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Mara A, Rader R, Bylund C, Eggly S, Weiss E, Szumita L, Sitlinger A, Friedman D. QIM23-139: Creating a Fellowship Curriculum: Clinical Trial Patient Conversations. J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7195] [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: 04/03/2023]
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Friedman D, Zubair N, Favara MT, Lafferty M, Carola D, Adeniyi-Jones S, Solarin K, Aghai ZH. Do small for gestational age infants have less severe neonatal abstinence syndrome? J Neonatal Perinatal Med 2022; 15:753-758. [PMID: 35811547 DOI: 10.3233/npm-221053] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Small for gestational age (SGA) infants are likely to have decreased placental transfer of opioids and other substances and lower amounts of fat deposition, hence less severe neonatal abstinence syndrome (NAS). The goal of this study is to correlate SGA status and severity of NAS in infants admitted to the neonatal intensive care unit (NICU). METHODS This is a retrospective analysis of term and late-preterm infants (≥35 weeks gestation) exposed to in-utero substances, born between September 2006 and May 2021, and admitted to an inner-city NICU for medical therapy for NAS. Indicators of the severity of NAS (duration of medical treatment, duration of hospitalization, use of phenobarbital, and use of clonidine) were compared between infants characterized as SGA (birth weight <10th percentile for gestational age) to those not categorized as SGA (non-SGA). RESULTS A total of 992 infants met the study criteria; 205 (20.7%) in the SGA group and 787 (79.3%) in the non-SGA group. The median duration of medical treatment was significantly lower in infants in the SGA group (22 days vs. 26 days, p = 0.04) and they were less likely to be treated with phenobarbital (19% vs. 26.8%, p = 0.02). CONCLUSION SGA infants displayed less severe NAS symptoms as indicated by shorter a duration of medical treatment and decreased need for phenobarbital. Our findings may impact decisions around identifying the optimum treatment protocols catered to SGA infants with NAS.
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Affiliation(s)
- D Friedman
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - N Zubair
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - M T Favara
- Neonatology, Christiana Care Health System, Newark, DE, USA
| | - M Lafferty
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - D Carola
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - K Solarin
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Z H Aghai
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Friedman D, Zimmerman S, Tan Z, Freeman J, Curtis J. Watchman device migration and embolization: a report from the NCDR LAAO registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.631] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Incomplete anchoring of the Watchman left atrial appendage closure (LAAO) device can result in substantial device migration or device embolization requiring percutaneous or surgical retrieval.
Purpose
To report rates and characteristics of in-hospital and post-discharge Watchman device migration and embolization events in the United States.
Methods
We performed a retrospective analysis of Watchman procedures (January 2016 through March 2021) reported to the National Cardiovascular Data Registry LAAO Registry. We excluded patients with prior LAAO interventions, no device released, and missing device information. In-hospital events were assessed among all patients and post-discharge events were assessed among patients with 45-day follow-up.
Results
Of 120,278 Watchman procedures, device migration or embolization occurred in 0.07% of patients (n=84) during the index hospitalization and surgery was performed in 39 patients. The in-hospital mortality rate was 14% among patients with device migration or embolization and 20.5% among patients who underwent surgery. In-hospital migration or embolization was more common: at hospitals with a lower median annual procedure volume (24 vs. 41 procedures, p<0.0001), with first-generation Watchman versus next-generation Watchman FLX devices (0.08% vs. 0.04%, p=0.0048), with larger LAA ostia (median 23 mm vs. 21 mm, p=0.004), and with a smaller difference between device and LAA ostial size (median difference 4 mm vs. 5 mm, p=0.04). There were no differences by age, sex, hospital type, hospital size, or teaching versus non-teaching status. Of 98,147 patients with 45-day follow-up, device migration or embolization after discharge occurred in 0.06% (n=54) patients and cardiac surgery was performed in 7.4% (n=4) of cases. The 45-day mortality rate was 3.7% (n=2) among patients with post-discharge device migration or embolization. Post-discharge migration or embolization was more common among men (79.7% of events but 58.9% of all procedures, p=0.0019), taller patients (177.9 cm vs. 172 cm, p=0.0005), and those with greater body mass (99.9 kg vs. 85.5 kg, p=0.0055); in contrast to in-hospital events, there were no differences in hospital volume, device characteristics, or LAA characteristics.
Conclusions
Watchman device migration or embolization is rare but associated with high mortality (Figure 1) and frequently requires surgical retrieval. A substantial proportion of all device migration or embolization cases occur after discharge and different patient and procedure characteristics are associated with in-hospital versus post-discharge cases. Given the morbidity and mortality associated with device migration or embolization, risk mitigation strategies and on-site cardiac surgical back-up are of paramount importance.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health
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Affiliation(s)
- D Friedman
- Duke University , Durham , United States of America
| | - S Zimmerman
- Yale University , New Haven , United States of America
| | - Z Tan
- Yale University , New Haven , United States of America
| | - J Freeman
- Yale University , New Haven , United States of America
| | - J Curtis
- Yale University , New Haven , United States of America
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Georgiopoulos A, Smith B, Sher Y, Bruce A, He J, Kim J, Chaudhary N, Hardcastle M, Pollinger S, Polineni D, Mohabir P, Shea N, Roach C, Richards C, Miller C, Dvorak M, Quittner A, Friedman D. 312 Barriers to sustaining daily care in adults with cystic fibrosis with mild depression and anxiety. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01002-5] [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: 11/07/2022]
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DiFiglia S, Georgiopoulos A, Portenoy R, Berdella M, Friedman D, Kier C, Linnemann R, Middour-Oxler B, Walker P, Wang J, Buehler B, Chaudhary N, Esposito C, Henthorne K, Hunter E, Plachta A, Pollinger S, Stables-Carney T, Trentacoste J, Dhingra L. 242 Palliative care needs in cystic fibrosis: Baseline data from the Improving Life with Cystic Fibrosis Multi-site Implementation Trial for Primary Palliative Care Intervention. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00932-8] [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: 11/05/2022]
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Georgiopoulos A, Friedman D, Schwartz C, Smith B, Bruce A, Sher Y, Quittner A. WS09.04 Psychometric characteristics of the CF Coping Self-Efficacy (CF-CSE) scale. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dalgaard F, Fudim M, Al-Khatib S, Friedman D, Abraham WT, Cleland JF, Curtis AB, Gold MR, Kutyifa V, Linde C, Young J, Ali-Ahmad F, Olivas-Martinez A, Inoue LYT, Sanders GD. Cardiac resynchronization therapy in patients with a history of atrial fibrillation: insights from five major clinical trials. Europace 2022. [DOI: 10.1093/europace/euac053.386] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Heart, Lung, and Blood Institute
Background
Many patients with heart failure who are considered for cardiac resynchronization therapy (CRT) have a history of (h/o) atrial fibrillation (AF) but there are doubts about the efficacy of CRT in patients with AF.
Purpose
To investigate the association of CRT on morbidity and mortality among patients with and without a h/o AF.
Methods
Original, patient-level data from five clinical trials of CRT that permitted enrolment of patients with a h/o AF were included: COMPANION, MADIT-CRT, BLOCK HF, REVERSE, and MIRACLE trial. Patients with permanent or persistent AF were excluded from these trials, and therefore from this analysis. The outcomes of interest were the composite endpoint of time to heart failure hospitalization (HFH) or all-cause mortality or all-cause mortality alone. The association of CRT (versus no CRT) with outcomes for patients with and without a h/o AF was assessed using a Bayesian-Weibull survival regression model with random terms for the trial-specific treatment effects and the trial-specific baseline hazard functions including an interaction between history of paroxysmal AF and CRT. All results are presented as hazard ratios (HRs) with 95% posterior credible intervals (CIs) and posterior probabilities of no association, adjusting for baseline characteristics.
Results
A total of 4062 patients were included, 661 (16.3%) of whom had a h/o AF. Patients with a h/o AF were older (mean [SD] age 68 [10] years versus 64 [11] years) and had a higher proportion of ischemic cardiomyopathy (67% versus 53%, p<0.001), a higher baseline serum creatinine (1.3 mg/dl versus 1.2 mg/dl, p<0.001), and a lower left ventricular ejection fraction (25% versus 26%, p<0.001). The HRs for all outcomes and the interaction term are shown in Table 1. For the overall population, CRT delayed the time to HFH or all-cause mortality (HR: 0.74, 95% CI: 0.62 – 0.87, p=0.005); for patients with a h/o AF, it did not (HR: 0.87, 95% CI: 0.64 to 1.19, p=0.37). In this patient-level meta-analysis, CRT was not associated with a reduction in mortality, overall or by h/o AF. Howevber, the interaction (estimate shown as a ratio of HRs) between those with or without a h/o AF and the effects of CRT was not significant for either outcome (Table 1).
Conclusion
In the largest post hoc analysis to date, we confirm the benefits of CRT in patients without a h/o AF in reducing HFH or mortality. There was no statistically significant interaction between CRT and h/o AF for any analysed outcome.
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Affiliation(s)
- F Dalgaard
- Gentofte University Hospital, Gentofte, Denmark
| | - M Fudim
- Duke Clinical Research Institute, Durham, United States of America
| | - S Al-Khatib
- Duke Clinical Research Institute, Durham, United States of America
| | - D Friedman
- Duke Clinical Research Institute, Durham, United States of America
| | - WT Abraham
- The Ohio State University, Division of Cardiovascular Medicine, Columbus, United States of America
| | - JF Cleland
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - AB Curtis
- University At Buffalo, Department of Medicine, Buffalo, United States of America
| | - MR Gold
- Medical University of South Carolina, Charleston, United States of America
| | - V Kutyifa
- University of Rochester Medical Center, Division of Cardiology, Rochester, United States of America
| | - C Linde
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - J Young
- Cleveland Clinic, Cleveland, United States of America
| | - F Ali-Ahmad
- Duke Clinical Research Institute, Durham, United States of America
| | - A Olivas-Martinez
- University of Washington, Department of Biostatistics, Seattle, United States of America
| | - LYT Inoue
- University of Washington, Department of Biostatistics, Seattle, United States of America
| | - GD Sanders
- Duke Clinical Research Institute, Durham, United States of America
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Cornacchia C, Dessalvi S, Santori G, Canobbio F, Atzori G, De Paoli F, Diaz R, Franchelli S, Gipponi M, Murelli F, Sparavigna M, Pitto F, Fozza A, Boccardo F, Friedman D, Fregatti P. Breast Edema after Conservative Surgery for Early-Stage Breast Cancer: A Retrospective Single-Center Assessment of Risk Factors. Lymphology 2022; 55:167-177. [PMID: 37553005] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Breast-conserving surgery (BCS) is the standard of care for early-stage breast cancer. We retrospectively enrolled 530 patients (mean age: 62.96 ± 12.69 years) undergoing BCS between January 1, 2018, and December 31, 2019. During the COVID-19 pandemic, all patients with at least 1 year of follow-up were telephonically asked after surgery to provide clinical signs and symptoms attributable to postoperative breast cancer-related lymphedema of the breast (BCRL-B). Thirty-one (5.8%) patients reported breast edema and were visited to measure the tissue dielectric constant (TDC) and to assess the induration of the skin. There was a difference seen in treatment with lumpectomy + ALND performed more frequently in patients with (29%) than without (12%) BCRL-B. In the subgroup of patients with BCRL-B (n=31), significantly higher values of local total water were calculated in the nine patients who underwent Lump + ALND procedure (1.86 ± 0.48 vs. 1.48 ± 0.38; p = 0.046). Among patients with BCRL-B (n=31), in eight patients (25.8%) tissue induration measured with SkinFibroMeter was >0.100 N, thus suggesting tissue fibrosis. Cumulative survival probability at 1-year after surgery was 0.992. No statistical differences in 1-year survival after surgery were found for type of surgery (p = 0.890) or absence/presence of BCRL-B (p = 0.480). In univariate logistic regression, only lumpectomy + ALND surgery (p = 0.009) and any subsequent axillary lymph node removal surgery (p = 0.003) were associated with BCRL-B. Both of these variables were also found to be statistically significant in the multivariate regression model. Further prospective research is warranted to analyze potentential predictors of BCRL-B and to reduce/ prevent this complication.
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Affiliation(s)
- C Cornacchia
- Department of Onco-Hematology - Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Dessalvi
- Department of Surgical Sciences and Integrated Diagnostics (DISC) - Unit of Lymphatic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - G Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - F Canobbio
- School of Medicine, University of Genoa, Genoa, Italy
| | - G Atzori
- Department of Onco-Hematology - Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F De Paoli
- Department of Onco-Hematology - Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - R Diaz
- Department of Onco-Hematology - Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Franchelli
- Department of Onco-Hematology - Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Gipponi
- Department of Onco-Hematology - Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F Murelli
- Department of Onco-Hematology - Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Sparavigna
- Department of Onco-Hematology - Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F Pitto
- Department of Laboratory Diagnostics - Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Fozza
- Department of Diagnostic Imaging and Radiotherapy - Unit of Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F Boccardo
- Department of Surgical Sciences and Integrated Diagnostics (DISC) - Unit of Lymphatic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - D Friedman
- Department of Onco-Hematology - Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - P Fregatti
- Department of Onco-Hematology - Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Friedman D, Smith B, Sher Y, Bruce A, Chaudhary N, Hardcastle M, Pollinger S, Polineni D, Mohabir P, Shea N, Roach C, Miller C, Richards C, Dvorak M, Quittner A, Georgiopoulos A. 302: Perceived stress and quality of life in adults with CF with mild depression and anxiety. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01727-6] [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: 11/16/2022]
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10
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Middour-Oxler B, Dhingra L, Georgiopoulos A, Wang J, Friedman D, Shiffman M, Portenoy R, DiFiglia S, Fischer F, Abdullah R, Berdella M, Hadjiliadis D, Kier C, Markovitz M, Walker P, Yonker L, Linnemann R. 219: Improving assessment for CF pediatric palliative care: Initial development of the ADAPT-CF communication guide with children and caregivers. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01644-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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Milgrom S, Kim J, Hoppe B, Pei Q, Wu Y, Lo A, Kessel S, McCarten K, Roberts K, Hodgson D, Schwartz C, Friedman D, Kelly K, Cho S. PET-Based Quantification of Baseline Metabolic Tumor Burden Improves Risk Stratification in High-Risk Hodgkin Lymphoma: A Children's Oncology Group Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.192] [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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12
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Reddington H, Figueroa A, Cohen A, Castro R, Payne C, Lotakis D, Wallack M, Friedman D, Cooper A. Rectal prolapse and abdominal compartment syndrome: Formerly unknown complications of hernia repair in a neonate. Journal of Pediatric Surgery Case Reports 2021. [DOI: 10.1016/j.epsc.2021.101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Friedman D, Quittner A, Kaskas M, Hardcastle M, Pollinger S, Smith B, Georgiopoulos. A. WS11.6 Stakeholder input into the development of a cystic fibrosis-specific cognitive-behavioral intervention for adolescents. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)00980-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Wilson T, Gray R, Ellenberger K, Friedman D, Lambros J, Eggleton S, Freeman T, Mathur G, Cranney G, Yu J. Comparison of Hospital Resource Allocation Associated With CTCA for Intermediate-Risk ACS as Inpatient vs Expedited Outpatient. Heart Lung Circ 2021. [PMCID: PMC8324090 DOI: 10.1016/j.hlc.2021.06.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Freeman J, Bjerre J, Parzynski C, Minges K, Ahmad T, Desai N, Enriquez A, Spatz E, Friedman D, Curtis J, Hlatky M, Higgins A. Mortality and readmission in non-ischemic compared with ischemic cardiomyopathies after implantable cardioverter-defibrillator implantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0788] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Uncertainty remains regarding the benefit of primary prevention ICDs overall in contemporary practice, and particularly in those with NICM compared with ICM.
Purpose
To evaluate the contemporary risk of death and readmission following following implantable cardioverter-defibrillator (ICD) implantation in patients with non-ischemic cardiomyopathies (NICM) compared with ischemic cardiomyopathies (ICM) in a large nationally representative cohort in the United States.
Methods
We used data from the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) ICD Registry linked with Medicare claims from April 1, 2010 to December 31, 2013 to establish a cohort of NICM and ICM patients with a left ventricular ejection fraction ≤35% who received a de novo, primary prevention ICD. We compared mortality, all-cause readmission, and heart failure readmission using Kaplan-Meier curves and Cox proportional hazard regressions models. We also evaluated temporal trends in mortality.
Results
Among 31,044 NICM and 68,458 ICM patients with a median follow up of 2.4 years, one-year mortality was significantly higher in ICM patients (12.3%) compared with NICM (7.9%, p<0.001). The higher mortality in ICM patients remained significant after adjustment for covariates (hazard ratio (HR) 1.40; 95% confidence interval (CI) 1.36 to 1.45), and was consistent in subgroup analyses. These findings were consistent across the duration of the study. ICM patients were also significantly more likely to be readmitted for all causes (adjusted HR 1.15, CI 1.12 to 1.18) and for heart failure (adjusted HR 1.25, CI 1.21 to 1.31).
Conclusions
The risks of mortality and hospital readmission after primary prevention ICD implantation were significantly higher in patients with ICM compared with NICM, and these findings were consistent across all patient subgroups tested and over the duration of the study.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Freeman
- Yale University, New Haven, United States of America
| | - J Bjerre
- Gentofte Hospital - Copenhagen University Hospital, Hellerup, Denmark
| | - C Parzynski
- Yale New Haven Hospital, New Haven, United States of America
| | - K Minges
- Yale New Haven Hospital, New Haven, United States of America
| | - T Ahmad
- Yale University, New Haven, United States of America
| | - N Desai
- Yale University, New Haven, United States of America
| | - A Enriquez
- Yale University, New Haven, United States of America
| | - E Spatz
- Yale University, New Haven, United States of America
| | - D Friedman
- Yale University, New Haven, United States of America
| | - J Curtis
- Yale University, New Haven, United States of America
| | - M Hlatky
- Stanford University Medical Center, Stanford, United States of America
| | - A Higgins
- Yale New Haven Hospital, New Haven, United States of America
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Serra M, Li AQ, Cataliotti L, Cianchetti E, Corsi F, De Vita R, Fabiocchi L, Fortunato L, Friedman D, Klinger M, Marotti L, Murgo R, Ponti A, Roncella M, Del Turco MR, Rinaldi S, Surace A, Taffurelli M, Tinterri C, Tomatis M, Mano MP. Aesthetic results following breast cancer surgery: A prospective study on 6515 cases from ten Italian Senonetwork breast centers. Eur J Surg Oncol 2020; 46:1861-1866. [PMID: 32723610 DOI: 10.1016/j.ejso.2020.04.036] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022] Open
Abstract
Breast cancer treatment has deeply changed in the last decades, since clinical and oncological cure cannot be achieved without patient's satisfaction in term of aesthetic outcomes. Several methods have been proposed to objectively assess these results. However, Italian breast centers have not yet agreed on measurable, reproducible and validated aesthetic outcome indicators to monitor their performance. METHODS The study was designed and conducted by Senonetwork, a not-for-profit association of Italian breast centers. Ten breast centers were selected based on specific eligibility criteria. This multicentre observational prospective study recruited 6515 patients with diagnosis of in situ or invasive breast cancer who underwent breast surgery in the years 2013-2016. Thirteen indicators of aesthetic results and of related quality of care were analyzed. Data collection and analysis were conducted using a common study database. RESULTS On average, seven out of ten centers were able to collect data on the proposed indicators with a proportion of missing values < 25%. By expert consensus based on study results, some seven indicators have been defined as "mandatory" while the remaining six have been defined as "recommended" because they require further refinement before they can be proposed for monitoring aesthetic outcomes or because there are doubts on the feasibility of data collection. The minimum standard is reached for 5 of 13 indicators. This finding and the wide range between centers reveal that there is ample room for improvement. CONCLUSIONS From the present study useful measurable aesthetic parameters have emerged, leading to the definition of target objectives that breast centers can use for benchmarking and improvement of quality of care.
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Affiliation(s)
- M Serra
- UOC di Chirurgia Generale e Della Mammella Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy.
| | - A Quattrini Li
- Centro Senologico Azienda Ospedaliera Universitaria Pisana Ospedale Santa Chiara, Pisa, Italy
| | | | - E Cianchetti
- Breast Centre Asl 02 Abruzzo, P.O. G. Bernabeo Ortona, Chieti, Italy
| | - F Corsi
- Breast Unit, Surgery Department, ICS Maugeri S.p.A. SB, Pavia, Italy; Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - R De Vita
- Istituto Nazionale Dei Tumori di Roma "Regina Elena", Rome, Italy
| | - L Fabiocchi
- Centro Di Senologia Rimini - Sant'Arcangelo di Romagna, Rimini, Italy
| | - L Fortunato
- UOSD Centro di Senologia, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - D Friedman
- Policlinico San Martino di Genova. University of Genova, DISC Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Genova, Italy
| | - M Klinger
- Breast Centre Humanitas - Istituto Clinico Humanitas - Humanitas Mirasole Spa, Rozzano, (Milan), Italy
| | - L Marotti
- European Society of Breast Cancer Specialists, Florence, Italy
| | - R Murgo
- Dipartimento di Oncoematologia/Unità Operativa Complessa di Chirurgia Senologica, IRCCS Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - A Ponti
- CPO Piemonte - SSD Epidemiologia Screening - AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - M Roncella
- Centro Senologico Azienda Ospedaliera Universitaria Pisana Ospedale Santa Chiara, Pisa, Italy
| | | | - S Rinaldi
- UOSVD di Chirurgia Senologica Ospedale San Paolo, Bari, Italy
| | - A Surace
- CPO Piemonte - SSD Epidemiologia Screening - AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - M Taffurelli
- UOC di Chirurgia Generale e Della Mammella Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - C Tinterri
- Breast Centre Humanitas - Istituto Clinico Humanitas - Humanitas Mirasole Spa, Rozzano, (Milan), Italy
| | - M Tomatis
- CPO Piemonte - SSD Epidemiologia Screening - AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - M P Mano
- CPO Piemonte - AOU Città Della Salute e Della Scienza di Torino and University of Turin, Turin, Italy
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Gray R, Friedman D, Yu J, Vickers D, Moragues J, Mathur G. 215 Exercise Induced Ventricular Tachycardia in a Patient With Mitral Annular Disjunction. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.222] [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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Gabriel PG, Chen KJ, Alasfour A, Pailla T, Doyle WK, Devinsky O, Friedman D, Dugan P, Melloni L, Thesen T, Gonda D, Sattar S, Wang SG, Gilja V. Neural correlates of unstructured motor behaviors. J Neural Eng 2019; 16:066026. [DOI: 10.1088/1741-2552/ab355c] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cohen A, Friedman D, Stankard B, Li T, Stevens G, Nelson M. 37 Point-of-Care Lung Ultrasound to Predict Hospital Re-admission Rates in Patients With Acute Heart Failure Exacerbations. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.040] [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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Taffurelli M, Pellegrini A, Meattini I, Orzalesi L, Tinterri C, Roncella M, Terribile D, Caruso F, Tazzioli G, Pollini G, Friedman D, Mariotti C, Cianchetti E, Cabula C, Thomas R, Cedolini C, Rovera F, Grassi M, Lucani G, Cappella A, Bortul M, Stacul G, Scarabeo F, Procaccini E, Galimberti V. Corrigendum to "Secondary breast angiosarcoma: A multicentre retrospective survey by the national Italian association of breast surgeons (ANISC)" [Breast 2019 56-60]. Breast 2019; 48:101. [PMID: 31543291 DOI: 10.1016/j.breast.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- M Taffurelli
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy
| | - A Pellegrini
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy.
| | - I Meattini
- AOU Carreggi Breast Unit, Firenze, Italy
| | - L Orzalesi
- AOU Carreggi Breast Unit, Firenze, Italy
| | - C Tinterri
- Humanitas Research Hospital, Milano, Italy
| | | | | | - F Caruso
- Breast Centre Humanitas, Catania, Italy
| | - G Tazzioli
- Breast Unit AOU Policlinico di, Modena, Italy
| | | | | | | | - E Cianchetti
- Oncologia Chirurgica Ospedale A. Businco, Ortona, Italy
| | - C Cabula
- Ospedale Oncologico di, Cagliari, Italy
| | - R Thomas
- Clinica Mediterranea, Napoli, Italy
| | - C Cedolini
- Ospedale S. Maria Misericordia, Udine, Italy
| | - F Rovera
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - M Grassi
- Humanitas Gavezzani, Bergamo, Italy
| | - G Lucani
- Breast Unit Policlinico di, Monza, Italy
| | - A Cappella
- Centro di Riferimento Oncologico IRCC, Aviano, Italy
| | | | - G Stacul
- SC Chirurgia Generale Ospedale di, Gorizia, Italy
| | - F Scarabeo
- Policlinico P. Veneziale, Isernia, Italy
| | - E Procaccini
- Breast Unit Seconda Università di, Napoli, Italy
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21
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Garlaschi A, Fregatti P, Oddone C, Friedman D, Houssami N, Calabrese M, Tagliafico AS. Intraoperative digital breast tomosynthesis using a dedicated device is more accurate than standard intraoperative mammography for identifying positive margins. Clin Radiol 2019; 74:974.e1-974.e6. [PMID: 31521327 DOI: 10.1016/j.crad.2019.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022]
Abstract
AIM To compare a standard intra-operative mammography (IM) device with digital breast tomosynthesis using a dedicated device (Mozart system) in the evaluation of surgical margins at first excision. MATERIALS AND METHODS The study received institutional review board approval and written informed consent was obtained from participants. From January 2018 to December 2018, a prospective analysis of the images of IM device and intra-operative digital breast tomosynthesis with a dedicated device (Mozart system) in n=89 breast cancer patients (average patients age: 58 years, age range: 35-76 years) was undertaken. Images were evaluated by two expert breast radiologists independently of each other and blinded to each other's interpretation, who indicated the positive cases requiring surgical re-excision intra-operatively. RESULTS Mean cancer size was 12.5±4.5 mm. Radiological signs of the lesions were microcalcifications (n=71), nodules (n=10), and architectural distortions (n=8). A total of 20/89 (17%) patients underwent intra-operative re-excision for positive margins. Intra-operative digital breast tomosynthesis with a dedicated device and IM showed discrepancies in 15/89 cases (17%). Mozart system results informed the necessity to perform a re-excision (n=15). Overall, receiver operating characteristic (ROC) curve analysis showed and area under the ROC curve (AUC) of 0.82 for the Mozart system versus 0.65 for IM. ROC analysis of radiological findings with microcalcifications showed an AUC of 0.92 for the Mozart system versus 0.74 for IM, whereas AUC in cases with no microcalcifications were 0.87 and 0.75, respectively. CONCLUSION Intra-operative digital breast tomosynthesis with a dedicated device provides more information (better accuracy) than IM and facilitated a reduction in re-excision rates.
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Affiliation(s)
- A Garlaschi
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy
| | - P Fregatti
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - C Oddone
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy
| | - D Friedman
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - N Houssami
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - M Calabrese
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy
| | - A S Tagliafico
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy; Department of Health Sciences (DISSAL) - Radiology Unit, University of Genoa, Genoa, Italy.
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Henderson W, Friedman D, Parker M. Partners in Oncology Care: Coordinated Follicular Lymphoma Management. Fed Pract 2019; 36:S21-S23. [PMID: 31507309 PMCID: PMC6719805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Four case examples illustrate the important role of multidisciplinary medical care for the optimal long-term care of patients with follicular lymphoma.
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Affiliation(s)
- Wendy Henderson
- is Associate Chief of Staff for Ambulatory Care; is a Staff Physician, Hematology-Oncology; and is 1F/1D Ambulatory Care Clinics-Chief, Clinical Pharmacy Specialist; all at Durham VA Medical Center in North Carolina. Wendy Henderson is an Assistant Professor, general internal medicine; and Daphne Friedman is an Associate Professor, medical oncology, both at Duke University in Durham, North Carolina
| | - Daphne Friedman
- is Associate Chief of Staff for Ambulatory Care; is a Staff Physician, Hematology-Oncology; and is 1F/1D Ambulatory Care Clinics-Chief, Clinical Pharmacy Specialist; all at Durham VA Medical Center in North Carolina. Wendy Henderson is an Assistant Professor, general internal medicine; and Daphne Friedman is an Associate Professor, medical oncology, both at Duke University in Durham, North Carolina
| | - Mary Parker
- is Associate Chief of Staff for Ambulatory Care; is a Staff Physician, Hematology-Oncology; and is 1F/1D Ambulatory Care Clinics-Chief, Clinical Pharmacy Specialist; all at Durham VA Medical Center in North Carolina. Wendy Henderson is an Assistant Professor, general internal medicine; and Daphne Friedman is an Associate Professor, medical oncology, both at Duke University in Durham, North Carolina
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Taffurelli M, Pellegrini A, Meattini I, Orzalesi L, Tinterri C, Roncella M, Terribile D, Caruso F, Tazzioli G, Pollini G, Friedman D, Mariotti C, Cianchetti E, Cabula C, Thomas R, Cedolini C, Rovera F, Grassi M, Lucani G, Cappella A, Bortul M, Stacul G, Scarabeo F, Procaccini E, Galimberti V. Secondary breast angiosarcoma: A multicentre retrospective survey by the national Italian association of Breast Surgeons (ANISC). Breast 2019; 45:56-60. [PMID: 30877870 DOI: 10.1016/j.breast.2019.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/07/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Breast angiosarcoma is a malignant mesenchymal neoplasm, which accounts for approximately 2% of all soft tissue sarcomas. Secondary breast angiosarcoma (SBA) may be related to chronic lymphedema after a mastectomy with lymph node dissection (Stewart Treves syndrome) and previous radiotherapy for complications from breast radiation treatment. It is a very rare condition; therefore, diagnosis and management are still a challenge. METHODS The ANISC collected SBA data by means of a survey sent to all Italian breast centres in the ANISC. The clinicopathological characteristics and the management of this disease were analysed. RESULTS Twenty-four centres participated in this survey in which 112 cases of SBA were analysed. The median age of the women with SBA was 68.9 years and it appeared approximately 90 months after the first irradiation for breast cancer. In 92% of cases, a mastectomy was performed without axillary dissection for those patients having a high grade of SBA (74.2%). The prognosis was worse in the high-grade cases (overall survival-OS: 36 months) as compared with the low-grade cases (OS: 48 months). After a follow-up of 5 years, 50.5% of the patients were still alive. Disease-free survival (DFS) was 35 months, and there were no differences between the groups of patients with either high- or low-grade histology. CONCLUSIONS Secondary breast angiosarcoma is a very aggressive disease associated with a short survival outcome. The surgical approach still remains an important step in the course of treatment; furthermore, an accurate histological examination is helpful in establishing the prognosis of the patient. A mastectomy is mandatory. A longer OS was observed in patients with low-grade angiosarcoma as compared to high-grade angiosarcoma (C.I. 40-57 vs. 31-41 months).
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Affiliation(s)
- M Taffurelli
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy
| | - A Pellegrini
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy.
| | - I Meattini
- AOU Carreggi Breast Unit, Firenze, Italy
| | - L Orzalesi
- AOU Carreggi Breast Unit, Firenze, Italy
| | - C Tinterri
- Humanitas Research Hospital, Milano, Italy
| | | | | | - F Caruso
- Breast Centre Humanitas, Catania, Italy
| | - G Tazzioli
- Breast Unit AOU Policlinico di, Modena, Italy
| | | | | | | | - E Cianchetti
- Oncologia Chirurgica Ospedale A. Businco, Ortona, Italy
| | - C Cabula
- Ospedale Oncologico di, Cagliari, Italy
| | - R Thomas
- Clinica Mediterranea, Napoli, Italy
| | - C Cedolini
- Ospedale S. Maria Misericordia, Udine, Italy
| | - F Rovera
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - M Grassi
- Humanitas Gavezzani, Bergamo, Italy
| | - G Lucani
- Breast Unit Policlinico di, Monza, Italy
| | - A Cappella
- Centro di Riferimento Oncologico IRCC, Aviano, Italy
| | | | - G Stacul
- SC Chirurgia Generale Ospedale di, Gorizia, Italy
| | - F Scarabeo
- Policlinico P. Veneziale, Isernia, Italy
| | - E Procaccini
- Breast Unit Seconda Università di, Napoli, Italy
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Fregatti P, Gipponi M, Depaoli F, Murelli F, Rattaro A, Vecchio C, Friedman D. “No ink on Ductal Carcinoma in situ? ” A single Center experience”. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.342] [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] Open
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25
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Belza B, X Marquez D, Croff R, Friedman D, Karlawish J, Mohler J. THE CDC HEALTHY BRAIN RESEARCH NETWORK: COLLECTIVE IMPACT IN ACTION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.328] [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)
- B Belza
- University of Washington, Seattle, Washington, United States
| | - D X Marquez
- University of Illinois, Chicago, Chicago, IL, USA
| | - R Croff
- Oregon Health and Science University, Portland, OR, USA
| | - D Friedman
- University of South Carolina, Columbia, South Carolina, SC, USA
| | - J Karlawish
- University of Pennsylvania, Philadelphia, PA, USA
| | - J Mohler
- University of Arizona, Tucson, AZ, USA
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Friedman D, Pearson JL, Melinda Spencer S. THE ARNOLD SCHOOL OF PUBLIC HEALTH OFFICE FOR THE STUDY OF AGING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1285] [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)
- D Friedman
- University of South Carolina, Columbia, South Carolina, United States
| | - J L Pearson
- University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - S Melinda Spencer
- University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
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Polcwiartek C, Kragholm K, Hansen S, Graff C, Nielsen JB, Pietersen A, Nielsen J, Friedman D, Atwater B, Sogaard P, Torp-Pedersen C, Jensen S. P3455Common electrocardiogram abnormalities confer increased mortality in patients with schizophrenia exposed to antipsychotic drugs: a register-based cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3455] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Polcwiartek
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - K Kragholm
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - S Hansen
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - C Graff
- Aalborg University, Health Science and Technology, Aalborg, Denmark
| | - J B Nielsen
- University of Michigan, Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, United States of America
| | - A Pietersen
- Rigshospitalet - Copenhagen University Hospital, Laboratory for Molecular Cardiology, The Heart Center, Copenhagen, Denmark
| | - J Nielsen
- Glostrup Hospital - Copenhagen University Hospital, Mental Health Center, Copenhagen, Denmark
| | - D Friedman
- Duke University Medical Center, Clinical Cardiac Electrophysiology Laboratories and Electrophysiology Clinical Research Unit, Durham, United States of America
| | - B Atwater
- Duke University Medical Center, Clinical Cardiac Electrophysiology Laboratories and Electrophysiology Clinical Research Unit, Durham, United States of America
| | - P Sogaard
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics, Aalborg, Denmark
| | - S Jensen
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
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Vicini E, Invento A, Cuoghi M, Bafile A, Battaglia C, Biglia N, Busani M, Bussone R, Cianchetti E, Caruso F, Cucchi M, Dessena M, Di Filippo F, Fabi N, Folli S, Friedman D, Macellari G, Mainente P, Murgo R, Neri A, Pollini G, Palli D, Ricci F, Scalco G, Taffurelli M, Trunfio M, Galimberti V. Neoadjuvant systemic treatment for breast cancer in Italy: The Italian Society of Surgical Oncology (SICO) Breast Oncoteam survey. Eur J Surg Oncol 2018; 44:1157-1163. [DOI: 10.1016/j.ejso.2018.03.018] [Citation(s) in RCA: 4] [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] [Received: 10/01/2017] [Revised: 03/01/2018] [Accepted: 03/20/2018] [Indexed: 01/09/2023] Open
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Guiney L, Liou K, Friedman D, Kushwaha V. Real-Time Intravascular Ultrasound-Guided Ostial Stent Deployment in Coronary Bifurcation Lesions: Case Report. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.977] [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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Ramulu P, Mihailovic A, Gitlin L, West S, Friedman D. TIME AND ACTIVITY-NORMALIZED FALL RATES IN GLAUCOMA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3839] [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: 11/13/2022] Open
Affiliation(s)
- P. Ramulu
- Ophthalmolgoy, Johns Hopkins Medical Center, Baltimore, Maryland
| | - A. Mihailovic
- Ophthalmolgoy, Johns Hopkins Medical Center, Baltimore, Maryland
| | - L.N. Gitlin
- Ophthalmolgoy, Johns Hopkins Medical Center, Baltimore, Maryland
| | - S. West
- Ophthalmolgoy, Johns Hopkins Medical Center, Baltimore, Maryland
| | - D. Friedman
- Ophthalmolgoy, Johns Hopkins Medical Center, Baltimore, Maryland
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Affiliation(s)
- K Choy
- Department of General Medicine; University Hospital Geelong, Barwon Health; Barwon Health Geelong Victoria Australia
| | - S Holgate
- Department of General Medicine; University Hospital Geelong, Barwon Health; Barwon Health Geelong Victoria Australia
| | - L Delmenico
- Department of General Medicine; University Hospital Geelong, Barwon Health; Barwon Health Geelong Victoria Australia
| | - M McVeigh
- Department of General Medicine; University Hospital Geelong, Barwon Health; Barwon Health Geelong Victoria Australia
| | - D Friedman
- Department of General Medicine; University Hospital Geelong, Barwon Health; Barwon Health Geelong Victoria Australia
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Sethwala A, Wang X, Sturm E, Collins K, O'Donnabhain R, Friedman D. Predictive value of symptoms, signs and biomarkers on computer tomography pulmonary angiogram results. Intern Med J 2017. [DOI: 10.1111/imj.4_13462] [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: 11/28/2022]
Affiliation(s)
- A Sethwala
- Department of General Medicine; University Hospital Geelong, Barwon Health; Geelong Victoria Australia
| | - X Wang
- Department of General Medicine; University Hospital Geelong, Barwon Health; Geelong Victoria Australia
| | - E Sturm
- Department of General Medicine; University Hospital Geelong, Barwon Health; Geelong Victoria Australia
| | - K Collins
- Department of General Medicine; University Hospital Geelong, Barwon Health; Geelong Victoria Australia
| | - R O'Donnabhain
- Department of General Medicine; University Hospital Geelong, Barwon Health; Geelong Victoria Australia
| | - D Friedman
- Department of General Medicine; University Hospital Geelong, Barwon Health; Geelong Victoria Australia
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McCarty K, Friedman D, Cottam B, Newell P, Gough M, Crittenden M, Young K. Targeting Cancer-Associated Fibroblasts in Combination With Radiation. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2118] [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: 11/16/2022]
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D’Ambrosio M, Bakalar M, Reber C, Myers F, Friedman D, Joffe A, Fletcher D. Automated disease diagnostics for low-resource areas using mobile
phones. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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35
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Friedman D, Bierzynski A, Coplan N. MP14: UTILIZATION OF THE INVASIVE CARDIAC LABORATORY FOR IMMEDIATE CARDIAC CATHETERIZATION: A QUALITY IMPROVEMENT PROJECT. J Investig Med 2016. [DOI: 10.1136/jim-2016-000080.26] [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: 11/04/2022]
Abstract
Purpose of StudyImmediate cardiac catheterization is indicated for patients presenting with ST elevation (STE) myocardial infarction, and door-to-balloon time should be <90 min. Patients with non-ST elevation myocardial infarction (NSTEMI) can often be stabilized with medication, and only require urgent invasive evaluation if there is persistent chest pain(despite medical therapy) or hemodynamic or electrical instability. Immediate cardiac catheterization for patients presenting to the ER with chest pain is available in many hospitals, but it involves a large investment of resources which need to be properly utilized. This study evaluated patients sent for urgent invasive evaluation to determine how the facility is utilized.Abstract MP14 Table 1STE+STE−≥90%2910≤90% 4 7Methods UsedIn a retrospective chart review, charts from all STEMI code patients presenting between the dates 1/1/15–9/1/15 were studied. The presenting EKG was evaluated to determine whether STE criteria (as per ACC guidelines) were met. The charts were reviewed for angiographic data to determine whether there was ≥90% stenosis of a coronary artery (≥90%) or not (≤90%). Clinical parameters were studied to determine if there were any differences between the groups.Summary of ResultsThe study group included 50 patients who went to the cardiology catheterization lab emergently secondary to an indication of STE; 33/50 (66%) patients met guideline criteria for ST elevation (STE+) while 17/50 (34%) did not (STE−). In the STE+ group, 29/33 (88%) had ≥90% occlusion of a coronary artery, while 10/17 (59%) in the STE-group had this degree of stenosis. The sensitivity and specificity of STE for ≥90% coronary artery occlusion on angiography was 74% and 64% respectively. The PPV of STE for >90% stenosis was 88%, while the NPV was 41%.ConclusionsSignificant STE in the proper clinical situation is a Class 1 indication for immediate coronary catheterization. However, 34% referred for immediate catheterization in this study did not meet ACC criteria for STEMI. Although a significant % in the NSTEMI group had ≥90% stenosis, urgent catheterization is only indicated in this group when there is a clinical parameter which dictates the necessity of immediate evaluation.
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Stuart RL, Marshall C, Orr E, Bennett N, Athan E, Friedman D, Reilly M. Survey of infection control and antimicrobial stewardship practices in Australian residential aged-care facilities. Intern Med J 2016; 45:576-80. [PMID: 25955463 DOI: 10.1111/imj.12740] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/29/2015] [Indexed: 11/27/2022]
Abstract
This study assessed infection prevention and antimicrobial stewardship (AMS) practices in Australian residential aged-care facilities (RACF). Two hundred and sixty-five surveys (15.6%) were completed with all states represented and the majority (177 (67.3%)) privately run. Only 30.6% RACF had infection control trained staff on site. Few facilities had AMS policies, only 14% had antimicrobial prescribing restrictions. Most facilities offered vaccination to residents (influenza vaccination rates >75% in 73% of facilities), but pneumococcal vaccination was poor.
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Affiliation(s)
- R L Stuart
- Department of Infectious Diseases, Monash Health, Melbourne, Australia.,Department Medicine, Monash University, Melbourne, Australia
| | - C Marshall
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia.,Department Medicine, University of Melbourne, Melbourne, Australia
| | - E Orr
- Department of Infectious Diseases, Monash Health, Melbourne, Australia
| | - N Bennett
- VICNISS Coordinating Centre, Melbourne, Australia
| | - E Athan
- Department Infectious Disease, Barwon Health, Geelong, Victoria, Australia.,Department of Medicine, Deakin University, Geelong, Victoria, Australia
| | - D Friedman
- Department Infectious Disease, Barwon Health, Geelong, Victoria, Australia.,Department of Medicine, Deakin University, Geelong, Victoria, Australia
| | - M Reilly
- Hands-On Infection Control, Perth, Western Australia, Australia
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D’Angelo-Scott H, Cutler J, Friedman D, Hendriks A, Jolly AM. Social network investigation of a syphilis outbreak in Ottawa, Ontario. Can J Infect Dis Med Microbiol 2015; 26:268-72. [PMID: 26600816 PMCID: PMC4644011 DOI: 10.1155/2015/705720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND The incidence of syphilis in Ottawa, Ontario, has risen substantially since 2000 to six cases per 100,000 in 2003, again to nine cases per 100,000 in 2007, and recently rose to 11 cases per 100,000 in 2010. The number of cases reported in the first quarter of 2010 was more than double that in the first quarter of 2009. OBJECTIVE In May 2010, the Ontario Ministry of Health and Long Term Care requested the assistance of the Field Epidemiology Program to describe the increase in infectious syphilis rates and to identify social network sources and prevention messages. METHODS Syphilis surveillance data were routinely collected from January 1, 2009 to July 15, 2010, and social networks were constructed from an enhanced social network questionnaire. Univariate comparisons between the enhanced surveillance group and the remaining cases from 2009 on non-normally distributed data were conducted using Kruskal-Wallis tests and χ(2) tests. RESULTS The outbreak cases were comprised of 89% men. Seventeen of the 19 most recent cases consented to answer the questionnaire, which revealed infrequent use of condoms, multiple sex partners and sex with a same-sex partner. Information regarding social venues where sex partners were met was plotted together with sexual partnerships, linking 18 cases and 40 contacts, representing 37% of the outbreak population and connecting many of the single individuals and dyads. CONCLUSION Uncovering the places sex partners met was an effective proxy measure of high-risk activities shared with infected individuals and demonstrates the potential for focusing on interventions at one named bar and one Internet site to reach a high proportion of the population at risk.
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Affiliation(s)
- H D’Angelo-Scott
- Canadian Field Epidemiology Program, Public Health Agency of Canada
| | - J Cutler
- Canadian Field Epidemiology Program, Public Health Agency of Canada
| | - D Friedman
- City of Ottawa Public Health, Centre for Communicable Disease and Infection Control
| | - A Hendriks
- City of Ottawa Public Health, Centre for Communicable Disease and Infection Control
| | - AM Jolly
- University of Ottawa, Ottawa, Ontario
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Gagnon I, Grilli L, Friedman D, Iverson GL. A pilot study of active rehabilitation for adolescents who are slow to recover from sport-related concussion. Scand J Med Sci Sports 2015; 26:299-306. [DOI: 10.1111/sms.12441] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2015] [Indexed: 11/28/2022]
Affiliation(s)
- I. Gagnon
- School of Physical and Occupational Therapy; Faculty of Medicine; McGill University; Montreal Quebec Canada
- Trauma Center; The Montreal Children's Hospital; McGill University Health Center; Montreal Quebec Canada
- Department of Pediatrics; Faculty of Medicine; McGill University; Montreal Quebec Canada
| | - L. Grilli
- Trauma Center; The Montreal Children's Hospital; McGill University Health Center; Montreal Quebec Canada
| | - D. Friedman
- Trauma Center; The Montreal Children's Hospital; McGill University Health Center; Montreal Quebec Canada
- Department of Pediatrics; Faculty of Medicine; McGill University; Montreal Quebec Canada
- Canadian Hospitals Injury Reporting and Prevention Program; Montreal Quebec Canada
| | - G. L. Iverson
- Department of Physical Medicine and Rehabilitation; Harvard Medical School; Boston Massachusetts USA
- Spaulding Rehabilitation Hospital; Boston Massachusetts USA
- Mass General Hospital for Children Sports Concussion Program; Boston Massachusetts USA
- Red Sox Foundation and Massachusetts General Hospital Home Base Program; Boston Massachusetts USA
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Ford T, Nguyen K, Pitney M, Friedman D, Lau A, Giles R, Allan R, Jepson N. Balloon aortic valvuloplasty: contemporary single centre experience in the TAVI era. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.360] [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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Jiang Z, Mclean C, Perez C, Barnett S, Friedman D, Batra P. Long-Term Surgical Outcomes of Spontaneous CSF Rhinorrhea. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1383995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dubrovsky S, Friedman D, Kocilowicz H. 21: Pediatric Post-Traumatic Headaches and Peripheral Nerve Blocks of the Scalp: A Case Series and Satisfaction Survey. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-21] [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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McCarten K, Friedman D, Schwartz C, Voss S, Cho S, Evangelista P. Retrospective Review of Bone Changes in Hodgkin Lymphoma utilizing CT, 18F FDG-PET, 99mTc-MDPbone Scan and MRI from Children's Oncology Group Intermediate Stage Protocol AHOD0031. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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McCarten K, Metzger M, Drachtman R, Voss S, Friedman D, Schwartz C, Cho S. Pleural Effusion in Intermediate Hodgkin Lymphoma COG Protocol AHOD0031-Evolution with Therapy and Association with Bulk Mediastinal Disease or Bone, Lung or Pleural Nodular Disease. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371170] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jefferson A, Byant A, Devinsky O, Fusco H, Shafi M, Barr W, Friedman D, Press D, Herman S, O'Connor M, Schachter S, Pascual-Leone A, Liu A. Efficacy of tDCS for Treating Working Memory Dysfunction and Depression in Patients with Temporal Lobe Epilepsy. Brain Stimul 2014. [DOI: 10.1016/j.brs.2014.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Sathananthan G, Chik W, Zahid S, Aggarwal G, Friedman D, Thiagalingam A. Evaluation of cardiac axis changes related to obesity and aging by surface electrocardiogram and cardiac computed tomography. Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2014.04.152] [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: 11/24/2022]
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Gnaneswaran G, Aggarwal G, Zahid S, Chik W, Friedman D, Thiagalingam A. Computed Tomography Guided In Vivo Cardiac Orientation and ECG Correlation in Individuals Without Structural Heart Disease. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.04.027] [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: 10/26/2022]
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Carlyle A, Pitney M, Friedman D. Radiation in CT vs Angiography (RICTA Study), Early Results. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.363] [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: 10/26/2022]
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Gnaneswaran G, Aggarwal G, Friedman D, Zahid S, Chik W, Thiagalingam A. Computed Tomography Guided In Vivo Cardiac Orientation and ECG Correlation in Individuals Without Structural Heart Disease. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.407] [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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Adami GF, Friedman D, Cuneo S, Cuneo G, Marinari G, Gandolfo P, Scopinaro N. Intravenous nutritional support in pregnancy. Experience following biliopancreatic diversion. Clin Nutr 2012; 11:106-9. [PMID: 16839982 DOI: 10.1016/0261-5614(92)90020-q] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/1991] [Accepted: 01/10/1992] [Indexed: 01/15/2023]
Abstract
11 pregnant women with protein malnutrition following biliopancreatic diversion for obesity were supported by parenteral nutrition (PN). In 2 cases high concentration glucose, lipid emulsions and standard aminoacid mixtures were infused via a central venous catheter; in the other subjects, because oral intake was normal or increased, only aminoacids with or without lipids were administered through a peripheral vein. PN promoted foetal growth and was very well tolerated and totally safe both for mother and infant.
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Affiliation(s)
- G F Adami
- Istituto di Clinica Chirurgica, Universita' di Genova, Italy
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Friedman D. Safety and Immunogenicity of LC16m8, an Attenuated Smallpox Vaccine in Vaccinia-Naive Adults. J Infect Dis 2012; 206:1149; author reply 1149-50. [DOI: 10.1093/infdis/jis453] [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: 11/14/2022] Open
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