable analysis reinforce the need to address barriers to improve diabetes care, particularly in more susceptible groups.
Collapse
Affiliation(s)
- M F B Braga
- Department of Medicine, Division of Endocrinology & Metabolism, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Goodman S, Kerr C, Green M, Gladstone D, Mendelsohn A, Mitchell L, Fournier C, Cox J, Talajic M, Lin P, Langer A, Dorian P. 171 The risk stratification and stroke prevention therapy care gap in canadian atrial fibrillation patients: Insights from the Facilitating Review and Education to Optimize Stroke Prevention in Atrial Fibrillation (FREEDOM AF) knowledge translation program. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.119] [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: 11/26/2022] Open
|
26
|
Bugiardini R, Yan AT, Yan RT, Fitchett D, Langer A, Manfrini O, Goodman SG. Factors influencing underutilization of evidence-based therapies in women. Eur Heart J 2011; 32:1337-1344. [DOI: 10.1093/eurheartj/ehr027] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
27
|
Sodha SV, Lynch M, Wannemuehler K, Leeper M, Malavet M, Schaffzin J, Chen T, Langer A, Glenshaw M, Hoefer D, Dumas N, Lind L, Iwamoto M, Ayers T, Nguyen T, Biggerstaff M, Olson C, Sheth A, Braden C. Multistate outbreak of Escherichia coli O157:H7 infections associated with a national fast-food chain, 2006: a study incorporating epidemiological and food source traceback results. Epidemiol Infect 2011; 139:309-16. [PMID: 20429971 DOI: 10.1017/s0950268810000920] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A multistate outbreak of Escherichia coli O157:H7 infections occurred in the USA in November-December 2006 in patrons of restaurant chain A. We identified 77 cases with chain A exposure in four states - Delaware, New Jersey, New York, and Pennsylvania. Fifty-one (66%) patients were hospitalized, and seven (9%) developed haemolytic uraemic syndrome; none died. In a matched analysis controlling for age in 31 cases and 55 controls, illness was associated with consumption of shredded iceberg lettuce [matched odds ratio (mOR) 8·0, 95% confidence interval (CI) 1·1-348·1] and shredded cheddar cheese (mOR 6·2, CI 1·7-33·7). Lettuce, an uncooked ingredient, was more commonly consumed (97% of patients) than cheddar cheese (84%) and a single source supplied all affected restaurants. A single source of cheese could not explain the regional distribution of outbreak cases. The outbreak highlights challenges in conducting rapid multistate investigations and the importance of incorporating epidemiological study results with other investigative findings.
Collapse
Affiliation(s)
- S V Sodha
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Feller A, Langer A. Strahlenmessungen an Mit Radiologischen Arbeiten Beschaftigtem Personal Und Einige Schutzmassnahmen Gegen γ-Strahlen. Acta Radiol 2010. [DOI: 10.3109/00016923709132410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
29
|
Martín-Murcia F, Langer A, Cangas A. P02-330 - Treatment of anorexia nervosa and obsessive personality disorder with third-generation therapies: a case study. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71029-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
30
|
Langer A, Cangas A, Berrio-Lopez V, Ibañez-Rojo V. PW01-95 - Is it possible to distinguish hallucination like experiences between clinical and general population? Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
31
|
Murray C, Villar J, Kirtley S, Shalini F, Walker D, Fawole B, Langer A, Kennedy S. O647 Designing an e-learning module for the management of pre-eclampsia and eclampsia in India, Mexico and Nigeria - a pilot study. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61020-1] [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: 11/25/2022]
|
32
|
Teoh H, Braga M, Casanova A, Drouin D, Goodman S, Harris S, Langer A, Tan M, Ur E, Woo V, Zinman B, Leiter L. Time to do more: Feedback based national glycaemic treatment optimization program can improve attainment of glycaemic targets. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Langer A, Phokeo V. An interprofessional diabetes health promotion clinic at an academic urban family health team – an innovative way to improve access to diabetes care. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33330-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
34
|
Teoh H, Braga M, Casanova A, Drouin D, Goodman S, Harris S, Langer A, Tan M, Ur E, Woo V, Zinman B, Leiter L. Private drug coverage is not associated with better attainment of glycaemic targets in a Canadian glycaemic treatment optimization program. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33208-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
35
|
Chérel P, Hagay C, Benaim B, De Maulmont C, Engerand S, Langer A, Talma V. [Mammographic evaluation of dense breasts: techniques and limits]. ACTA ACUST UNITED AC 2008; 89:1156-68. [PMID: 18772800 DOI: 10.1016/s0221-0363(08)73926-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Breast density is a radiological concept based on the proportion of radiopaque glandular tissue relative to radiolucent fatty tissue. Mammographic evaluation of dense breasts is more difficult, related to technical difficulties, with decreased rates for detection and characterization of breast lesions, resulting in reduced sensitivity with increased number of interval cancers at routine follow-up when compared to radiolucent breasts. We will review the definition of dense breasts and their frequency, especially their relationship with the age of patients. We will discuss the current technical problems and the impact of breast density on the efficacy of conventional mammography. We will discuss the value of digital mammography, the role of computer assisted diagnosis (CAD) systems and tomosynthesis in the evaluation of dense breasts.
Collapse
Affiliation(s)
- P Chérel
- Centre René Huguenin, Service de radiodiagnostic, 35 rue Dailly, 92210 Saint-Cloud, France.
| | | | | | | | | | | | | |
Collapse
|
36
|
Langer A. Bilan préopératoire. PSYCHO-ONCOLOGIE 2008. [DOI: 10.1007/s11839-008-0073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
37
|
|
38
|
Vijayaraghavan R, Yan AT, Tan M, Fitchett DH, Georgescu AA, Hassan Q, Langer A, Goodman SG. Local hospital vs. core-laboratory interpretation of the admission electrocardiogram in acute coronary syndromes: increased mortality in patients with unrecognized ST-elevation myocardial infarction. Eur Heart J 2007; 29:31-7. [DOI: 10.1093/eurheartj/ehm503] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
39
|
Gupta M, de Teresa E, Farsang C, Gaw A, Gensini G, Leiter L, Martineau P, Langer A. PO23-732 LDL-C AND CRP LOWERING WITH ATORVASTATIN IN SOUTH ASIANS AND CAUCASIANS: INSIGHTS FROM THE ACTFAST STUDY. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71742-7] [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: 11/25/2022]
|
40
|
Martineau P, Gaw A, de Teresa E, Farsang C, Gensini GF, Leiter LA, Langer A. Effect of individualizing starting doses of a statin according to baseline LDL-cholesterol levels on achieving cholesterol targets: The Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (ACTFAST) study. Atherosclerosis 2007; 191:135-46. [PMID: 16643923 DOI: 10.1016/j.atherosclerosis.2006.03.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 02/14/2006] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
AIMS To investigate whether selecting the starting dose of atorvastatin according to baseline and target (<2.6 mmol/L) LDL-cholesterol (LDL-C) values would allow high-risk subjects to achieve target LDL-C concentration within 12 weeks, with the initial dose or a single uptitration. METHODS AND RESULTS Twelve-week, prospective, open-label trial that enrolled 2117 high-risk subjects (statin-free [SF] or statin-treated [ST]). Subjects with LDL-C >2.6 mmol/L (100mg/dL) but <or=5.7 mmol/L (220 mg/dL) were assigned a starting dose of atorvastatin (10, 20, 40 or 80 mg/day) based on LDL-C and status of statin use at baseline, with a single uptitration at 6 weeks, if required. There was no washout for ST subjects. At study end, 80% of SF (82%, 82%, 83% and 72% with 10, 20, 40 and 80 mg, respectively) and 59% of ST (60%, 61% and 51% with 20, 40 and 80 mg, respectively) subjects reached LDL-C target. In the ST group, an additional 21-41% reduction in LDL-C was observed over the statin used at baseline. Atorvastatin was well tolerated. CONCLUSION This study confirms that individualizing the starting dose of atorvastatin according to baseline and target LDL-C values (i.e. the required LDL-C reduction), allows a large majority of high-risk subjects to achieve target safely, within 12 weeks, with the initial dose or with a single titration.
Collapse
Affiliation(s)
- P Martineau
- Medical Division, Pfizer Canada, Kirkland, Que., Canada
| | | | | | | | | | | | | |
Collapse
|
41
|
Gülmezoglu AM, Langer A, Piaggio G, Lumbiganon P, Villar J, Grimshaw J. Cluster randomised trial of an active, multifaceted educational intervention based on the WHO Reproductive Health Library to improve obstetric practices. BJOG 2006; 114:16-23. [PMID: 17010115 DOI: 10.1111/j.1471-0528.2006.01091.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We conducted a trial to evaluate the effect of an active, multifaceted educational strategy to promote the use of the WHO Reproductive Health Library (RHL) on obstetric practices. DESIGN Cluster randomised trial. The trial was assigned the International Standardised Randomised Controlled Trial Number ISRCTN14055385. SETTINGS Twenty-two hospitals in Mexico City and 18 in the Northeast region of Thailand. METHODS The intervention consisted primarily of three interactive workshops using RHL over a period of 6 months. The focus of the workshops was to provide access to knowledge and enable its use. A computer and support for using both the computer and RHL were provided at each hospital. The control hospitals did not receive any intervention. MAIN OUTCOME MEASURES The main outcome measures were changes in ten selected clinical practices as recommended in RHL starting approximately four to six months after the third workshop. Clinical practice data were collected at each hospital from 1000 consecutively delivered women or for a 6-month period whichever was reached sooner. RESULTS The active, multifaceted educational intervention we employed did not affect the ten targeted practices in a consistent and substantive way. Iron/folate supplementation, uterotonic use after birth and breastfeeding on demand were already frequently practiced, and we were unable to measure external cephalic version. Of the remaining six practices, selective, as opposed to routine episiotomy policy increased in the intervention group (difference in adjusted mean rate = 5.3%; 95% CI -0.1 to 10.7%) in Thailand, and there was a trend towards an increased use of antibiotics at caesarean section in Mexico (difference in adjusted mean rate = 19.0%; 95% CI: -8.0 to 46.0%). There were no differences in the use of labour companionship, magnesium sulphate use for eclampsia, corticosteroids for women delivering before 34 weeks and vacuum extraction. RHL awareness (24.8-65.5% in Mexico and 33.9-83.3% in Thailand) and use (4.8-34.9% in Mexico and 15.5-76.4% in Thailand) increased substantially after the intervention in both countries. CONCLUSION The multifaceted, active strategy to provide health workers with the knowledge and skills to use RHL to improve their practice led to increased access to and use of RHL, however, no consistent or substantive changes in clinical practices were detected within 4-6 months after the third workshop.
Collapse
Affiliation(s)
- A M Gülmezoglu
- UNDP/UNFPA/WHO/World Bank Special Programme on Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | | | | | | | | | | |
Collapse
|
42
|
Piastra M, Caresta E, Tempera A, Langer A, Zorzi G, Pulitanò S, Chiaretti A, Genovese O, Viola L, Tortorolo L, Polidori G. Sharing features of uncommon respiratory syncytial virus complications in infants. Pediatr Emerg Care 2006; 22:574-8. [PMID: 16912626 DOI: 10.1097/01.pec.0000230704.74022.3e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 11/25/2022]
Abstract
We describe 4 nonconsecutive cases of infants admitted to Catholic University pediatric intensive care unit (PICU) because of complicated respiratory syncytial virus (RSV) infection during winter RSV outbreaks from the year 2000 to the year 2003. A hyponatremic epileptic status (as in the first case) has been reported by several authors as a rare RSV complication, potentially leading to death. The second infant developed a serious pulmonary edema after a subglottic obstruction (croup) associated with RSV infection. The remaining 2 infants developed a pneumothorax and subcutaneous emphysema while breathing spontaneously during an RSV bronchiolitis. In all infants, a full recovery and PICU discharge was achieved despite the need for mechanical ventilation in cases 1 and 2. Increased intrapleural negative pressure or its combination with hypoxia/hypercapnia has been suggested as the common factor possibly joining these different clinical pictures.
Collapse
Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit, Catholic University Medical School, Gemelli Hospital, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Viola L, Langer A, Pulitanò S, Chiaretti A, Piastra M, Polidori G. Serious Pseudomonas aeruginosa infection in healthy children: case report and review of the literature. Pediatr Int 2006; 48:330-3. [PMID: 16732805 DOI: 10.1111/j.1442-200x.2006.02214.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [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: 11/30/2022]
Affiliation(s)
- Luigi Viola
- Pediatric Intensive Care Unit, Institute of Pediatrics, Catholic University of Rome, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
44
|
Langer A, Mayer C. NMR-Characterization of Magnetic Fluids. Z PHYS CHEM 2006. [DOI: 10.1524/zpch.2006.220.1.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Summary
31P-NMR spectra have been measured on aqueous solutions and gels of phosphorylated polyvinyl alcohol in absence and in presence of dispersed magnetic nanoparticles. In this system, the rotational diffusion is still rapid enough for a sufficient averaging of the CSA tensor of the 31P nucleus. At the same time, the lateral diffusion of the 31P nuclei is significantly reduced. Under these circumstances, it is possible to detect the spatial distribution of the local field by 31P-NMR. The obtained line shape exhibits the characteristic shark fin pattern which has been predicted on a theoretical basis. This basically supports the proposed dependence of the NMR line shape on the velocity of lateral diffusion which allows for detailed analysis of lateral motion.
Collapse
|
45
|
Sachtler D, Mayer C, Langer A, Melzer A. Untersuchung des Signalverhaltens verschiedener paramagnetischer Nanopartikel in der Magnetresonanztomographie (MRT). ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-941116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
46
|
Tortorolo L, Langer A, Polidori G, Vento G, Stampachiacchere B, Aloe L, Piedimonte G. Neurotrophin overexpression in lower airways of infants with respiratory syncytial virus infection. Am J Respir Crit Care Med 2005; 172:233-7. [PMID: 15879412 DOI: 10.1164/rccm.200412-1693oc] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Nerve growth factor and its receptors are upregulated in the lungs of weanling rats with lower respiratory tract infection caused by the respiratory syncytial virus (RSV), and this is a major mechanism of the inflammatory response against the virus. However, no information is available in humans. OBJECTIVES We sought to determine whether the expression of neurotrophic factors and receptors is increased in human infants infected with RSV. METHODS We used a highly sensitive immunoassay to measure the concentrations of nerve growth factor and brain-derived neurotrophic factor proteins in serum samples and in the supernatants and cell fractions of nonbronchoscopic bronchoalveolar lavage fluid. We also used immunofluorescence to detect expression in airway cells of the tyrosine kinase receptor TrkA, which binds nerve growth factor with high affinity. Samples were obtained at 24 and 48 hours postintubation from 31 mechanically ventilated infants: 15 patients with RSV infection, 5 patients with respiratory infection negative for RSV, and 11 postsurgical patients without respiratory infection. MAIN RESULTS Data show significantly higher concentrations of both neurotrophins in the cell fractions of bronchoalveolar lavage samples obtained from infants with RSV infection compared with control infants, whereas no significant difference was found in supernatants or serum samples. We also detected tyrosine kinase receptor immunoreactivity only in cells from airways infected with RSV. CONCLUSIONS We conclude that neurotrophic factors and receptors are overexpressed in human airways infected by RSV, and may contribute to airway inflammation and hyperreactivity.
Collapse
Affiliation(s)
- Luca Tortorolo
- Pediatric Pulmonary Research, Batchelor Children's Research Institute, 1580 NW 10th Avenue (D-820), Miami, FL 33136, USA
| | | | | | | | | | | | | |
Collapse
|
47
|
Faisang C, de Teresa E, Gaw A, Gensini G, Leiters L, Martineau P, Langer A. W16-P-027 Achieve cholesterol targets fast with atorvastatin stratified titration: The ACTFAST 2 study. ATHEROSCLEROSIS SUPP 2005. [DOI: 10.1016/s1567-5688(05)80423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
48
|
Abstract
Pain therapy is an important aspect of medical practice for patients of all ages, to optimize care, to obtain an adequate quality of life and to improve their general conditions. Pain is among the most prevalent symptoms experienced by patients undergoing surgery. The success of postoperative pain therapy depends on the ability of the clinician to assess the presenting problems, identify and evaluate pain syndromes and formulate a plan for comprehensive continuing care. The prevalence of acute pain has led to the need to develop techniques for the assessment and management of this symptom in order to focus the attention on an interdisciplinary therapeutic approach (including pharmacologic, cognitive-behavioral, psychologic and physical treatment) and on the timing of different interventions (pre and postoperative). In this chapter we describe the principal therapeutic approaches to control pain in post-operative patients, such as non-opioid, opioid and adjuvant analgesics with particular attention in paediatric age. Moreover we report the principal scales to assess the pain intensity in the post-operative period. The need of a multidisciplinatory team and of a pre and postoperative pain management program represents an important goal in order to obtain effective pain relief and optimize pediatric care and rapid recovery. The introduction of a perioperative team service will improve the approach to pain management programs and it is considered the most important challenge for future.
Collapse
Affiliation(s)
- A Chiaretti
- Paediatric Intensive Care Unit, Catholic University Medical School, Rome, Italy
| | | |
Collapse
|
49
|
Piastra M, Ruggiero A, Langer A, Caresta E, Chiaretti A, Pulitanò S, Polidori G, Riccardi R. Pulmonary Hemorrhage Complicating a Typical Hemolytic-Uremic Syndrome. Respiration 2004; 71:537-41. [PMID: 15467336 DOI: 10.1159/000080643] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 06/10/2003] [Accepted: 10/15/2003] [Indexed: 11/19/2022] Open
Abstract
We describe a case of pulmonary bleeding and subsequent acute respiratory distress syndrome (ARDS) in a 20-month-old female suffering from a typical postdiarrheal hemolytic-uremic syndrome (HUS). Acute renal failure was treated early by peritoneal dialysis. It is of interest to underline that thrombocytopenia or any coagulative impairment was absent when this complication occurred, and spontaneous diuresis recovery was ongoing. All examinations failed to identify a unique site of bleeding in the main stem bronchi or trachea. Complete renal and clinical recovery was obtained in spite of this very uncommon complication. Intensivists should be aware of this rare and potentially fatal complication of typical (D+)HUS.
Collapse
Affiliation(s)
- M Piastra
- Pediatric Intensive Care Unit, Catholic University Medical School, IT-00168 Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
OBJECTIVES To identify new and underutilized technologies that may assist in reducing maternal mortality due to obstetric hemorrhage. METHODS Review of published and unpublished literature, including systematic reviews of randomized trials and individual clinical studies. RESULTS Hemorrhage, primarily postpartum, accounts for approximately 25% of maternal deaths globally. Uterotonic drugs offer great promise for both prevention and management of postpartum hemorrhage (PPH). Other technologies--such as anti-shock garments, umbilical vein injection of oxytocin, and simple anemia detection methods--represent potential new opportunities to reduce PPH-related mortality. CONCLUSIONS Clinical and operational research is needed to answer remaining questions about misoprostol, the anti-shock garment, and umbilical vein injection of oxytocin for retained placenta. Efforts are needed to ensure the availability of technologies with proven value, such as oxytocin in Uniject prefilled injection devices. Equally important, technologies and techniques with proven efficacy--such as active management of third-stage labor and aortic compression--must be translated into general use by disseminating the evidence for them, incorporating them into national guidelines and training curricula, and ensuring the availability of supportive supplies and equipment.
Collapse
Affiliation(s)
- V D Tsu
- Program for Appropriate Technology in Health, Seattle, WA, USA.
| | | | | |
Collapse
|