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Abstract
Objective: Gender parity lags in academic medicine. We applied the Rank Equity Index (REI) to compare the longitudinal progress of women's academic medicine careers. We hypothesized that women have different rank parity in promotion by specialty based on the proportion of women in the specialty. Materials and Methods: Aggregate data by sex for medical students, residents, assistant professors, associate professors, and professors in nine specialties were obtained from the Association of American Medical Colleges for 2019-2020. Specialties were clustered into terciles based on the proportion of women in the field: upper (obstetrics and gynecology, pediatrics, psychiatry), middle (internal medicine, emergency medicine, anesthesia), and lower (surgery, urology, and orthopedic surgery). We calculated the percentage representation by sex by specialty and rank to calculate REI. Specialty-specific REI comparisons between each rank were performed to assess parity in advancement. Results: Only specialties in the upper tercile recruited proportionally more women medical students to residency training. All specialties advanced women for the resident-to-assistant professor with psychiatry, internal medicine, emergency medicine, anesthesia, urology, and orthopedic surgery that promoted women faculty at rates above parity. No specialty demonstrated parity in advancement based on sex for the assistant professor-to-associate professor or associate professor-to-professor transitions. Conclusion: Gender inequity in advancement is evident in academic medicine starting at the assistant professor-to-associate professor stage, regardless of overall proportion of women in the specialty. This suggests a common set of barriers to career advancement of women faculty in academic medicine that must be addressed starting at the early career stage.
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Affiliation(s)
- Moon O Lee
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Brenda Flores
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California, USA
| | - Cherri Hobgood
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Sekhar A, Lopes J, Dahal R, Flores B, Yohannan S, Patel A, Parikh A, Mukherjee D. OUTCOMES AFTER OUT-OF-HOSPITAL CARDIAC ARREST (OHCA) IN PREDOMINANTLY HISPANIC POPULATION IN EL PASO. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01715-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Haverfield MC, Victor R, Flores B, Altamirano J, Fassiotto M, Kline M, Weimer-Elder B. Qualitatively exploring the impact of a relationship-centered communication skills training program in improving patient perceptions of care. PEC Innov 2022; 1:100069. [PMID: 37213728 PMCID: PMC10194165 DOI: 10.1016/j.pecinn.2022.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/07/2022] [Accepted: 07/23/2022] [Indexed: 05/23/2023]
Abstract
Objective To explore qualitative patient experience comments before and after a relationship-centered communication skills training to understand patient experience, program impact, and opportunities for improvement. Methods Qualitative patient experience evaluation data was captured from January 2016 to December 2018 for 483 health care clinicians who participated in the skills training. A random sampling of available open-ended patient comments (N = 33,223) were selected pre-training (n = 668) and post-training (n = 566). Comments were coded for valence (negative/neutral/positive), generality versus specificity, and based on 12 communication behaviors reflective of training objectives. Results No significant difference was found in the valence of comments, or generality versus specificity of comments before and after the training. A significant decrease was present in perceived clinician concern. "Confidence in care provider" was the communication skill most frequently identified in comments both pre- and post-training. Conclusion Perceptions of interactions largely remained the same following training. Key relationship-centered communication skills require further attention in future training efforts. Measurements of patient satisfaction and engagement may not adequately represent patient experience. Innovation This study identified areas for improvement in the training program and offers a model for utilizing patient experience qualitative data in understanding communication training impact.
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Affiliation(s)
- Marie C. Haverfield
- Department of Communication Studies, San Jose State University, San Jose, CA, USA
- Corresponding author at: 220 E. San Fernando Street, San Jose, CA 95112, USA.
| | - Robert Victor
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Brenda Flores
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Merisa Kline
- Physician Partnership Program Patient Experience, Stanford Health Care, Stanford, CA, USA
| | - Barbette Weimer-Elder
- Physician Partnership Program Patient Experience, Stanford Health Care, Stanford, CA, USA
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Chick CF, Singh A, Anker LA, Buck C, Kawai M, Gould C, Cotto I, Schneider L, Linkovski O, Karna R, Pirog S, Parker-Fong K, Nolan CR, Shinsky DN, Hiteshi PN, Leyva O, Flores B, Matlow R, Bradley T, Jordan J, Carrion V, O’Hara R. A school-based health and mindfulness curriculum improves children's objectively measured sleep: a prospective observational cohort study. J Clin Sleep Med 2022; 18:2261-2271. [PMID: 34170222 PMCID: PMC9435327 DOI: 10.5664/jcsm.9508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/30/2021] [Accepted: 06/06/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Poor sleep impedes children's cognitive, emotional, and psychosocial development. Pediatric sleep dysregulation is common, and children who live in communities of low socioeconomic status experience additional risk factors for short sleep duration and poor sleep quality. School-based training in mindfulness and yoga-informed practices can improve children's behavior and well-being, but effects on objectively measured sleep are unknown. METHODS Effects of a school-based health and mindfulness curriculum, which taught practices such as paced breathing, on sleep and stress were examined in 115 children (49 girls, ages 8 to 11 at baseline). Fifty-eight children in a community of low socioeconomic status received the curriculum twice weekly for 2 years. Fifty-seven children in a socioeconomic status-matched community engaged in their usual physical education class instead. In-home ambulatory polysomnography and perceived social stress were measured in all children at 3 time points: at baseline (ie, prior to curriculum exposure) and at 2 yearly follow-ups. RESULTS Children receiving the curriculum gained an average of 74 minutes of total sleep time, and 24 minutes of rapid eye movement sleep, per night over the 2-year study period. Children not receiving the curriculum experienced a decrease in total sleep time averaging 64 minutes per night, with no changes in rapid eye movement sleep. Sleep improved within the first 3 months of curriculum exposure, in a dose-dependent fashion. Higher curriculum engagement (eg, using the breathing exercises outside of class) was associated with larger gains in total and rapid eye movement sleep duration. Aggregate within-group changes in social stress were not significant. However, among children receiving the curriculum, those who experienced larger gains in total and rapid eye movement sleep duration also experienced larger increases in perceived social stress. CONCLUSIONS A school-based health and mindfulness curriculum improved children's objectively measured sleep over 2 years. Social stress did not mediate these effects; instead, mindfulness training may have increased awareness of environmental stressors, while developing tools to reduce stress vulnerability. CITATION Chick CF, Singh A, Anker LA, et al. A school-based health and mindfulness curriculum improves children's objectively measured sleep: a prospective observational cohort study. J Clin Sleep Med. 2022;18(9):2261-2271.
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Affiliation(s)
- Christina F. Chick
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, California
| | - Anisha Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Rutgers University, New Brunswick, New Jersey
| | - Lauren A. Anker
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, California
| | - Casey Buck
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Makoto Kawai
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, California
| | - Christine Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, California
| | - Isabelle Cotto
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Logan Schneider
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, California
| | - Omer Linkovski
- Department of Medical Neurobiology and The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Rosy Karna
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Sophia Pirog
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Northwestern University, Evanston, Illinois
| | - Kai Parker-Fong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Christian R. Nolan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- San Francisco State University, San Francisco, California
| | - Deanna N. Shinsky
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Priyanka N. Hiteshi
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Western University of Health Sciences, Pomona, California
| | - Oscar Leyva
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Massachusetts General Hospital, Boston, Massachusetts
| | - Brenda Flores
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Ryan Matlow
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Travis Bradley
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Josh Jordan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Victor Carrion
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Ruth O’Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, California
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Flores B, Falsetta M. Azoles May Target Underlying Mechanism(s) of Localized Provoked Vulvodynia. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.05.121] [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]
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Falsetta M, Flores B, Fischer S, Bekauri T, Maddipati KR, Honn K, Haidaris C, Foster D, Wood R. “Off-label” use of common medicines could target the vulvodynia mechanism. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.05.007] [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: 11/28/2022]
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7
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Burton É, Flores B, Jerome B, Baiocchi M, Min Y, Maldonado YA, Fassiotto M. Assessment of Bias in Patient Safety Reporting Systems Categorized by Physician Gender, Race and Ethnicity, and Faculty Rank: A Qualitative Study. JAMA Netw Open 2022; 5:e2213234. [PMID: 35594045 PMCID: PMC9123495 DOI: 10.1001/jamanetworkopen.2022.13234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/14/2022] Open
Abstract
IMPORTANCE Patient safety reporting systems (PSRSs) are designed to decrease the risk of harm to patients due to medical errors. Owing to the voluntary nature of PSRSs, implicit bias of the reporter may affect the management of safety events reported. Stanford Alert For Events (SAFE) is the PSRS used at Stanford Health Care. OBJECTIVE To examine whether variation exists in the content of SAFE reports based on demographic characteristics of physicians who are the subject of the event report. DESIGN, SETTING, AND PARTICIPANTS This retrospective qualitative analysis from a single academic medical center evaluated SAFE reports from March 2011 to February 2020. Event reports were coded by theme and categorized by severity (scale of 1 to 3, with 1 being the lowest and 3 the highest). The reports were then analyzed from October 2020 to February 2022 and categorized by physician gender, race and ethnicity, and faculty rank. A total of 501 patient safety events were collected from the adult hospital during the study period, and 100 were excluded owing to incompleteness of information. MAIN OUTCOMES AND MEASURES This qualitative study had no planned outcome. RESULTS A qualitative analysis was performed on 401 reports representing 187 physicians (138 [73.8%] male and 49 [26.2%] female). In terms of race and ethnicity, 4 physicians (2.1%) were African American, 49 (26.2%) were Asian; 7 (3.7%), Hispanic or Latinx; 108 (57.7%), White; and 19 (10.2%), declined to state. Female physicians had disproportionate representation among reports referencing communication and conversational issues and the lowest severity level. Male physicians had disproportionate representation for ignoring or omitting procedures, process issues, and physical intimidation. African American physicians had disproportionate representation for lack of communication and process issues. Asian physicians had disproportionate representation for lack of communication, process issues, conversational conduct, and the lowest severity level. Latinx physicians had disproportionate representation for conversational conduct. White physicians had disproportionate representation for ignoring or omitting procedures, verbal abuse, physical intimidation, and the highest severity level. CONCLUSIONS AND RELEVANCE In this qualitative study, female physicians and physicians who were members of racial and ethnic minority groups were more likely to be reported for low-severity communication issues compared with their male and White counterparts, respectively. These findings suggest that there may be a lower threshold for reporting events when the subject of the report is female and/or a member of a racial or ethnic minority group. Restructuring the reporting and management of patient safety events may be needed to facilitate conflict resolution in a manner that reduces implicit bias and fosters team cohesion.
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Affiliation(s)
- Élan Burton
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Brenda Flores
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Palo Alto, California
| | - Barbara Jerome
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Palo Alto, California
| | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
| | - Yan Min
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
| | - Yvonne A. Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Palo Alto, California
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Palo Alto, California
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Flores B, Ramírez E, Moncada A, Salinas N, Fischer R, Hernández C, Mora-Sánchez B, Sheleby-Elías J, Jirón W, Balcázar JL. Antimicrobial effect of Moringa oleifera seed powder against Vibrio cholerae isolated from the rearing water of shrimp (Penaeus vannamei) postlarvae. Lett Appl Microbiol 2021; 74:238-246. [PMID: 34806784 DOI: 10.1111/lam.13604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/01/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
Shrimp farming has experienced rising costs as a result of disease outbreaks associated with Vibrio spp. Suitable strategies for disease prevention and control are therefore urgently needed. This study aimed to evaluate the antimicrobial effect of Moringa oleifera seed powder against Vibrio cholerae in the rearing water of Pacific white shrimp (Penaeus vannamei) postlarvae. In vitro assays included the determination of minimum inhibitory concentration (MIC) of M. oleifera seed powder against V. cholerae, whereas in vivo assays included the effect of M. oleifera seed powder on bacterial load and water quality parameters in the rearing tanks, as well as its effect on shrimp postlarvae survival. M. oleifera seed powder inhibited the growth of V. cholerae with MIC values of 62·5 µg ml-1 . Moreover, seawater pH of treated tanks (8·66) was significantly lower (P < 0·01) than pH of the control tanks (9·02), whereas the visibility of treated tanks (37·08 cm) was significantly higher (P < 0·01) as compared to control tanks (35·37 cm). Likewise, V. cholerae load was significantly reduced (P < 0·01) from 4·7 × 104 to 3·1 × 103 CFU per ml in tanks treated with M. oleifera seed powder. Altogether, this study demonstrates the antimicrobial activity of M. oleifera against V. cholerae in shrimp culture.
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Affiliation(s)
- B Flores
- Centro Veterinario de Diagnóstico e Investigación (CEVEDI), Departamento de Veterinaria y Zootecnia, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - E Ramírez
- Departamento Acuícola, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - A Moncada
- Departamento Acuícola, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - N Salinas
- Departamento Acuícola, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - R Fischer
- Department of Epidemiology and Biostatistics, Texas A & M University Health Science Center, College Station, TX, USA
| | - C Hernández
- Departamento Acuícola, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - B Mora-Sánchez
- Centro Veterinario de Diagnóstico e Investigación (CEVEDI), Departamento de Veterinaria y Zootecnia, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua.,Department of Animal Pathology, Faculty of Veterinary Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - J Sheleby-Elías
- Centro Veterinario de Diagnóstico e Investigación (CEVEDI), Departamento de Veterinaria y Zootecnia, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - W Jirón
- Centro Veterinario de Diagnóstico e Investigación (CEVEDI), Departamento de Veterinaria y Zootecnia, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - J L Balcázar
- Catalan Institute for Water Research (ICRA), Girona, Spain
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Fassiotto M, Flores B, Victor R, Altamirano J, Garcia LC, Kotadia S, Maldonado Y. Rank Equity Index: Measuring Parity in the Advancement of Underrepresented Populations in Academic Medicine. Acad Med 2020; 95:1844-1852. [PMID: 32889948 DOI: 10.1097/acm.0000000000003720] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
As educators, researchers, clinicians, and administrators, faculty serve pivotal roles in academic medical centers (AMCs). Thus, the quality of faculty members' experiences is inseparable from an AMC's success. In seeking new methods to assess equity in advancement in academic medicine, the authors developed the Rank Equity Index (REI)-adapted from the Executive Parity Index, a scale previously implemented within the business sector-to examine national data on gender and racial/ethnic equity across faculty ranks. The REI was employed on self-reported demographic data, collected by the Association of American Medical Colleges, from U.S. medical school faculty in 2017, to make pairwise rank comparisons of the professoriate by demographic characteristics and department. Overall results indicated that women did not attain parity at any pairwise rank comparison, while men were above parity at all ranks. Similar results were observed across all departments surveyed: women in the basic sciences had REIs closest to parity, women in pediatrics had the highest representation but had REIs that were further from parity than REIs in the basic sciences, and women in surgery demonstrated the lowest REIs. Nationally, REIs were below 1.00 for all racial/ethnic group rank comparisons except for White and, in one case, multiple-race non-Hispanic/Latinx. Across all analyzed departments, Black/African American, Asian, Hispanic/Latinx, and multiple-race Hispanic/Latinx faculty had REIs below parity at all ranks except in 2 cases. In a comparison of 2017 and 2007 data, REIs across both race/ethnicity and gender were lower in 2007 for nearly all groups. REI analyses can highlight inequities in faculty rank that may be masked when using aggregate faculty proportions, which do not account for rank. The REI provides AMCs with a new tool to better analyze institutional data to inform efforts to increase parity across all faculty ranks.
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Affiliation(s)
- Magali Fassiotto
- M. Fassiotto is associate dean for faculty development and diversity, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Brenda Flores
- B. Flores is research and program officer, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Robert Victor
- R. Victor is research and program officer, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Jonathan Altamirano
- J. Altamirano is senior research analyst, Office of Faculty Development and Diversity and Global Child Health Program, Stanford University School of Medicine, Stanford, California
| | - Luis C Garcia
- L.C. Garcia is a medical student and research assistant, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Shaila Kotadia
- S. Kotadia is director of culture and inclusion, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Yvonne Maldonado
- Y. Maldonado is professor of pediatrics and of epidemiology and population health, and senior associate dean for faculty development and diversity, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
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Abstract
The number of health disparities disproportionately affecting minority communities continue to rise. Thus, it is imperative to assess whether equity within medical school enrollment and along the academic pipeline has mirrored this growth, especially among elite surgical specialties such as otolaryngology. Census and educational data from 2010 and 2018 were used to assess the current otolaryngology, surgery, and internal medicine physician and faculty workforce diversity across each stage of the academic medicine trajectory by race and ethnicity. We found that disparities exist in medical school enrollment for minority students such that Hispanic/Latinx representation was only 30% and Black representation only 50% of their respective proportions in the US population in 2018. Disparities in achieving full professorship were also observed across all 3 specialties but most prominently in otolaryngology, with 1% Black representation among otolaryngology professors in 2018. A collective strategy toward diversifying the otolaryngology workforce should be explored.
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Affiliation(s)
- Mahbuba Tusty
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Brenda Flores
- Office of Faculty Development and Diversity, School of Medicine, Stanford University, Stanford, California, USA
| | - Robert Victor
- Office of Faculty Development and Diversity, School of Medicine, Stanford University, Stanford, California, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, School of Medicine, Stanford University, Stanford, California, USA
| | - Yvonne Maldonado
- Office of Faculty Development and Diversity, School of Medicine, Stanford University, Stanford, California, USA
| | - Javier Howard
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Tulio A Valdez
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
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Abdallah E, Souzae Silva V, Aguiar S, Takahashi R, Flores B, Braun A, Alves V, Rodríguez Tarazona J, Chinen L, Mello C. Circulating tumor cells levels correlate with carcinoembryonic antigen in patients with high-risk colon cancer who experienced disease progression. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.150] [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] Open
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Flores B, Ortiz M. Branding: A competitive strategy in the wine industry. BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191203010] [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: 11/14/2022] Open
Abstract
Over the years the wine has had a considerable development in terms of competitiveness given that more and more companies are joining this agro-industrial market and it is crucial to develop strategies such as branding aimed at the country variant so that this In this way, greater international support and recognition of a good land that harvests quality wine is generated. For this reason, in the following work we can observe a theoretical framework directed towards the explanation of competitiveness in a general way together with the development of the concept of branding together with the country variant, mentioned above, so that in this way there is a contribution towards the wine industry, a concept that is also explained in a concise way to give the reader an overview of the importance of the relationship between branding and competitiveness. This work is a qualitative analysis based on a descriptive-documentary study.
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Redondo MJ, Geyer S, Steck AK, Sharp S, Wentworth JM, Weedon MN, Antinozzi P, Sosenko J, Atkinson M, Pugliese A, Oram RA, Antinozzi P, Atkinson M, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Colman P, Gottlieb P, Herold K, Insel R, Kay T, Knip M, Marks J, Moran A, Palmer J, Peakman M, Philipson L, Pugliese A, Raskin P, Rodriguez H, Roep B, Russell W, Schatz D, Wherrett D, Wilson D, Winter W, Ziegler A, Benoist C, Blum J, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Kaufman F, Leschek E, Mahon J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Roncarolo M, Simell O, Sherwin R, Siegelman M, Steck A, Thomas J, Trucco M, Wagner J, Greenbaum ,CJ, Bourcier K, Insel R, Krischer JP, Leschek E, Rafkin L, Spain L, Cowie C, Foulkes M, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Kenyon NS, Santiago I, Sosenko JM, Bundy B, Abbondondolo M, Adams T, Amado D, Asif I, Boonstra M, Bundy 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P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 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Abstract
Measurements of cell cycle kinetics have been found to correlate with the clinical course of patients with breast cancer. However, the thymidine labeling index and more rapid methods like flow cytometry remain complicated and costly. We assessed cell proliferation of 67 breast carcinomas by an immunoperoxidase procedure using a monoclonal antibody, Ki-67, which reacts with a nuclear antigen in proliferating cells. The percentage of Ki-67 positive cells ranged from 2% to 70 %. Tumors with high mitotic rate, high nuclear grade, high histologic grade, and negative estrogen receptors had statistically higher Ki-67 labeling rates. We found no significant differences between the Ki-67 labeling rate and other clinical (age at diagnosis, menopausal status) or pathologic (necrosis, fibrosis, vascular invasion, lymphatic invasion, cellular reaction, tumor size, lymph node metastases) features assessed. These results parallel previously reported data, and confirm that this immunohistochemical staining of breast carcinoma by Ki-67 monoclonal antibody can be considered a rapid and convenient method for assessing cell cycle kinetics. However, further studies, evaluating the correlation between Ki-67 labeling rate and prognosis are needed to better define the real usefulness of this analysis in clinical practice.
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Affiliation(s)
- S Crispino
- Divisione di Radioterapia Oncologica, Nuovo Ospedale San Gerardo Monza, Milano-Italy
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Gonzalez-Cano T, Chung M, Flores B, Martinez M, Murray A, Ross J, Lee S. ETHNICITY AND SOCIOECONOMIC STATUS AS PLAYERS IN COMMUNITY-DWELLING OLDER ADULTS’ FALLS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T.V. Gonzalez-Cano
- University of Texas Health Science Center at San Antonio, San Antonio, Texas,
- South Texas Veterans Health Care System, San Antonio, Texas
| | - M. Chung
- University of Texas Health Science Center at San Antonio, San Antonio, Texas,
| | - B. Flores
- University of Texas Health Science Center at San Antonio, San Antonio, Texas,
| | - M. Martinez
- University of Texas Health Science Center at San Antonio, San Antonio, Texas,
| | - A. Murray
- University of Texas Health Science Center at San Antonio, San Antonio, Texas,
| | - J. Ross
- University of Texas Health Science Center at San Antonio, San Antonio, Texas,
- South Texas Veterans Health Care System, San Antonio, Texas
| | - S. Lee
- South Texas Veterans Health Care System, San Antonio, Texas
- University of Texas Health Science Center at San Antonio, San Antonio, Texas,
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Affiliation(s)
- L.C. Arevalo-Flechas
- GRECC, South Texas Veterans Health Care System, San Antonio, Texas,
- The University of TX HSC at San Antonio, San Antonio, Texas
| | - M. Martinez
- GRECC, South Texas Veterans Health Care System, San Antonio, Texas,
- The University of TX HSC at San Antonio, San Antonio, Texas
| | - B. Flores
- The University of TX HSC at San Antonio, San Antonio, Texas
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Sangüesa C, Campos J, Sanz J, Flores B, Espinosa M, Andreu J, Mulero J. AB1045 Diagnostic Value of Minor Salivary Gland Biopsy for Sjögren's Syndrome in a Cohort of 100 Patients. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3720] [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]
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Treglia G, Paone G, Flores B, Venzi G, Ceriani L, Giovanella L. A rare case of large cell neuroendocrine carcinoma of the urinary bladder evaluated by 18F-FDG-PET/CT. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2013.10.002] [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]
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Treglia G, Paone G, Flores B, Venzi G, Ceriani L, Giovanella L. A rare case of large cell neuroendocrine carcinoma of the urinary bladder evaluated by ¹⁸F-FDG-PET/CT. Rev Esp Med Nucl Imagen Mol 2014; 33:312-3. [PMID: 24440201 DOI: 10.1016/j.remn.2013.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 10/03/2013] [Accepted: 10/03/2013] [Indexed: 10/25/2022]
Affiliation(s)
- G Treglia
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - G Paone
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - B Flores
- Institute of Pathology, Locarno, Switzerland
| | - G Venzi
- Service of Urology, Regional Hospital of Lugano, Lugano, Switzerland
| | - L Ceriani
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - L Giovanella
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Sánchez-Bel P, Egea I, Martínez-Madrid MC, Flores B, Romojaro F. Influence of irrigation and organic/inorganic fertilization on chemical quality of almond (Prunus amygdalus cv. Guara). J Agric Food Chem 2008; 56:10056-10062. [PMID: 18847209 DOI: 10.1021/jf8012212] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The chemical quality of almonds variety Guara cultivated in nonirrigated farming (NI) and drip-irrigated farming (DI) conditions with different fertilizing treatments, two organic treatments (T1 and T2) and a mineral treatment (C), all of them with a N-P-K proportion of 1-2-1, is studied. Almonds obtained in irrigated farming showed higher content in sugars and organic acids and a better quality of oil. Among the fertilizing treatments employed, the organic ones have shown the best results related to chemical quality, regardless of the quantity of fertilizer employed (9.5 kg per T1 tree vs 4.5 kg per T2 tree). The organic treatments produced almonds with a higher content of sugar, organic acids and fiber and a similar fat content. These results are interesting from a commercial point of view since the consumers, even under the same conditions of chemical quality, prefer those products cultivated under organic conditions due to their benefits for health and because these practices are environment-friendly.
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Affiliation(s)
- P Sánchez-Bel
- Department of Biology of the Stress and Plant Pathology, CEBAS-CSIC, Apdo. 4195, 3100 Murcia, Spain.
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Escobar R, Ortiz A, Miranda A, Flores B. G.P.11.14 Detection of auditory neuropathy in a Charcot-Marie-Tooth patient type 1 with neurophysiological studies. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.221] [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]
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Del Pozo P, Lirón R, Pérez-Cuadrado E, Campillo-Soto A, Flores B, Miguel-Perelló J, Martín JG, Moreno A, Aguayo JL. [Colonic perforation during a colonoscopy secondary to a torsion of an epiploic appendix]. Rev Esp Enferm Dig 2006; 98:792-3. [PMID: 17094730] [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: 05/12/2023]
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Elías Y, Poblano A, Flores B, Arteaga C, Flores T, Pineda G. P04.10 Thinner abuse alters peak of frequency of EEG spectra analyses. Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.227] [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: 11/28/2022]
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Gallego AM, Aguayo JL, Flores B, Soria T, Hernández Q, Ortiz S, González-Costea R, Parrilla P. Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath haematoma. Br J Surg 2005. [DOI: 10.1046/j.1365-2168.1997.02803.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Flores B, Candel M, Soria V, Ayala F, García T, Aguayo J. Dispositivos de acceso venoso totalmente implantables para quimioterapia. Resultados y complicaciones. Cir Esp 2003. [DOI: 10.1016/s0009-739x(03)72144-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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de Alcalá Martínez D, Aguayo J, Flores B, Morales G, Pérez-Abad J, Alarte J. Resultados de la hospitalización en pacientes con pie diabético. Cir Esp 2003. [DOI: 10.1016/s0009-739x(03)72195-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Moreno-Egea A, Flores B, Girela E, Martín JG, Aguayo JL, Canteras M. Spigelian hernia: bibliographical study and presentation of a series of 28 patients. Hernia 2002; 6:167-70. [PMID: 12424594 DOI: 10.1007/s10029-002-0077-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [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: 02/14/2002] [Accepted: 07/01/2002] [Indexed: 11/25/2022]
Abstract
Spigelian hernias are rare defects of the abdominal wall. Our aim is to analyse the bibliography and present a series of 28 patients. A Medline bibliographical study was performed between 1970 and 2000 with analysis of the number of cases, series, ratio of cases to year and type of journal. We also present a personal study and analyse epidemiological, diagnostic, and treatment factors. There are 159 articles, 479 cases, and 19 series of more than five patients published in 85 journals (42.3% medical). Our diagnosis was preoperative in 75%, and programmed surgery was 3.6 times more common than emergency surgery. We found a significant relationship between hospital stay and type of surgery (P < 0.02) and surgical technique used (P < 0.001). We found that spigelian hernias have a multidisciplinary interest; they are given almost equal treatment in medical and surgical journals; preoperative diagnosis can be established in 75% of cases; and the best results are offered by the extraperitoneal laparoscopic approach.
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Affiliation(s)
- A Moreno-Egea
- Abdominal Wall Unit, Department of General Surgery, J Ma Morales Meseguer Hospital, Murcia, Spain.
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Moreno-Egea A, Lirón R, Flores B, Girela E, Aguayo J. Reparación laparoscópica de las hernias incisionales mediante malla bilaminar de Parietex: resultados con un año de seguimiento. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71758-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Carrasco L, Flores B, Aguayo JL, Cartagena J, Martin JG. Contribution of the outpatient surgery unit ITO the general surgery department of a district hospital. Ambul Surg 2000; 8:158. [PMID: 10856848 DOI: 10.1016/s0966-6532(00)00050-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The creation of Outpatient Surgery (OPS) units to combine the quality of medical attention and rationalize costs allows for greater efficiency in the use of resources. Aim: To report our series of patients undergoing surgery at the OPS units integrated into our Hospital (Type II): Patients and method: Between May 1994 and March 1998, 832 outpatients, of a total of 5230, underwent surgery at our General Surgery Unit. The criteria for exclusion from the programme depended on the patient and the enviroment or resulted from the operation itself. Results: Mean patient age was 47.5 years; there were 420 males and 412 females. Surgery was performed for 229 inguinofemoral hernias, 47 umbilical-epigastric hernias, nine incisional hernias, 193 pilonidal sinuses, 156 mammary nodules, 65 varicose veins, 64 arteriovenous fistulae and 69 proctology operations. The most common anesthesia techniques performed were rachianesthesia and local anesthesia. Eight point seven percent of the patients required admission (OPS failure), the most frequent causes being excessive pain, orthostatic-syncopal hypotension, nausea and vomiting and urine retention. There was no morbidity or mortality. Conclusion: OPS is a highly efficient procedure for resolving the most common pathologies in General Surgery. The anesthesia technique was an important factor in the rate of failure.
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Affiliation(s)
- L Carrasco
- Department of General Surgery, Surgical Ambulatory Unit, Hospital General Universitario 'J.M. Morales Meseguer', Murcia, Spain
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Flores B, Carrasco L, Aguayo JL, Cartagena J, Liron R, Candel MF. Treatment of the abdominal wall defects in an ambulatory surgical setting: our experience. Ambul Surg 2000; 8:158. [PMID: 10856849 DOI: 10.1016/s0966-6532(00)00051-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The creation of Outpatient Surgery (OPS) units has allowed to reduce the costs and the waiting lists in an efficient fashion. We describe our series of patients operated on for abdominal wall defects, a pathology suitable for ambulatory surgery. Patients and methods: Between May 1994 and March 1998, 206 inguinal hernias, 23 femoral hernias, 47 umbilical-epigastric hernias and nine incisional hernias were operated on in an ambulatory surgical setting. The patients were selected following the selection criteria previously established (related to the patient, the environment and the surgical procedure). The average age was 45 years, and the distribution by sex, 210 men and 75 women. Spinal anesthesia was preferently performed. The surgical techniques employed were Lichtenstein's hernioplasty and Shouldice and Bassini procedures for inguinal hernias; Lichtenstein's plug technique for femoral hernias and simple closure or preperitoneal mesh for the middle line defects. Results: 44 patients needed readmitttance to hospital (failure of OPS), the most important causes being excessive pain, urinary retention and nausea/vomiting. There was no severe morbidity nor mortality. Conclusion: Surgery for abdominal wall defects constitutes a group of procedures suitable for efficient and low risk OPS programs.
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Affiliation(s)
- B Flores
- Department of General Surgery, Ambulatory Surgical Unit, Hospital General Universitario 'J.M. Morales Meseguer', Murcia, Spain
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Lelièvre J, Amor M, Flores B, Gomez M, El-Yahyaoui F, Chatenet C, Périn C, Hernandez JA, Romojaro F, Latché A, Bouzayen M, Pitrat M, Dogimont C, Pech J. ETHYLENE-REGULATED GENES AND CLARIFICATION OF THE ROLE OF ETHYLENE IN THE REGULATION OF RIPENING AND QUALITY IN CANTALOUPE MELON FRUIT. ACTA ACUST UNITED AC 2000. [DOI: 10.17660/actahortic.2000.510.77] [Citation(s) in RCA: 2] [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]
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Aguayo JL, Martínez DA, Flores B, Martín JG, Candel MF, Aguilar J, Muelas MS, Pérez Abad JM, Carrasco L, De Andrés B, Molina J. Pancreaticoduodenectomy due to cancer in the elderly. Rev Esp Enferm Dig 1998; 90:708-13. [PMID: 9824936] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The elderly have traditionally been excluded from pancreaticoduodenectomy due to the high morbimortality of this procedure. Six cases of pancreaticoduodenectomy) 5 cephalic and 1 total) for periampullary tumors in patients over 70 are reported. There was no mortality. We conclude that, in selected cases, pancreaticoduodenectomy can be performed safely in the elderly.
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Affiliation(s)
- J L Aguayo
- Servicio de Cirugía General, Hospital General Universitario J. M. Morales Meseguer, Murcia
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Aguilar J, Rodriguez JM, Flores B, Sola J, Bas A, Soria T, Ramirez P, Parrilla P. Value of repeated fine-needle aspiration cytology and cytologic experience on the management of thyroid nodules. Otolaryngol Head Neck Surg 1998; 119:121-4. [PMID: 9674524 DOI: 10.1016/s0194-5998(98)70182-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
Although fine-needle aspiration is being currently accepted as the most reliable method to select patients with thyroid nodules for surgery, controversy remains about the accuracy in distinguishing benign nodules. We present our results from 636 fine-needle aspirations performed from 1984 to 1989. Our article focuses on the value of cytologic expertise and repeated punctures for follow-up of benign nodules. We found annual figures for specificity and positive predictive value to increase steadily from 1984 to 1989, thus suggesting that the power of the test is proportional to the experience of the cytologist. We also state that the value of performing repeated punctures for the follow-up of unselected benign nodules is low.
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Affiliation(s)
- J Aguilar
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain
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Andrés B, Luján J, Robles R, Aguilar J, Flores B, Parrilla P. Treatment of primary and secondary spontaneous pneumothorax using videothoracoscopy. Surg Laparosc Endosc Percutan Tech 1998; 8:108-12. [PMID: 9566562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Our aim is to assess the results of surgical treatment for spontaneous pneumothorax (SP) using video-assisted thoracoscopic surgery (VATS) and to determine whether this technique is equally effective for primary SP (PSP) and secondary SP (SSP). A prospective study was performed on 54 patients with persistent and recurrent SP (42 PSPs and 12 SSPs). Mean operating time, time before drainage removal, and hospital stay were significantly longer with SSP (67.1 vs. 48.1 minutes; 5.4 vs. 3.6 days; and 7.7 vs. 5.3 days; p < 0.01, respectively). There was one conversion due to bleeding (PSP). Postoperative complications were greater with SSP (33% vs. 12%; p = 0.09). Although these were mild in all cases, the most common was air leak (25 vs. 5%; p = 0.06). The SP persisted in three cases [2 (5%) with PSP, and 1 (8%) with SSP] and recurred in 2 (1 in each group; 2% and 8%, respectively). Follow-up averaged 24 months. VATS is effective in the surgical treatment of PSP and SSP, although the technical difficulty, morbidity rate, hospital stay, and incidence of persistences and recurrences are greater in the latter than in the former.
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Affiliation(s)
- B Andrés
- Department of General Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain
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Gallego AM, Aguayo JL, Flores B, Soria T, Hernández Q, Ortiz S, González-Costea R, Parrilla P. Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath haematoma. Br J Surg 1997. [DOI: 10.1002/bjs.1800840928] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Moreno Gallego A, Aguayo JL, Flores B, Soria T, Hernández Q, Ortiz S, González-Costea R, Parrilla P. Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath haematoma. Br J Surg 1997; 84:1295-7. [PMID: 9313718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Rectus sheath haematoma is a rare cause of abdominal pain. If accurately diagnosed, surgery can be avoided in most cases. This study assessed the role of ultrasonography and computed tomography (CT) in the diagnosis of rectus sheath haematoma. METHODS Thirty cases of rectus sheath haematoma diagnosed over 18 years were reviewed. Mean patient age was 59 years; there were 20 women and ten men. The results of imaging investigations were reviewed to determine their efficiency. Ultrasonography was performed in 21 patients and CT in nine. RESULTS Arterial hypertension, anticoagulant therapy and strained coughing were the most frequent predisposing factors. The most common clinical manifestation was abdominal pain with a palpable mass. Leucocytosis occurred in 18 patients and the haematocrit fell in 13 patients but markedly in seven. Ultrasonography was diagnostic in 15 of 21 patients imaged, and CT was diagnostic in all nine. Treatment was conservative in 22 patients. Eight patients required surgery: four for diagnosis and four for treatment. CONCLUSION Surgery can be avoided in most patients with rectus sheath haematoma. Although the numbers were small, CT appeared to be more accurate than ultrasonography in facilitating the diagnosis.
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Affiliation(s)
- A Moreno Gallego
- Department of General Surgery, University Hospital Virgen de la Arrixaca, Murcia, Spain
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Abstract
Mesenteric cysts are rare abdominal tumors which develop as a result of embryonic defects of the lymphatics. Symptoms derived from this pathology are vague and nonspecific, being frequently abdominal pain, heartburn, and nausea. The treatment of these tumors is complete surgical excision. The laparoscopic approach is replacing open abdominal surgical procedures. We present a case of successful laparoscopic resection of a mesenteric cyst using only three trocars.
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Affiliation(s)
- R Rosado
- General Surgery Department, Hospital del SAS, Huércal-Overa, Almería, Spain
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Rosado R, Aguilar J, Medina P, Ramírez D, Flores B, Silic J. [Do diagnostic laparoscopy and the use of drains favor the appearance of cutaneous metastases after oncological surgery?]. Rev Esp Enferm Dig 1996; 88:231-2. [PMID: 8645522] [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: 02/01/2023]
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Cousin PT, Diaz E, Flores B, Hernandez J. Looking forward: using a sociocultural perspective to reframe the study of learning disabilities. VODD group. J Learn Disabil 1995; 28:656-663. [PMID: 8537782 DOI: 10.1177/002221949502801007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The purpose of this series has been to invite educators involved with individuals with learning disabilities to look through other lenses and listen to other voices. In this article, the authors use a sociocultural perspective of teaching and learning, based on cultural-historical and activity theory, to synthesize the articles of this series and to project where inquiry in the field of learning disabilities might be headed. A model is used to organize the discussion and help illuminate the sociocultural nature of the pathways of ideas, expectations, and activities that either foster or hinder students' school experiences. This final article invites readers to refocus and reframe their conversations about learning disabilities based on the "new visions" that have been presented in this series.
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Affiliation(s)
- P T Cousin
- Advanced Studies Department, California State University, San Bernardino 92407, USA
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Flores B, Piñero A, Ramírez P, De Andrés B, Parrilla P. [Enterovesical fistula in Crohn's disease. Importance of CT and therapeutic management]. Rev Esp Enferm Dig 1995; 87:755-6. [PMID: 8519546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- B Flores
- Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia
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Carrasco L, Sánchez-Bueno F, Sola J, Acosta F, Ramirez P, Robles R, Flores B, Parrilla P. Is exfoliative bile cytology useful in the diagnosis of graft complications in liver transplantation? Transplant Proc 1995; 27:2281-2. [PMID: 7652806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- L Carrasco
- Liver Transplant Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
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Flanagan NG, Kelsey PR, Whitson A, Flores B, Lewis DR, Randall M. Infection in immunocompromised patients with malignant blood disorders in a district general hospital. J Infect 1994; 29:195-202. [PMID: 7806883 DOI: 10.1016/s0163-4453(94)90770-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The pattern and management of infection in immunocompromised patients over a period of 3 years in a district general hospital has been studied. A total of 222 positive cultures was obtained in 607 episodes of suspected infection all involving patients with malignant blood disorders. Febrile episodes requiring intravenous antibiotics occurred in 248 instances involving 107 patients. The pattern of organisms cultured and the responses to various antibiotic regimes are reported. The costs of antibiotic therapy are considered in the light of the overall response. Of the patients studied, 54 died, infection having a likely causative or contributory part in 21 of them (less than 10% of infective episodes). We conclude that the infective complications of these disorders, particularly in older patients, can be efficiently managed in a district general hospital when full supportive facilities are available.
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Affiliation(s)
- N G Flanagan
- Department of Clinical Haematology, Victoria Hospital, Blackpool, Lancs, U.K
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Buxton AE, Rosenthal ME, Marchlinski FE, Miller JM, Flores B, Josephson ME. Usefulness of the electrophysiology laboratory for evaluation of proarrhythmic drug response in coronary artery disease. Am J Cardiol 1991; 67:835-42. [PMID: 1707220 DOI: 10.1016/0002-9149(91)90616-s] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Two potential manifestations of proarrhythmic responses to type IA antiarrhythmic agents in the electrophysiology laboratory were evaluated in 122 patients with chronic coronary artery disease and previous myocardial infarction: (1) conversion of uniform nonsustained ventricular tachycardia (VT) into sustained VT after drug administration, and (2) induction of sustained VT by fewer extrastimuli after drug administration. Forty-two patients were evaluated for nonsustained VT. Eighty patients were evaluated for sustained VT: 30 of these had spontaneous sustained VT only while receiving empiric therapy with quinidine or procainamide, whereas the remaining 50 developed spontaneous VT in the absence of antiarrhythmic drugs. All patients underwent programmed stimulation in the baseline state and after procainamide. Four patients had conversion of induced uniform nonsustained VT into the same morphology, but sustained VT after procainamide administration. These responses only occurred in patients evaluated for nonsustained VT. Over 90% of patients presenting with sustained VT had uniform sustained VT induced at the baseline study and after procainamide, regardless of whether the spontaneous arrhythmia occurred only in the presence or absence of antiarrhythmic drugs. There was no significant difference in the change in mode of induction from baseline to procainamide study, regardless of whether patients had developed spontaneous VT only in the presence or absence of antiarrhythmic drugs. One patient with no inducible VT at the baseline study had inducible uniform sustained VT after procainamide administration, and 1 patient with inducible VT at baseline developed spontaneous sustained uniform VT after procainamide administration. Both patients had developed spontaneous sustained VT only while receiving therapy with type IA agents.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A E Buxton
- Clinical Electrophysiology Laboratory, Hospital of the University of Pennsylvania, Philadelphia 19104
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Marchlinski FE, Flores B, Miller JM, Gottlieb CD, Hargrove WC. Relation of the intraoperative defibrillation threshold to successful postoperative defibrillation with an automatic implantable cardioverter defibrillator. Am J Cardiol 1988; 62:393-8. [PMID: 3414516 DOI: 10.1016/0002-9149(88)90965-4] [Citation(s) in RCA: 101] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To determine the relation between the intraoperative defibrillation threshold and successful postoperative termination of induced ventricular fibrillation (VF) with the automatic implantable cardioverter defibrillator (AICD), 33 patients who underwent AICD implantation were studied. The defibrillation threshold, determined after at least 10 seconds of VF, was 5 J in 2, 10 J in 6, 15 J in 10, 20 J in 10 and 25 J in 5 patients. The AICD energy rating on the first discharge was 28 +/- 1.8 J. Defibrillation of induced VF was demonstrated postoperatively in 29 of 33 (88%) patients. The AICD terminated VF postoperatively in all 18 patients with a defibrillation threshold less than or equal to 15 J. Only 11 of the 15 (73%) patients with a defibrillation threshold greater than or equal to 20 J (p less than 0.04) had VF terminated postoperatively. In all 4 patients in whom the AICD failed to terminate induced VF, the energy difference between the AICD rating and the defibrillation threshold was less than or equal to 10 J. Among the 14 patients with a difference of less than or equal to 10 J between the AICD energy rating and the defibrillation threshold, there were no significant differences between the 4 patients with and the 10 without successful VF termination with respect to the duration of VF induced postoperatively or the AICD lead system. In summary, failure to terminate VF with the AICD is not uncommon (27%) when the defibrillation threshold approaches the energy delivering capacity of the AICD.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F E Marchlinski
- Clinical Electrophysiology Laboratory, Hospital of the University of Pennsylvania, Philadelphia 19104
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Kadish AH, Buxton AE, Waxman HL, Flores B, Josephson ME, Marchlinski FE. Usefulness of electrophysiologic study to determine the clinical tolerance of arrhythmia recurrences during amiodarone therapy. J Am Coll Cardiol 1987; 10:90-6. [PMID: 3598000 DOI: 10.1016/s0735-1097(87)80165-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The relation of clinical and electrophysiologic variables to outcome was evaluated in 121 patients treated with amiodarone for sustained ventricular tachyarrhythmias. Electrophysiologic study was performed in all patients a mean of 14 days after beginning amiodarone therapy. Forty-six patients who were given oral amiodarone therapy experienced arrhythmia recurrence. Multivariate analysis was performed using 16 clinical and electrophysiologic variables to determine which factors were associated with 1) arrhythmia recurrence and 2) a poorly tolerated arrhythmia recurrence (that is, cardiac arrest or sudden cardiac death) during oral amiodarone therapy. No variable predicted arrhythmia recurrence. Five variables correlated significantly with a poorly tolerated arrhythmia recurrence. Hemodynamic stability of the arrhythmia induced on electrophysiologic testing during amiodarone therapy had the best predictive value (p less than 0.001). Younger age, lower ejection fraction, a poorly tolerated rhythm at clinical presentation and absence of left ventricular aneurysm were also associated with a poorly tolerated arrhythmia recurrence. Only 3 of 57 patients who had a well tolerated arrhythmia induced on electrophysiologic testing during amiodarone therapy had recurrence of a poorly tolerated arrhythmia versus 19 of 47 who had hemodynamically unstable arrhythmias induced during amiodarone therapy (p less than 0.001). Thus, electrophysiologic testing during amiodarone therapy appears useful in identifying patients who are prone to have catastrophic arrhythmia recurrences and could allow for the institution of additional or alternative modes of therapy.
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Abstract
In 11 of 25 patients (44%) with sustained ventricular tachycardia (VT) who received intravenous verapamil (5 to 10 mg), acute severe hypotension or loss of consciousness developed, necessitating immediate cardioversion. Comparison of these 11 patients with the 14 who did not have adverse effects after verapamil revealed no significant difference in age, heart disease, ejection fraction, blood pressure before verapamil administration, other oral or intravenous drugs use, verapamil dose or VT characteristics (rate and morphologic pattern). Although most patients with severe adverse effects after verapamil had prior myocardial infarction, deterioration also occurred in patients without coronary disease and in patients with a normal left ventricular ejection fraction. VT terminated after verapamil infusion in 6 patients. No single electrocardiographic morphologic pattern characterized these patients. A control group of 25 patients presenting with hemodynamically stable VT who received other antiarrhythmic agents was examined. Hypotension developed in only 1 patient during acute therapy and did not require emergency cardioversion. Thus, although verapamil may terminate VT, severe adverse effects occur much more often. Use of verapamil to differentiate supraventricular tachycardia with aberrant conduction from ventricular tachycardia is hazardous.
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Cimolai N, Gill MJ, Jones A, Flores B, Stamm WE, Laurie W, Madden B, Shahrabadi MS. "Campylobacter cinaedi" bacteremia: case report and laboratory findings. J Clin Microbiol 1987; 25:942-3. [PMID: 3584432 PMCID: PMC266127 DOI: 10.1128/jcm.25.5.942-943.1987] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
"Campylobacter cinaedi" was isolated from the blood of a 29-year-old homosexual man with previously diagnosed acquired immune deficiency syndrome. Subculturing of the organism was achieved with the use of 7% lysed horse blood and 10% sheep blood agars at 37 degrees C in a microaerophilic atmosphere. Problems associated with the culturing of this organism are reviewed.
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Flores B, Hernández G, Lepe A, Contreras MC, Sandoval L, Villarroel F, Rojas A, González O, Schenone H. [Epidemiology of Chagas' disease in Chile. Rural sectors. Domiciliary triatomid infestation and Trypanosoma cruzi infection of the vector and domestic mammals in Region V 1983]. Bol Chil Parasitol 1984; 39:62-65. [PMID: 6443179] [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: 05/21/2023]
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