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Simmonds WM, Awuku Y, Barrett C, Brand M, Davidson K, Epstein D, Fredericks E, Gabriel S, Grobler S, Gounden C, Katsidzira L, Louw VJ, Naidoo V, Noel C, Ogutu E, Ramonate N, Seabi N, Setshedi M, Van Zyl J, Watermeyer G, Kassianides C. Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa. S Afr Med J 2024; 114:e711. [PMID: 38525666 DOI: 10.7196/samj.2024.v114i1b.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Over 30% of the world's population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID anaemia involves referral to a gastroenterologist. The current drive towards patient blood management in sub-Saharan Africa (SSA)prescribes that we regulate not only the use of blood transfusion but also the management of patients in whom the cause of iron loss or inadequate iron absorption is sought. Recommendations have been developed to: (i) aid clinicians in the evaluation of suspected gastrointestinal iron loss and iron malabsorption, and often a combination of these; (ii) improve clinical outcomes for patients with gastrointestinal causes of ID; (iii) provide current, evidence-based, context-specific recommendations for use in the management of ID; and (iv) conserve resources by ensuring rational utilisation of blood and blood products. METHOD Development of the guidance document was facilitated by the Gastroenterology Foundation of Sub-Saharan Africa and the South African Gastroenterology Society. The consensus recommendations are based on a rigorous process involving 21 experts in gastroenterology and haematology in SSA. Following discussion of the scope and purpose of the guidance document among the experts, an initial review of the literature and existing guidelines was undertaken. Thereafter, draft recommendation statements were produced to fulfil the outlined purpose of the guidance document. These were reviewed in a round-table discussion and were subjected to two rounds of anonymised consensus voting by the full committee in an electronic Delphi exercise during 2022 using the online platform, Research Electronic Data Capture. Recommendations were modified by considering feedback from the previous round, and those reaching a consensus of over 80% were incorporated into the final document. Finally, 44 statements in the document were read and approved by all members of the working group. CONCLUSION The recommendations incorporate six areas, namely: general recommendations and practice, Helicobacter pylori, coeliac disease, suspected small bowel bleeding, inflammatory bowel disease, and preoperative care. Implementation of the recommendations is aimed at various levels from individual practitioners to healthcare institutions, departments and regional, district, provincial and national platforms. It is intended that the recommendations spur the development of centre-specific guidelines and that they are integrated with the relevant patient blood management protocols. Integration of the recommendations is intended to promote optimal evaluation and management of patients with ID, regardless of the presence of anaemia.
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Affiliation(s)
- W M Simmonds
- Gastroenterology Division, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - Y Awuku
- Department of Medicine, University of Health and Allied Sciences, Ho, Ghana.
| | - C Barrett
- School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - M Brand
- Department of General Surgery, School of Medicine, University of Pretoria, South Africa.
| | - K Davidson
- Private practice, IBD nurse specialist, Cape Town, South Africa.
| | - D Epstein
- Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - E Fredericks
- Department of Medicine, Stellenbosch University, South Africa.
| | - S Gabriel
- Gastroenterology Unit, Tygerberg Hospital and Stellenbosch University, South Africa.
| | - S Grobler
- niversitas Netcare Private Hospital, Bloemfontein, South Africa.
| | - C Gounden
- Department of Gastroenterology, School of Clinical Medicine, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
| | - L Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
| | - V J Louw
- Division of Clinical Haematology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - V Naidoo
- Department of Gastroenterology, School of Clinical Medicine, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
| | - C Noel
- Division of Gastrointestinal Surgery, Department of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - E Ogutu
- Department of Internal Medicine, University of Nairobi and Kenyatta National Hospital, Kenya.
| | - N Ramonate
- Gastroenterology Division, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - N Seabi
- Gastroenterology Division, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
| | - M Setshedi
- Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - J Van Zyl
- Department of Internal Medicine, Faculty of Health Sciences, University of the Free State and Netcare Universitas Private Hospital, Bloemfontein, South Africa.
| | - G Watermeyer
- Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - C Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Morningside Mediclinic, Johannesburg, South Africa.
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Rusin CG, Acosta SI, Brady KM, Vu E, Scahill C, Fonseca B, Barrett C, Simsic J, Yates AR, Klepczynski B, Gaynor WJ, Penny DJ. Automated prediction of cardiorespiratory deterioration in patients with single-ventricle parallel circulation: A multicenter validation study. JTCVS Open 2023; 15:406-411. [PMID: 37808061 PMCID: PMC10556807 DOI: 10.1016/j.xjon.2023.05.012] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/13/2023] [Accepted: 05/02/2023] [Indexed: 10/10/2023]
Abstract
Objectives Patients with single-ventricle physiology have a significant risk of cardiorespiratory deterioration between their first- and second-stage palliation surgeries. Detection of deterioration episodes may allow for early intervention and improved outcomes. Methods A prospective study was executed at Nationwide Children's Hospital, Children's Hospital of Philadelphia, and Children's Hospital Colorado to collect physiologic data of subjects with single ventricle physiology during all hospitalizations between neonatal palliation and II surgeries using the Sickbay software platform (Medical Informatics Corp). Timing of cardiorespiratory deterioration events was captured via chart review. The predictive algorithm previously developed and validated at Texas Children's Hospital was applied to these data without retraining. Standard metrics such as receiver operating curve area, positive and negative likelihood ratio, and alert rates were calculated to establish clinical performance of the predictive algorithm. Results Our cohort consisted of 58 subjects admitted to the cardiac intensive care unit and stepdown units of participating centers over 14 months. Approximately 28,991 hours of high-resolution physiologic waveform and vital sign data were collected using the Sickbay. A total of 30 cardiorespiratory deterioration events were observed. the risk index metric generated by our algorithm was found to be both sensitive and specific for detecting impending events one to two hours in advance of overt extremis (receiver operating curve = 0.927). Conclusions Our algorithm can provide a 1- to 2-hour advanced warning for 53.6% of all cardiorespiratory deterioration events in children with single ventricle physiology during their initial postop course as well as interstage hospitalizations after stage I palliation with only 2.5 alarms being generated per patient per day.
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Affiliation(s)
- Craig G. Rusin
- Department of Pediatrics—Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex
| | - Sebastian I. Acosta
- Department of Pediatrics—Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex
| | - Kennith M. Brady
- Department of Anesthesiology, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Eric Vu
- Department of Anesthesiology, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Carly Scahill
- Department of Pediatrics—Cardiology, Children's Hospital Colorado, Aurora, Colo
| | - Brian Fonseca
- Department of Pediatrics—Cardiology, Children's Hospital Colorado, Aurora, Colo
| | - Cindy Barrett
- Department of Pediatrics—Cardiology, Children's Hospital Colorado, Aurora, Colo
| | - Janet Simsic
- Department of Pediatrics—Cardiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Andrew R. Yates
- Department of Pediatrics—Cardiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Brenna Klepczynski
- Department of Cardiovascular Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - William J. Gaynor
- Department of Cardiovascular Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Daniel J. Penny
- Department of Pediatrics—Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex
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Curzen N, Nicholas Z, Stuart B, Wilding S, Hill K, Shambrook J, Eminton Z, Ball D, Barrett C, Johnson L, Nuttall J, Fox K, Connolly D, O'Kane P, Hobson A, Chauhan A, Uren N, Mccann GP, Berry C, Carter J, Roobottom C, Mamas M, Rajani R, Ford I, Douglas P, Hlatky MA. Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial. Eur Heart J 2021; 42:3844-3852. [PMID: 34269376 PMCID: PMC8648068 DOI: 10.1093/eurheartj/ehab444] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [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: 02/17/2021] [Revised: 05/10/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Aims Fractional flow reserve (FFRCT) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFRCT would improve economic and clinical outcomes compared with standard care. Methods and results Overall, 1400 patients with stable chest pain in 11 centres were randomized to initial testing with CTCA with selective FFRCT (experimental group) or standard clinical care pathways (standard group). The primary endpoint was total cardiac costs at 9 months. Secondary endpoints were angina status, quality of life, major adverse cardiac and cerebrovascular events, and use of invasive coronary angiography. Randomized groups were similar at baseline. Most patients had an initial CTCA: 439 (63%) in the standard group vs. 674 (96%) in the experimental group, 254 of whom (38%) underwent FFRCT. Mean total cardiac costs were higher by £114 (+8%) in the experimental group, with a 95% confidence interval from −£112 (−8%) to +£337 (+23%), though the difference was not significant (P = 0.10). Major adverse cardiac and cerebrovascular events did not differ significantly (10.2% in the experimental group vs. 10.6% in the standard group) and angina and quality of life improved to a similar degree over follow-up in both randomized groups. Invasive angiography was reduced significantly in the experimental group (19% vs. 25%, P = 0.01). Conclusion A strategy of CTCA with selective FFRCT in patients with stable angina did not differ significantly from standard clinical care pathways in cost or clinical outcomes, but did reduce the use of invasive coronary angiography.
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Affiliation(s)
- N Curzen
- Faculty of Medicine, University of Southampton.,Coronary Research Group, University Hospital Southampton
| | - Z Nicholas
- Coronary Research Group, University Hospital Southampton
| | - B Stuart
- Clinical Trials Unit, University of Southampton
| | - S Wilding
- Clinical Trials Unit, University of Southampton
| | - K Hill
- Clinical Trials Unit, University of Southampton
| | - J Shambrook
- Cardiothoracic Radiology, University Hospital Southampton
| | - Z Eminton
- Clinical Trials Unit, University of Southampton
| | - D Ball
- Clinical Trials Unit, University of Southampton
| | - C Barrett
- Clinical Trials Unit, University of Southampton
| | - L Johnson
- Clinical Trials Unit, University of Southampton
| | - J Nuttall
- Clinical Trials Unit, University of Southampton
| | - K Fox
- Imperial College, London, UK
| | | | - P O'Kane
- Dorset Heart Centre, University Hospitals Dorset, Bournemouth
| | - A Hobson
- Queen Alexandra Hospital, Portsmouth
| | | | - N Uren
- Royal Infirmary, Edinburgh
| | - G P Mccann
- Department of Cardiovascular Sciences, University of Leicester & NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - C Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow
| | - J Carter
- University Hospital of North Tees, Stockton on Tees
| | | | - M Mamas
- Royal Stoke University Hospital, Stoke-on-Trent
| | - R Rajani
- Guy's & St Thomas' Hospital, London
| | - I Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow
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Oh Y, Hennessey A, Young L, Yates D, Barrett C. OP0274-PARE EVALUATION OF PATIENT SATISFACTION FOR TELEHEALTH (PHONE AND VIDEO) IN RHEUMATOLOGY OUTPATIENTS DURING COVID-19 PANDEMIC. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Telehealth via phone (TPhone) or video conference (TVideo) in rheumatology has been a topic of interest for many years. Its use was rapidly expanded due to the international public health emergency of coronavirus disease-19 (COVID-19) outbreak in 2020. Australian Medicare Benefits Schedule (MBS) swiftly enabled temporary MBS telehealth items on 13 March 2020, currently extended until 31 March 20211. In the early phase of the COVID-19 pandemic, Antony et al. conducted a single-centre public survey to assess patient perception of rheumatology telehealth. Their results showed that 98.4% of patients consider telehealth acceptable during the pandemic2. It is unclear, however, whether this positive perception persists after patients experience a telehealth. In addition, a survey data in 2019 suggested more than half of Australian rheumatologists work in private practice3. Therefore, inclusion of private patients will better represent patient perception of telehealth.Objectives:The aim of this study was to evaluate patient satisfaction with telehealth during the COVID-19 pandemic. This would determine its feasibility to be integrated in future rheumatology outpatient model.Methods:A questionnaire containing 30 questions was sent to rheumatology patients who attended telehealth appointments at a level 2 public hospital and a local private clinic between April and May 2020. The questionnaires aimed to obtain information on baseline demographics (sex, age, public or private patient, employment status, visual or auditory impairment), appointment details (TPhone or TVideo, usual arrangement for face-to-face (F2F) appointment, cost effectiveness) and appointment satisfaction using a 5-point Likert scale. Descriptive statistical analysis was conducted.Results:The questionnaire was sent to 1452 patients, of which 494 patients responded (34%). Female predominance (77.1%) and a higher proportion of TPhone (79.1%) was seen in the respondents. A majority of patients were existing patients known to the services (90.9%). More than 70% of responses indicated overall satisfaction in specialist care via telehealth, and 88.7% perceived this suitable during a pandemic. Of all respondents, 21.7% were prescribed new medication, and the majority of these patients were confident in taking the new medication after the telehealth appointment. Future acceptability for TPhone was significantly lower in private patients compared to public patients (p= 0.01). Subgroup analysis revealed that higher telehealth satisfaction was associated with needing to take time off work to attend face-to-face appointment (p= 0.02), perception of cost effectiveness (p<0.001) and TVideo (p=0.03).Conclusion:This is the first study which included both public and private rheumatology patients to evaluate patient satisfaction for telehealth during the COVID-19 pandemic. Overall high level of satisfaction was seen in telehealth most notably associated with its cost effectiveness. A higher percentage of patients who had TVideo compared to TPhone were receptive to future telehealth via TVideo, supportive of the importance of visual cues. This in turn will have significant administrative and technological burdens to coordinate in comparison to a F2F or TPhone review. This qualitative study provides valuable insight of patient perception of telehealth, which has the potential to compliment the traditional rheumatology outpatient model of care following the pandemic.References:[1]COVID-19 Temporary MBS Telehealth Services 2020 [Available from: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB.[2]Antony A, Connelly K, De Silva T, Eades L, Tillett W, Ayoub S, et al. Perspectives of Patients With Rheumatic Diseases in the Early Phase of COVID-19. Arthritis Care & Research. 2020;72(9):1189-95.[3]Association AR. Workforce Survey Exective Summary 2019 2019 [Available from: https://rheumatology.org.au/members/documents/WorkforceSurveyExecutiveSummary-websiteMay2019.pdf.Acknowledgements:University of QueenslandNursing staff at Redcliffe Hospital and Administration officers at Redcliffe & Northside RheumatologyDisclosure of Interests:None declared
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Barrett C, Stein Z, Hernandez J, Naraparaju R, Schulz U, Tetard L, Raghavan S. Detrimental effects of sand ingression in jet engine ceramic coatings captured with Raman-based 3D rendering. Ann Ital Chir 2021. [DOI: 10.1016/j.jeurceramsoc.2020.09.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chatterjee D, Houska N, Barrett C, Ing RJ. Standardizing Outcomes for Survivors of Pediatric Cardiac Arrests. J Cardiothorac Vasc Anesth 2021; 35:1927-1929. [PMID: 33618963 DOI: 10.1053/j.jvca.2021.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Cindy Barrett
- Department of Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
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Ing RJ, Barrett C, Chatterjee D, Twite M, Whitney GM. Perioperative Preparations for COVID-19: The Pediatric Cardiac Team Perspective. J Cardiothorac Vasc Anesth 2020; 34:2307-2311. [PMID: 32451272 PMCID: PMC7187810 DOI: 10.1053/j.jvca.2020.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Richard J Ing
- Department of Anesthesiology; University of Colorado School of Medicine
| | - Cindy Barrett
- University of Colorado School of Medicine; Department of Cardiology, Children's Hospital Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Mark Twite
- Department of Anesthesiology; University of Colorado School of Medicine
| | - Gina M Whitney
- Department of Anesthesiology; University of Colorado School of Medicine
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Reungwetwattana T, Gray J, Markovets A, Nogami N, Lee J, Cho B, Chewaskulyong B, Majem M, Peled N, Vishwanathan K, Todd A, Rukazenkov Y, Johnson M, Barrett C, Chmielecki J, Hartmaier R, Ramalingam S. Longitudinal circulating tumour DNA (ctDNA) monitoring for early detection of disease progression and resistance in advanced NSCLC in FLAURA. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz446.016] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Gray J, Peled N, Markovets A, Nogami N, Lee JS, Cho B, Chewaskulyong B, Majem M, Reungwetwattana T, Vishwanathan K, Todd A, Rukazenkov Y, Johnson M, Barrett C, Chmielecki J, Hartmaier R, Ramalingam S. Longitudinal circulating tumour DNA (ctDNA) monitoring for early detection of disease progression and resistance in advanced NSCLC in FLAURA. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.083] [Citation(s) in RCA: 1] [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] Open
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Di Maria MV, Barrett C, Rafferty C, Wolfe K, Kelly SL, Liptzin DR, Brigham D, Younoszai A. Initiating a Fontan multidisciplinary clinic: Decreasing care variability, improving surveillance, and subsequent treatment of Fontan survivors. CONGENIT HEART DIS 2019; 14:590-599. [PMID: 30957968 DOI: 10.1111/chd.12769] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/29/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Children with single ventricle (SV) heart disease who undergo Fontan operation are at risk for developing multiorgan dysfunction. Although survival has improved, significant comorbidities involving multiple organ systems may develop, requiring evaluation and management by many subspecialists. Using data from an internal survey, we documented high care variability for our Fontan population. We then developed a multidisciplinary clinic, designed and implemented a clinical care pathway to decrease variability of patient assessment. METHODS After creating a multidisciplinary team and a clinical care pathway, we initiated a multidisciplinary clinic (MDC) where patients could see multiple subspecialists during a single encounter. We then monitored our effectiveness by retrospective chart review to determine care pathway adherence (process measure) and incidence of new diagnoses of end-organ injury (outcome measure) as well interventions implemented. Adherence was analyzed using statistical process control (SPC) charts. RESULTS Eighty-six patients were seen in the MDC from January 2016 to September 2017. The proportion of patients with appropriate testing increased, related to strong care pathway adherence. A significant amount of novel pathology was diagnosed in all evaluated organ systems, both Fontan-associated comorbidities and general pediatric diagnoses. Subsequent interventions included cardiac catheterization n = 21 (31%) with more than half of these patients undergoing intervention n = 17 (20%), and liver biopsy n = 9 (10%). Additionally, 58 patients (67%) were referred to a neuropsychologist based on perceived clinical need, with n = 34 (40%) undergoing a neuropsychological evaluation. CONCLUSIONS Children who have undergone Fontan palliation are at risk for developing cardiac and noncardiac comorbidities. Use and adherence to an institutional care pathway resulted in the diagnosis of significant novel pathology and subsequently provided opportunity for intervention.
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Affiliation(s)
- Michael V Di Maria
- Heart Institute, Section of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Cindy Barrett
- Heart Institute, Section of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Carey Rafferty
- Heart Institute, Section of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Kelly Wolfe
- Heart Institute, Section of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Sarah L Kelly
- Heart Institute, Section of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Deborah R Liptzin
- Breathing Institute, Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Dania Brigham
- Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Adel Younoszai
- Heart Institute, Section of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
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Alexander K, Barrett C, Dobos K, Cheng P, Liao R, Wheeler M, Liedtke M, Weisshaar D, Witteles R. Contemporary Outcomes in Patients with Cardiac Amyloidosis Undergoing Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.524] [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] Open
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Cho B, Cheng Y, Zhou C, Ohe Y, Imamura F, Lin MC, Majem M, Shah R, Rukazenkov Y, Todd A, Markovets A, Barrett C, Chmielecki J, Gray J, Ramalingam S. Mechanisms of acquired resistance to first-line osimertinib: Preliminary data from the phase III FLAURA study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy483.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jone PN, Gould R, Barrett C, Younoszai AK, Fonseca B. Data-Driven Quality Improvement Project to Increase the Value of the Congenital Echocardiographic Report. Pediatr Cardiol 2018; 39:726-730. [PMID: 29350246 DOI: 10.1007/s00246-018-1812-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Abstract
Echocardiography is the primary diagnostic modality for congenital heart disease patients. The written report is used to communicate with the care team and organization is often divided into the body with detailed findings and the conclusions with important findings summarized. Strategies to increase workflow efficiency include batch writing of reports after performance of multiple echocardiograms and the use of report templates which may contribute to discrepancies within report leading to potential downstream medical errors. The aim of this project was to measure the rate of inconsistencies in the echocardiogram reports and through an iterative series of process improvement decrease this rate while maintaining sonographer efficiency and diagnostic accuracy. The discrepancy rate, diagnostic error rate, and sonographer productivity were collected one-year prior and during the iterative quality improvement process. The primary outcome and discrepancies in reports were determined by two reviewers: an experienced pediatric echocardiographic cardiologist and a senior sonographer. Minor discrepancies were defined as contradictions between the body and the conclusion of the report that were unlikely to affect patient care. Major discrepancies were defined as discrepancies between the body and the conclusion that had significant potential to affect patient care. Sonographer productivity was measured as studies per sonographer per month. Our primary intervention was to initiate a quarterly QI meeting and to decrease the batch writing of preliminary echocardiogram reports. No major discrepancies were identified pre- or post-intervention. The minor discrepancies decreased from 40.7 to 6%. Sonographer productivity was not significantly changed with a slight increase from 100 studies/sonographer/month during the baseline to 101 studies/sonographer/month during the intervention. There was no change in major or minor diagnostic error rate. Our quality improvement intervention increased the value of our reports by significantly decreasing minor discrepancies without negatively impacting sonographer productivity or diagnostic accuracy.
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Affiliation(s)
- Pei-Ni Jone
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA.
| | - Ruthanne Gould
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA
| | - Cindy Barrett
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA
| | - Adel K Younoszai
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA
| | - Brian Fonseca
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA
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Friedlander M, Rau J, Lee C, Meier W, Lesoin A, Kim JW, Poveda A, Buck M, Scambia G, Shimada M, Hilpert F, King M, Debruyne P, Bologna A, Malander S, Monk B, Petru E, Calvert P, Herzog T, Barrett C, du Bois A. Quality of life in patients with advanced epithelial ovarian cancer (EOC) randomized to maintenance pazopanib or placebo after first-line chemotherapy in the AGO-OVAR 16 trial. Measuring what matters—patient-centered end points in trials of maintenance therapy. Ann Oncol 2018; 29:737-743. [DOI: 10.1093/annonc/mdx796] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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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15
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Ehrmann DE, Mulvahill M, Harendt S, Church J, Stimmler A, Vichayavilas P, Batz S, Rodgers J, DiMaria M, Jaggers J, Barrett C, Kaufman J. Toward standardization of care: The feeding readiness assessment after congenital cardiac surgery. CONGENIT HEART DIS 2017; 13:31-37. [PMID: 29148256 DOI: 10.1111/chd.12550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/21/2017] [Accepted: 10/28/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Feeding practices after neonatal and congenital heart surgery are complicated and variable, which may be associated with prolonged hospitalization length of stay (LOS). Systematic assessment of feeding skills after cardiac surgery may earlier identify those likely to have protracted feeding difficulties, which may promote standardization of care. METHODS Neonates and infants ≤3 months old admitted for their first cardiac surgery were retrospectively identified during a 1-year period at a single center. A systematic feeding readiness assessment (FRA) was utilized to score infant feeding skills. FRA scores were assigned immediately prior to surgery and 1, 2, and 3 weeks after surgery. FRA scores were analyzed individually and in combination as predictors of gastrostomy tube (GT) placement prior to hospital discharge by logistic regression. RESULTS Eighty-six patients met inclusion criteria and 69 patients had complete data to be included in the final model. The mean age of admit was five days and 51% were male. Forty-six percent had single ventricle physiology. Twenty-nine (42%) underwent GT placement. The model containing both immediate presurgical and 1-week postoperative FRA scores was of highest utility in predicting discharge with GT (intercept odds = 10.9, P = .0002; sensitivity 69%, specificity 93%, AUC 0.913). The false positive rate was 7.5%. CONCLUSIONS In this analysis, systematic and standardized measurements of feeding readiness employed immediately before and one week after congenital cardiac surgery predicted need for GT placement prior to hospital discharge. The FRA score may be used to risk stratify patients based on likelihood of prolonged feeding difficulties, which may further improve standardization of care.
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Affiliation(s)
- Daniel E Ehrmann
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Matthew Mulvahill
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shaunda Harendt
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Audiology, Speech Pathology, & Learning Services, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jessica Church
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amy Stimmler
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Piyagarnt Vichayavilas
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Clinical Nutrition, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sanja Batz
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Occupational Therapy, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jennifer Rodgers
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Occupational Therapy, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Michael DiMaria
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - James Jaggers
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Cindy Barrett
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jon Kaufman
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA
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Sun J, Li Y, Milbury C, Skoletsky J, Burns C, Yip W, Luo J, Dewal N, Johnson A, Gowen K, Tong J, He Y, He J, White J, Roels S, Tsuji A, Truesdell J, Peters E, Gilbert H, Wu C, Schleifman E, Barrett C, Thress K, Jenkins S, Elvin J, Otto G, Lipson D, Ross J, Miller V, Stephens P, Doherty M, Vietz C. P2.02-052 A Clinically-Validated Universal Companion Diagnostic Platform for Cancer Patient Care. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1230] [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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17
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Keane F, Greally M, Harrold E, Barrett C, McCaffrey J. Epithelioid Angiomyolipoma - a case report and review of the literature. Ir Med J 2017; 110:604. [PMID: 29341516] [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: 06/07/2023]
Abstract
Herein we present the case of a 43-year-old female in whom a left renal mass was identified incidentally on imaging performed for staging of a newly diagnosed breast carcinoma. The mass was resected and histologic examination and immunohistochemistry confirmed a diagnosis of epithelioid angiomyolipoma.
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Affiliation(s)
- F Keane
- Department of Medical Oncology, Mater Misericordiae Hospital, Dublin
| | - M Greally
- Department of Medical Oncology, Mater Misericordiae Hospital, Dublin
| | - E Harrold
- Department of Medical Oncology, Mater Misericordiae Hospital, Dublin
| | - C Barrett
- Department of Pathology, Mater Misericordiae Hospital, Dublin
| | - J McCaffrey
- Department of Medical Oncology, Mater Misericordiae Hospital, Dublin
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18
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Comiskey D, Api A, Barrett C, Ellis G, McNamara C, O'Mahony C, Robison S, Rose J, Safford B, Smith B, Tozer S. Integrating habits and practices data for soaps, cosmetics and air care products into an existing aggregate exposure model. Regul Toxicol Pharmacol 2017; 88:144-156. [DOI: 10.1016/j.yrtph.2017.05.017] [Citation(s) in RCA: 1034] [Impact Index Per Article: 147.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/08/2017] [Accepted: 05/23/2017] [Indexed: 12/11/2022]
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19
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Ng C, Rozen G, Biton Y, Leyton-Mange J, Barrett C. P389Direct ultrasound visualization in combination with micropuncture needle reduces vascular access complications in cardiac electrophysiological procedures. Europace 2017. [DOI: 10.1093/ehjci/eux141.114] [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: 11/12/2022] Open
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20
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Ing RJ, Twite M, Barrett C. Review of the Society of Thoracic Surgeons Congenital Heart Surgery Database: 2017 Update on Outcomes and Quality Implications for the Anesthesiologist. J Cardiothorac Vasc Anesth 2017; 31:1934-1938. [PMID: 29107588 DOI: 10.1053/j.jvca.2017.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Richard J Ing
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Mark Twite
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Cindy Barrett
- Department of Cardiology and Critical Care, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
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21
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Chowdhury D, Gurvitz M, Marelli A, Anderson J, Baker-Smith C, Diab KA, Edwards TC, Hougen T, Jedeikin R, Johnson JN, Karpawich P, Lai W, Lu JC, Mitchell S, Newburger JW, Penny DJ, Portman MA, Satou G, Teitel D, Villafane J, Williams R, Jenkins K, Williams R, Jenkins K, Gurvitz M, Marelli A, Campbell R, Chowdhury D, Jedeikin R, Behera S, Hokanson J, Lu J, Kakavand B, Boris J, Cardis B, Bansal M, Anderson J, Schultz A, O'Connor M, Vinocur JM, Halnon N, Johnson J, Barrett C, Graham E, Krawczeski C, Franklin W, McGovern J, Hattendorf B, Teitel D, Cotts T, Davidson A, Harahsheh A, Johnson W, Jone PN, Sutton N, Tani L, Dahdah N, Portman M, Mensch D, Newburger J, Hougen T, Cross R, Diab K, Karpawich P, Lai W, Peuster M, Schiff R, Saarel E, Satou G, Serwer G, Villafane J, Edwards T, Penny D, Carlson K, Jayakumar KA, Park M, Tede N, Uzark K, Baker Smith C, Fleishman C, Connuck D, Ettedgui J, Likes M, Tsuda T. Development of Quality Metrics in Ambulatory Pediatric Cardiology. J Am Coll Cardiol 2017; 69:541-555. [DOI: 10.1016/j.jacc.2016.11.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/25/2016] [Accepted: 11/18/2016] [Indexed: 11/24/2022]
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22
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Barrett C, Henderson R, Galwey N, Flint S, Gibson A, Savage C. THU0006 Novel Changes in B and T-Cell Phenotypes with Belimumab in An Autoantibody Mediated Disease. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1508] [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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23
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Oxnard G, Thress K, Alden R, Lawrance R, Paweletz C, Cantarini M, Barrett C, Yang J, Jänne P. 135O_PR: Plasma genotyping for predicting benefit from osimertinib in patients (pts) with advanced NSCLC. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30328-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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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24
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Yeh T, Jacobs V, Angell H, Geradts J, Hou J, Karakunnel J, Barrett C. 60PD Inhibition of pEGFR in paired tumour biopsies from TKI treatment-naïve EGFR mutant NSCLC patients treated with gefitinib (EGFR inhibitor) or gefitinib in combination with durvalumab (anti-PD-L1). J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30173-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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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25
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Reddy V, Short S, Barrett C, Washington M, Williams C. BVES is Regulated in Response to Radiation and Influences Intestinal Stem Cell Programs and Recovery After Radiation. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.178] [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: 10/22/2022]
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26
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Timms K, Neff C, Morris B, Hodgson D, Orr M, Zhongwu L, Fielding A, Dougherty B, Spencer S, Robertson J, Barrett C, Gutin A, Lanchbury J. 466 Next generation sequencing of BRCA1 and BRCA2 genes in ovarian tumors captures all germline mutations and expands the potential treatment group for the PARP inhibitor olaparib. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30300-8] [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: 10/22/2022]
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27
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Jarmuz P, Ocali O, Baldwin M, Sakkas D, Barrett C. Success rates of rescue ICSI and analysis of embryo cleavage rates by real time video imaging. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.943] [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: 11/30/2022]
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28
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Helsby N, Yang J, Goldthorpe M, Barrett C, Wilson G, Broom R, Findlay M, Porter D. CYP2C19 Phenoconversion in patients with Breast Cancer and alterations in Bioactivation of Cyclophosphamide. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.123] [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: 10/23/2022]
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29
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Kaufman J, Vichayavilas P, Rannie M, Peyton C, Carpenter E, Hull D, Alpern J, Barrett C, da Cruz EM, Roosevelt G. Improved nutrition delivery and nutrition status in critically ill children with heart disease. Pediatrics 2015; 135:e717-25. [PMID: 25687139 DOI: 10.1542/peds.2014-1835] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This initiative sought to improve nutrition delivery in critically ill children with heart disease admitted to the cardiac ICU (CICU) and neonates undergoing stage 1 palliation (S1P) for single-ventricle physiology through interdisciplinary team interventions. Specific goals were increased caloric and protein delivery for all patients and a more nourished state for infants with single ventricles at the time of discharge. METHODS We developed a nutrition flow sheet in the electronic health record to track whether daily nutrition goals were met. Interventions included nurses reporting daily whether caloric and protein goals were met, mandatory involvement of feeding specialists, and introduction of an enteral nutrition guideline. For infants undergoing S1P, weight-for-age z score (as an indicator for assessing malnutrition) was calculated at admission and discharge. RESULTS The percentage of patient days per month when daily caloric goals were met increased from 50.1% to 60.7%, and protein goals met increased from 51.6% to 72.7%. Hospital length of stay, need for ventilation, and mortality did not differ. Patients undergoing S1P demonstrated a statistically significant improvement in weight-for-age z score compared with the preintervention group (P = .003). Thirteen S1P patients were discharged undernourished in the preintervention group; 5 were severely undernourished. In the intervention group, 4 patients were discharged undernourished, and none were severely undernourished. CONCLUSIONS This initiative resulted in improved nutrition delivery for a heterogeneous population of cardiac patients in the CICU as well as significant improvements in weight gain and nourishment status at discharge in infants undergoing S1P.
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Affiliation(s)
- Jon Kaufman
- The Heart Institute at Children's Hospital Colorado, Department of Pediatrics,
| | - Piyagarnt Vichayavilas
- The Heart Institute at Children's Hospital Colorado, Clinical Nutrition at Children's Hospital Colorado, and
| | - Michael Rannie
- Clinical Informatics at Children's Hospital Colorado, Aurora, Colorado
| | - Christine Peyton
- The Heart Institute at Children's Hospital Colorado, School of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | - Esther Carpenter
- The Heart Institute at Children's Hospital Colorado, School of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | - Danielle Hull
- Clinical Nutrition at Children's Hospital Colorado, and
| | - Jennifer Alpern
- The Heart Institute at Children's Hospital Colorado, School of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | - Cindy Barrett
- The Heart Institute at Children's Hospital Colorado, Department of Pediatrics
| | - Eduardo M da Cruz
- The Heart Institute at Children's Hospital Colorado, Department of Pediatrics
| | - Genie Roosevelt
- Department of Emergency Medicine, Denver Health Hospital Authority, Denver, Colorado
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30
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Rooney C, Geh C, Williams V, Cresswell C, Al-Kadhimi K, Dymond M, French T, Smith P, Barrett C, Harrington E, Kilgour E. 520 Validation of Nanostring for FGFR1 gene expression analysis in squamous non-small cell lung cancer (sqNSCLC) tissue. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70646-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: 11/25/2022]
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31
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Nomura H, Hanker L, Fabbro M, Rau J, Kim Y, Arija JA, Friedlander M, Ferrandina G, Vuylsteke P, Colombo N, Malander S, Monk B, Petru E, Calvert P, Herzog T, Barrett C, Jobanputra M, Wang Q, Elser G, Du Bois A. Pazopanib Versus Placebo in Women Without Progression After First-Line Chemotherapy for Advanced Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer (Aeoc): Second Interim Overall Survival Analysis from the Ago-Ovar16 Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.6] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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32
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Barrett C, van Uum S, Lenders JW. Risks of catecholaminergic crisis following steroid administration in patients with an adrenal mass: a literature review. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372147] [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: 10/25/2022]
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33
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Ellis WC, Butler K, Campbell D, Barrett C, Buckvold S. One-way valve malfunction in an extracorporeal membrane oxygenation priming circuit. J Extra Corpor Technol 2014; 46:98-100. [PMID: 24779127 PMCID: PMC4557520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Abstract
Developing technologies have changed both the components and the management style when extracorporeal membrane oxygenation (ECMO) is used to support critically ill cardiac and respiratory patients. The Cardiohelp system is a small, portable extracorporeal system just recently available within the United States. Manufacturing standards and quality processes have made mechanical failure and malfunction of extracorporeal components less common; however, there is still potential for mechanical failure or component malfunction before or during extracorporeal support. This case review describes the malfunction of a Retroguard unidirectional flow valve integrated into the priming setup of a Cardiohelp system during the priming process.
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Abstract
Australia is a vast country with one-third of the population living outside capital cities. Providing specialist rheumatologist services to regional, rural and remote Australians has generally required expensive and time-consuming travel for the patient and/or specialist. As a result, access to specialist care for remote Australians is poor. Rheumatoid arthritis is a common disease, but like many rheumatic diseases, it is complex to treat. Time-dependent joint damage and disability occur unless best evidence care is implemented. The relatively poor access to rheumatologist care allotted to nonmetropolitan Australians therefore represents a significant cause of potentially preventable disability in Australia. Telehealth has the potential to improve access to specialist rheumatologists for patients with rheumatoid arthritis and other rheumatic diseases, thereby decreasing the burden of disability caused by these diseases. Advances in videoconferencing technology, the national broadband rollout and recent Federal government financial incentives have led to a heightened interest in exploring the use of this technology in Australian rheumatology practice. This review summarises the current evidence base, outlines telehealth's strengths and weaknesses in managing rheumatic disease, and discusses the technological, medicolegal and financial aspects of this model of care. A mixed model offering both face-to-face and virtual consultations appears to be the best option, as it can overcome the barriers to accessing care posed by distance while also mitigating the risks of virtual consultation.
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Affiliation(s)
- L J Roberts
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
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Barrett C, Thiagarajan R. Reply: To PMID 22921236. Ann Thorac Surg 2013; 96:376-7. [PMID: 23816102 DOI: 10.1016/j.athoracsur.2013.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 03/04/2013] [Accepted: 03/25/2013] [Indexed: 11/30/2022]
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36
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Kaufman J, Twite M, Barrett C, Peyton C, Koehler J, Rannie M, Kahn MG, Schofield S, Ing RJ, Jaggers J, Hyman D, da Cruz EM. A Handoff Protocol from the Cardiovascular Operating Room to Cardiac ICU Is Associated with Improvements in Care Beyond the Immediate Postoperative Period. Jt Comm J Qual Patient Saf 2013; 39:306-11. [DOI: 10.1016/s1553-7250(13)39043-6] [Citation(s) in RCA: 34] [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: 11/26/2022]
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37
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Affiliation(s)
- L. J. Roberts
- Department of Rheumatology; Townsville Hospital; Townsville
| | - E. G. LaMont
- School of Medicine and Dentistry; James Cook University; Townsville
| | - I. Lim
- BJC Health; Sydney; New South Wales; Australia
| | | | - C. Barrett
- Department of Rheumatology; Redcliffe Hospital; Brisbane; Queensland
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Singhal NR, Da Cruz EM, Nicolarsen J, Schwartz LI, Merritt GR, Barrett C, Twite MD, Ing RJ. Perioperative management of shock in two fontan patients with plastic bronchitis. Semin Cardiothorac Vasc Anesth 2013; 17:55-60. [PMID: 23381614 DOI: 10.1177/1089253213475879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Plastic bronchitis is potentially a life-threatening complication of long-standing surgically palliated single ventricle congenital heart disease. Patients can present with hypoxia requiring urgent bronchoscopy for removal of bronchial casts. Perioperative care for these patients is challenging and anesthesia is associated with significant cardiac risk. As more surgically corrected single ventricle patients survive to adulthood, these patients are expected to present more frequently. This report details the perioperative management of 2 Fontan patients with hypoxia and significant plastic bronchitis disease burden.
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Affiliation(s)
- Niel Raj Singhal
- Children's Hospital Colorado and University of Colorado, Denver, Aurora, CO, USA
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39
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Guild S, Stehlin E, Malpas S, Barrett C. Left Ventricular Pressure (LVP) Measurement in Conscious Small Animals via Telemetry. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.08.035] [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]
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40
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Pinkham M, Barrett C. Sympathetic Activation after Myocardial Infarction in the Rat: Role of the Arterial Baroreflex, Cardiac Afferent Reflexes and Sex. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.08.038] [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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41
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Bowes MJ, Ings NL, McCall SJ, Warwick A, Barrett C, Wickham HD, Harman SA, Armstrong LK, Scarlett PM, Roberts C, Lehmann K, Singer AC. Nutrient and light limitation of periphyton in the River Thames: implications for catchment management. Sci Total Environ 2012; 434:201-12. [PMID: 22035560 DOI: 10.1016/j.scitotenv.2011.09.082] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/01/2011] [Accepted: 09/07/2011] [Indexed: 05/07/2023]
Abstract
Soluble reactive phosphorus (SRP) concentrations in the River Thames, south east England, have significantly decreased from an annual maximum of 2100 μg l(-1) in 1997 to 344 in 2010, primarily due to the introduction of phosphorus (P) removal at sewage treatment works within the catchment. However, despite this improvement in water quality, phytoplankton biomass in the River Thames has greatly increased in recent years, with peak chlorophyll concentrations increasing from 87 μg l(-1) in the period 1997 to 2002, to 328 μg l(-1) in 2009. A series of within-river flume mesocosm experiments were performed to determine the effect of changing nutrient concentrations and light levels on periphyton biomass accrual. Nutrient enrichment experiments showed that phosphorus, nitrogen and silicon were not limiting or co-limiting periphyton growth in the Thames at the time of the experiment (August-September 2010). Decreasing ambient SRP concentration from 225 μg l(-1) to 173 μg l(-1) had no effect on periphyton biomass accrual rate or diatom assemblage. Phosphorus limitation became apparent at 83 μg SRP l(-1), at which point a 25% reduction in periphyton biomass was observed. Diatom assemblage significantly changed when the SRP concentration was reduced to 30 μg l(-1). Such stringent phosphorus targets are costly and difficult to achieve for the River Thames, due to the high population density and intensive agriculture within the Thames basin. Reducing light levels by shading reduced the periphyton accrual rate by 50%. Providing shading along the River Thames by planting riparian tree cover could be an effective measure to reduce the risk of excessive algal growth. If the ecology of the Thames is to reach the WFD's "good ecological status", then both SRP concentration reductions (probably to below 100 μg l(-1)) and increased shading will be required.
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Affiliation(s)
- M J Bowes
- Centre for Ecology and Hydrology, Crowmarsh Gifford, Wallingford, Oxfordshire, UK.
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Eadsforth T, Grewal I, Barrett C, Pillay R. Management and Outcomes of Intentional Durotomies. J Neurol Surg A Cent Eur Neurosurg 2012. [DOI: 10.1055/s-0032-1316241] [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]
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Dahab R, Barrett C, Pillay R, De Matas M. Anterior thigh compartment syndrome after prone positioning for lumbosacral fixation. Eur Spine J 2012; 21 Suppl 4:S554-6. [PMID: 22481550 DOI: 10.1007/s00586-012-2282-3] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/23/2012] [Accepted: 03/14/2012] [Indexed: 12/28/2022]
Abstract
We report a case of a patient who developed anterior thigh compartment syndrome after being positioned prone for instrumented lumbar spine surgery. Although rare, clinicians should be aware that compartment syndrome is a possible complication of spinal surgery.
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Affiliation(s)
- R Dahab
- The Royal Liverpool University Hospital, Liverpool, UK.
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Betit P, Matte GS, Howe R, Iudiciani P, Barrett C, Thiagarajan R, Fynn-Thompson F. The addition of a membrane oxygenator to a ventricular assist device in a patient with acute respiratory distress syndrome. J Extra Corpor Technol 2011; 43:264-266. [PMID: 22416609 PMCID: PMC4557432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 12-year-old boy with Marfan's syndrome required a biventricular assist device (VAD) after an aortic root replacement. The patient developed acute respiratory distress syndrome and required escalating ventilator support. We hypothesized that the addition of a membrane oxygenator in series with the assist device would improve gas exchange and allow for a more lung-protective ventilator approach. A membrane oxygenator was placed in series with the right VAD resulting in a blood path of right atrium to VAD to oxygenator to pulmonary artery. Circuit function was gauged by monitoring flow and oxygenator pressures and periodic circuit inspections and oxygenator blood gases. Heparin was titrated to maintain unfractionated antifactor Xa levels of .3-.7 IU/mL and partial thromboplastin time of 60-80 seconds. The initial sweep gas supplying the oxygenator was 5 L/min at an F1O2 of 1.0, which achieved a pH > 7.40 and a PF ratio > 250. The pre- and post-oxygenator pressures were 55-60 mmHg and 45-50 mmHg, respectively, and the measured flow at the oxygenator outlet was 2.0-2.2 L/min. The patient was changed from high-frequency oscillatory ventilation to pressure-controlled synchronized intermittent ventilation with pH maintained at 7.35-7.40 and PF ratio > 250. Paralytics were discontinued and the patient's neurologic condition was deemed intact. The patient hemorrhaged after a sternal closure and required transfusions and antifibrinolytics that led to thrombus in the membrane and membrane circuitry, which were replaced without incident. The patient's respiratory status remained stable; however, his overall condition worsened as a result of additional organ dysfunction and septicemia, and he did not survive. The addition of a membrane oxygenator to a VAD is feasible and supplements gas exchange permitting the use of more lung protective ventilation.
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Affiliation(s)
- Peter Betit
- Children's Hospital Boston, Respiratory Care, Boston, Massachusetts 02115, USA.
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Beinart R, Danik S, Palacios I, Barrett C, Inglessis I, Agnihotri A, Passeri J. Ventricular tachycardia following trans-apical aortic valve replacement. Europace 2011; 14:450-2. [DOI: 10.1093/europace/eur324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Grimminger PP, Shi M, Barrett C, Lebwohl D, Danenberg KD, Brabender J, Vigen CLP, Danenberg PV, Winder T, Lenz HJ. TS and ERCC-1 mRNA expressions and clinical outcome in patients with metastatic colon cancer in CONFIRM-1 and -2 clinical trials. Pharmacogenomics J 2011; 12:404-11. [PMID: 21788964 DOI: 10.1038/tpj.2011.29] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
To validate established cutoff levels of thymidylate synthase (TS) and excision repair cross-complementing (ERCC-1) intratumoral mRNA expressions in tumor samples from metastatic colorectal cancer (mCRC) patients treated with PTK787/ZK222584 (PTK/ZK). From 122 samples of patients with mCRC enrolled in CONFIRM-1 (Colorectal Oral Novel Therapy for the Inhibition of Angiogenesis and Retarding of Metastases) or CONFIRM-2, mRNA was isolated of microdissected formalin-fixed paraffin-embedded samples and quantitated using TaqMan-based technology. Existing TS and ERCC-1 cutoff levels were tested for their prognostic value in first-line and second-line therapy. TS expression was associated with overall survival (OS) in first-line, but not second-line therapy. ERCC-1 was associated with OS in patients treated with first-line and second-line FOLFOX4. In first-line FOLFOX4, combination of high TS and/or high ERCC-1 was associated with shorter OS. A correlation was observed between ERCC-1 expression and benefit from PTK/ZK+FOLFOX4 treatment. TS and ERCC-1 expression is associated with clinical outcome in mCRC. Baseline TS and ERCC-1 levels may allow the selection of patients who benefit from FOLFOX4 chemotherapy.
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Affiliation(s)
- P P Grimminger
- Department of Molecular Biology and Biochemistry, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
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Coss C, Barrett C, Kim J, Li C, Dalton JT, Veverka KA. Importance of CYP2D6 metabolism in the in vitro antiestrogenic activity of toremifene and tamoxifen. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13067] [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: 11/20/2022] Open
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Nuciforo P, Burzykowski T, Lambertini C, Gardner H, Liu WH, Lee B, Barzaghi-Rinaudo P, Rheinhardt J, Barrett C, Linnartz R, Dugan M, Hackl W, Eiermann W, Pienkowski T, Crown J, Robert N, Pawlicki M, Martin M, Finn R, Lindsay MA, Slamon D, Press M. Abstract P3-10-24: Fibroblast Growth Factor Receptor 1 Amplification and Overexpression in Breast Cancer Tissue Microarrays Using Chromogenic In Situ Hybridization and Immunohistochemistry. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p3-10-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Fibroblast growth factor receptors 1 (FGFR1) belongs to a subfamily of receptor tyrosine kinases (RTKs), which are involved in proliferation and apoptosis. FGFR1 amplification and mRNA overexpression occurs in ∼10% of breast cancers and has been associated with poor outcome. However, studies assessing FGFR1 amplification and protein overexpression in a large collection of breast tumors are lacking. In this prospective, we examined a series of primary breast cancers samples derived from the BCIRG trials assembled into 15 tissue microarrays. FGFR1 gene amplification was studied using chromogenic in situ hybridization (CISH) and evaluated with respect to association with level of protein expression and clinicopathological parameters. FGFR1 gene amplification was significantly associated with high protein levels as determined by immunohistochemistry (P<0.0001, 3294 pts with available matched CISH and IHC records). Overall, the incidence of FGFR1 amplification found was 9.7% (160 out of 1646 pts. with available clinicopathological records) without a statistically significant difference between Her2- (78 out 720 pts., 11%) and Her2+ (82 out of 926 pts., 9%) cancers. In both cohorts, the hormone receptor-positive (ER+/PR+) cancers showed statistically significant higher levels of FGFR1 amplification compared to hormone receptor-negative tumors. In the analysis of the association of FGFR1 and the presence of PIK3CA mutations, the incidence of FGFR1 amplificationwas greatly reduced in mutant vs. wt PI3KCA tumors. In these cohorts, a clear relationship between FGFR1 amplification status and clinical outcome was not detected. Data from this large study confirms recently reported incidences of FGFR1 amplification in breast cancer and shows for the first time an association between FGFR1 gene amplification and protein overexpression. Moreover, the lower incidence of FGFR1 amplification in PIK3CA mutated cancers suggests that these are largely exclusive molecular events that could benefit from different targeted therapies.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-10-24.
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Affiliation(s)
- P Nuciforo
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - T Burzykowski
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - C Lambertini
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - H Gardner
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - WH Liu
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - B Lee
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - P Barzaghi-Rinaudo
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - J Rheinhardt
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - C Barrett
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - R Linnartz
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - M Dugan
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - W Hackl
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - W Eiermann
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - T Pienkowski
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - J Crown
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - N Robert
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - M Pawlicki
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - M Martin
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - R Finn
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - M-A Lindsay
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - D Slamon
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
| | - M Press
- Novartis Pharma AG, Basel, Switzerland; International Drug Development Institute, Louvain-la-Neuve, Belgium; Novartis Institutes for Biomedical Research, Cambridge, MA; Norvartis Pharmaceuticals, Florham Park, NJ; GBG, Munchen, Germany; Oncology Center, Warsaw, Poland; ICORG, Dublin, Ireland; US Oncology, Houston, TX; Maria Sklodowska-Curie Centre, Warsaw, Poland; GEICAM, Madrid, Spain; UCLA, Los Angeles, CA; CIRG, Edmonton, Canada; USC, Los Angeles, CA
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Pien GC, LeBenger KS, Carotenuto DR, Difilippi M, Scolpino D, Simmons JM, Barrett C, Brenner RW. Coordination of multidisciplinary resources for vaccination of egg-allergic individuals during an H1N1 (novel) influenza pandemic. Allergy Asthma Proc 2010; 31:507-10. [PMID: 20943012 DOI: 10.2500/aap.2010.31.3396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Egg allergy is a contraindication for influenza vaccination because of the presence of trace egg protein. Although recent reports suggest that egg-allergic individuals can be safely immunized with seasonal influenza vaccine, the safety of H1N1 influenza vaccine in this context has not previously been reported. This study was designed to investigate how to safely immunize high-risk populations during the H1N1 influenza pandemic for whom the vaccine would be contraindicated. Vaccination of egg-allergic children was conducted at a large, multispecialty practice. Pediatricians raised awareness of vaccination and referred egg-allergic individuals to allergists. Allergists performed skin testing to H1N1 vaccine and, if negative, performed graded vaccine desensitizations in the office. Mass immunization of egg-allergic individuals was achieved within a 3-week period after receipt of vaccine. Sixty-three children (average age, 3.7 years) were evaluated and skin tested to the H1N1 influenza vaccine. All had a clinical history of egg allergy and recent positive skin-prick to egg. All had negative skin-prick test to the H1N1 vaccine and received graded challenge with three divided doses. All 62 children were successfully immunized without allergic reactions. Vaccination of egg-allergic individuals during a pandemic can be safely and efficiently accomplished with the coordination of multidisciplinary resources. Although this was conducted at a multispecialty practice, we believe that this invaluable public health service can be done outside of this context. Allergists, with the help of local pediatricians and urgent care centers or hospitals, can effectively mobilize to help protect the most vulnerable populations during pandemics.
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Affiliation(s)
- Gary C. Pien
- Department of Pediatrics, Summit Medical Group, Berkeley Heights, New Jersey, USA
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