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Ismael S, Patrick D, Salman M, Parveen A, Stanfill AG, Ishrat T. Verapamil inhibits TXNIP-NLRP3 inflammasome activation and preserves functional recovery after intracerebral hemorrhage in mice. Neurochem Int 2022; 161:105423. [PMID: 36244583 DOI: 10.1016/j.neuint.2022.105423] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/08/2022]
Abstract
Intracerebral hemorrhage (ICH) is the second most common type of stroke with no satisfactory treatment. Recent studies from our group and others indicated a potential positive effect of verapamil, a commonly prescribed calcium channel blocker, with thioredoxin-interacting protein (TXNIP) inhibitor properties, in ischemic stroke and cognitive disorders. It is unclear whether there would be a beneficial effect of verapamil administration in ICH. Therefore, this study was designed to determine the neuroprotective effects of verapamil in a murine ICH model. ICH was induced by stereotactic injection of collagenase type VII (0.075 U) into the right striatum of adult male C57BL/6 mice. Verapamil (0.15 mg/kg) or saline was administered intravenously at 1 h post-ICH followed by oral (1 mg/kg/d) administration in drinking water for 28 days. Motor and cognitive function were assessed using established tests for motor coordination, spatial learning, short- and long-term memory. A subset of animals was sacrificed at 72 h after ICH for molecular analysis. Verapamil treatment reduced expression of TXNIP and NOD-like receptor pyrin domain-containing-3 inflammasome activation in the perihematomal area. These protective effects of verapamil were associated with decreased proinflammatory mediators, microglial activation, and blood-brain barrier permeability markers and paralleled less phosphorylated nuclear factor kappa B level. Our findings also demonstrate that long-term low-dose verapamil effectively attenuated motor and cognitive impairments. Taken together, these data indicate that verapamil has therapeutic potential in improving acute motor function after ICH. Further investigations are needed to confirm whether verapamil treatment could be a promising candidate for clinical trials.
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Affiliation(s)
- Saifudeen Ismael
- Department of Anatomy and Neurobiology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Devlin Patrick
- Department of Anatomy and Neurobiology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA; Department of Acute and Tertiary Care, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mohd Salman
- Department of Anatomy and Neurobiology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Arshi Parveen
- Department of Anatomy and Neurobiology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ansley Grimes Stanfill
- Department of Acute and Tertiary Care, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Tauheed Ishrat
- Department of Anatomy and Neurobiology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA; Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Eqbal A, Martin A, Doecke JD, Patrick D. Low dose thioguanine guided by therapeutic drug monitoring is a safe and effective alternative in inflammatory bowel disease patients intolerant to conventional thiopurines. Intern Med J 2021; 53:559-567. [PMID: 34874611 DOI: 10.1111/imj.15639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Thioguanine is an alternative thiopurine for IBD patients. We evaluated the short-term efficacy and safety of low dose therapeutic drug monitored (TDM) thioguanine. METHODS A retrospective evaluation of IBD patients intolerant to conventional thiopurines started on thioguanine from 2017-2019 with dosing guided by TDM was conducted. Clinical response was defined for Ulcerative colitis (UC) as a reduction of partial MAYO score ≥ 3 with reduction in rectal bleeding score of at least 1 and a final rectal bleeding sub score of 0-1 at week 12 of therapy. Crohn's disease (CD) response was defined as a reduction of Harvey-Bradshaw index ≥ 3 (HBI) at week 12 of therapy. Remission was defined in UC as partial MAYO score of < 2 and in CD as HBI score of < 5. RESULTS 46 patients were included in the study. The median thioguanine dose was 20 mg/day (SD 7.3, range: 10-40 mg/day) with a median 6-TGN level of 564 pmol/8×108 (IQR 517) for CD and 672 pmol/8×108 (IQR 349) for UC. The overall clinical response rate was 62% (13/21), intention to treat (ITT). Maintenance of remission was 76% (19/25, ITT). 37% (17/46) of patients experienced an adverse effect. No early cases of NRH were seen. CONCLUSION Thioguanine was tolerated well in 63% of patients. Clinical response was seen in 62 % of and maintenance of remission was high at 76 %. No cases of early NRH were seen. Longer-term follow-up is required to ensure safety and to assess durability of response. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- A Eqbal
- Department of Gastroenterology and Hepatology, Sunshine Coast University Public Hospital, Sunshine Coast, Queensland, Australia
| | - A Martin
- Department of Gastroenterology and Hepatology, Sunshine Coast University Public Hospital, Sunshine Coast, Queensland, Australia
| | - J D Doecke
- Department of Gastroenterology and Hepatology, Sunshine Coast University Public Hospital, Sunshine Coast, Queensland, Australia.,CSIRO Health and Biosecurity/Australian E-Health Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - D Patrick
- Department of Gastroenterology and Hepatology, Sunshine Coast University Public Hospital, Sunshine Coast, Queensland, Australia
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Cau A, Cheng MP, Lee T, Levin A, Lee TC, Vinh DC, Lamontagne F, Singer J, Walley KR, Murthy S, Patrick D, Rewa O, Winston B, Marshall J, Boyd J, Russell JA. Acute Kidney Injury and Renal Replacement Therapy in COVID-19 Versus Other Respiratory Viruses: A Systematic Review and Meta-Analysis. Can J Kidney Health Dis 2021; 8:20543581211052185. [PMID: 34733538 PMCID: PMC8558598 DOI: 10.1177/20543581211052185] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a potentially fatal complication of Coronavirus Disease-2019 (COVID-19). Binding of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, to its viral receptor, angiotensin converting enzyme 2 (ACE2), results in viral entry and may cause AKI. OBJECTIVES We performed a systematic review and meta-analysis of the frequencies of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients and compared those frequencies with patients who were infected by respiratory viruses that bind or downregulate ACE2 (ACE2-associated viruses) and viruses that do not bind nor downregulate ACE2 (non-ACE2-associated viruses). DESIGN Systematic review and meta-analysis. SETTING Observational studies on COVID-19 and other respiratory viral infections reporting AKI and RRT were included. The exclusion criteria were non-English articles, non-peer-reviewed articles, review articles, studies that included patients under the age of 18, studies including fewer than 10 patients, and studies not reporting AKI and RRT rates. PATIENTS Adult COVID-19, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and influenza patients. MEASUREMENTS We extracted the following data from the included studies: author, year, study location, age, sex, race, diabetes mellitus, hypertension, chronic kidney disease, shock, vasopressor use, mortality, intensive care unit (ICU) admission, ICU mortality, AKI, and RRT. METHODS We systematically searched PubMed and EMBASE for articles reporting AKI or RRT. AKI was defined by authors of included studies. Critical illness was defined by ICU admission. We performed a random effects meta-analysis to calculate pooled estimates for the AKI and RRT rate within each virus group using a random intercept logistic regression model. RESULTS Of 23 655 hospitalized, critically ill COVID-19 patients, AKI frequencies were not significantly different between COVID-19 patients (51%, 95% confidence interval [CI]: 44%-57%) and critically ill patients infected with ACE2-associated (56%, 95% CI: 37%-74%, P = .610) or non-ACE2-associated viruses (63%, 95% CI: 43%-79%, P = .255). Pooled RRT rates were also not significantly different between critically ill, hospitalized patients with COVID-19 (20%, 95% CI: 16%-24%) and ACE2-associated viruses (18%, 95% CI: 8%-33%, P = .747). RRT rates for both COVID-19 and ACE2-associated viruses were significantly different (P < .001 for both) from non-ACE2-associated viruses (49%, 95% CI: 44%-54%). After adjusting for shock or vasopressor use, AKI and RRT rates were not significantly different between groups. LIMITATIONS Limitations of this study include the heterogeneity of definitions of AKI that were used across different virus studies. We could not match severity of infection or do propensity matching across studies. Most of the included studies were conducted in retrospective fashion. Last, we did not include non-English publications. CONCLUSIONS Our findings suggest that viral ACE2 association does not significantly alter the rates of AKI and RRT among critically ill patients admitted to the ICU. However, the rate of RRT is lower in patients with COVID-19 or ACE2-associated viruses when compared with patients infected with non-ACE2-binding viruses, which might partly be due to the lower frequencies of shock and use of vasopressors in these two virus groups. Prospective studies are necessary to demonstrate whether modulation of the ACE2 axis with Renin-Angiotensin System inhibitors impacts the rates of AKI and whether they are beneficial or harmful in COVID-19 patients.
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Affiliation(s)
- A. Cau
- The University of British Columbia, Vancouver, BC, Canada
| | - M. P. Cheng
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Terry Lee
- Centre for Health Evaluation & Outcomes Science, The University of British Columbia, Vancouver, BC, Canada
| | - A. Levin
- Division of Nephrology, St. Paul’s Hospital, Vancouver, BC, Canada
| | - T. C. Lee
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - D. C. Vinh
- Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - J. Singer
- Centre for Health Evaluation & Outcomes Science, The University of British Columbia, Vancouver, BC, Canada
| | - K. R. Walley
- Centre for Heart Lung Innovation, St. Paul’s Hospital and The University of British Columbia, Vancouver, BC, Canada
| | - S. Murthy
- BC Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - D. Patrick
- British Columbia Centre for Disease Control and The University of British Columbia, Vancouver, BC, Canada
| | - O. Rewa
- University of Alberta, Edmonton, AB, Canada
| | - B. Winston
- University of Calgary, Calgary, AB, Canada
| | - J. Marshall
- St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - J. Boyd
- Centre for Heart Lung Innovation, St. Paul’s Hospital and The University of British Columbia, Vancouver, BC, Canada
| | - JA Russell
- Centre for Heart Lung Innovation, St. Paul’s Hospital and The University of British Columbia, Vancouver, BC, Canada
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Affiliation(s)
- Lidwine B Mokkink
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lex M Bouter
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jordi A Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - D Patrick
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Henrica C W de Vet
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Alam J, Blackburn K, Patrick D. Neflamapimod: Clinical Phase 2b-Ready Oral Small Molecule Inhibitor of p38α to Reverse Synaptic Dysfunction in Early Alzheimer's Disease. J Prev Alzheimers Dis 2018; 4:273-278. [PMID: 29181493 DOI: 10.14283/jpad.2017.41] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Neflamapimod (previously code named VX-745) is a clinical phase 2b-ready highly specific inhibitor of the intra-cellular enzyme p38 mitogen activated protein kinase alpha ("p38α") that is being developed as a disease-modifying drug for Alzheimer's disease (AD) that acts via targeting synaptic dysfunction. Neflamapimod was discovered through a proprietary structure-based drug discovery platform at Vertex Pharmaceuticals, and developed previously by Vertex through to phase 2a in rheumatoid arthritis. EIP Pharma licensed the compound in 2014 for development and commercialization as a treatment of central nervous system (CNS) disorders. Neflamapimod is the most advanced in the clinic drug that targets specific molecular mechanisms within neurons that leads to synaptic dysfunction, the pathogenic process that is now considered to be a major driver of the development of memory deficits and disease progression in the early stages of AD. Based on the scientific rationale of targeting synaptic dysfunction and the preclinical data, neflamapimod has the potential to both reverse memory deficits and slow disease progression. Phase 2a clinical data in patients with early-stage AD (MMSE 20-28, biomarker positive) provides evidence that the preclinical science may be translatable to human Alzheimer's, as 6- to 12-weeks of neflamapimod treatment led to significant improvement in episodic memory, the best clinical measure of synaptic dysfunction in AD. A phase 2b six-month placebo-controlled 150-patient clinical study is anticipated to start by end of 2017. This study is designed to definitively demonstrate that neflamapimod reverses memory deficits, and also to provide preliminary evidence that the drug slows disease progression.
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Affiliation(s)
- J Alam
- John Alam, MD, EIP Pharma, LLC, 11 Channing Street, Cambridge MA 02138, phone: 617-945-0794,
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Abstract
SummaryAn in vitro system which expresses all enzyme activities related to vitamin K-dependent carboxylation of blood clotting factors was prepared from livers of rats overdosed with warfarin, difenacoum and dicumarol respectively. In this system, the activities of the two pathways that are known to produce active reduced vitamin K1 cofactor for the carboxylation reaction were measured. Also the ability of high concentrations of vitamin Kx to overcome inhibition of clotting factor synthesis was studied. In the systems prepared from livers of warfarin and difenacoum intoxicated rats, pathway I was inactive. Vitamin K epoxide reductase was also inactive which strongly suggests that this enzyme catalyzes the activity of pathway I in vivo. Reduction of vitamin by pathway II bypassed the inactive pathway I and resulted in carboxylation activity. This pathway therefore mediates the antidotic effect of vitamin K1 in the coumarin intoxicated liver. In the in vitro system prepared from dicumarol intoxicated livers the activity of pathway I was not significantly affected. Dicumarol however was a strong inhibitor when added to liver microsomes in vitro.
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Affiliation(s)
- R Wallin
- The Departments of Physiology and Medicine, The Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - D Susan
- The Departments of Physiology and Medicine, The Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - D Patrick
- The Departments of Physiology and Medicine, The Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - J O Ballard
- The Departments of Physiology and Medicine, The Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, Pennsylvania, USA
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Patrick D, Smith M, Cleeland C, Fallowfield L, Tombal B, Oudard S, Shore N, Saad F, Marx G, Coleman R, Gómez-Veiga F, Damião R, Zhou Y, Arellano J, Braun A, Qian Y. 99 The impact of bone metastases on pain: Results from a phase III denosumab study in men with nonmetastatic castration-resistant prostate cancer. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s1569-9056(13)60591-6] [Citation(s) in RCA: 5] [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: 11/15/2022]
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Satoh M, Terata S, Kikuya M, Ohkubo T, Hashimoto T, Hara A, Hirose T, Obara T, Metoki H, Inoue R, Asayama K, Nakayama M, Kanno A, Totsune K, Hoshi H, Satoh H, Sato H, Imai Y, Palmer S, Germaine W, Iff S, Craig J, Mitchell P, Wang JJ, Strippoli G, Palmer S, Craig J, Navaneethan S, Tonelli M, Pellegrini F, Strippoli G, Stracke S, Ernst F, Robinson D, Schwahn C, John U, Felix SB, Volzke H, Mysula I, Gozhenko A, Susla O, Minutolo R, Gabbai FB, Agarwal R, Bellizzi V, Nappi F, Conte G, De Nicola L, Smith E, Tomlinson L, Ford M, Mcmahon L, Rajkumar C, Holt S, Lee S, Kim I, Lee D, Rhee H, Song S, Seong E, Kwak I, Redal-Baigorri B, Rasmusen K, Goya Heaf J, Sombolos K, Tsakiris D, John B, Vlahakos D, Siamopoulos K, Vargiemezis V, Nikolaidis P, Iatrou C, Dafnis E, Argyropoulos C, Xynos K, Ramona H, Jos D, Guido F, Patrick D, Dominique L, Begona MYK, Antoon DS, Marc VS, Hellberg M, Wiberg EM, Hoglund P, Simonsen O, Clyne N, Manfredini F, Manfredini F, Bolignano D, Rastelli S, Barilla A, Bertoli S, Ciurlino D, Messa P, Fabrizi F, Zuccala A, Rapana R, Fatuzzo P, Rapisarda F, Bonanno G, Lombardi L, De Paola L, Cupisti A, Fuiano G, Lucisano G, Tripepi G, Catizone L, Zoccali C, Mallamaci F, Ishigami T, Ishigami T, Yamamoto R, Nagasawa Y, Isaka Y, Konta T, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Yoshida H, Fujimoto S, Asahi K, Watanabe T, Morales E, Gutierrez E, Forteza A, Bellot R, Sanchez V, Sanz MP, Evangelista A, Cortina J, Praga M, Hung CC, Yang ML, Hwang SJ, Chen HC, Saglimbene VM, Palmer S, Craig J, Pellegrini F, Vecchio M, Ruospo M, De Berardis G, Strippoli G, DI Iorio B, Bellasi A, Pota A, Russo L, Russo D, Nakano C, Nakano C, Hamano T, Fujii N, Obi Y, Matsui I, Mikami S, Inoue K, Shimomura A, Rakugi H, Isaka Y, Yen CY, Wang HH, Hung CC, Hwang SJ, Chen HC, Postorino M, Postorino M, Cutrupi S, Pizzini P, Marino C, D'arrigo G, Tripepi G, Zoccali C, Ghasemi H, Afshar R, Afshar R, Shabpirai H, Davati A, Zerafatjou N, Abdi S, Khorsand Askari M, Almeida E, Lavinas C, Teixeira C, Raimundo M, Nogueira C, Ferreira M, Sampaio A, Henriques I, Teixeira C, Gomes Da Costa A, Leal M, Ekart R, Hojs N, Pecovnik Balon B, Bevc S, Dvorsak B, Stropnik Galuf T, Hojs R, Lin WH, Guo CY, Wang WM, Yang DC, Kuo TH, Liu MF, Wang MC, Hara S, Tanaka K, Tsuji H, Ohmoto Y, Amaka K, Ubara Y, Arase K, Yilmaz MI, Solak Y, Saglam M, Yaman H, Unal HU, Gok M, Cetinkaya H, Biyik Z, Gaipov A, Caglar K, Tonbul HZ, Turk S, Wang HH, Yen CY, Hung CC, Hwang SJ, Chen HC, Krivoshiev S, Krivoshiev S, Koteva A, Kraev Z, Mihaylov G, Shikov P, David R, Jeffrey J, Andrew S, Michael R, Charmot D, Fouda R, Abdelhamid Y, Alsayed D, Salah S, Belal D, Salem M, Ahmed H, Vecchio M, Palmer S, Saglimbene VM, Ruospo M, Gargano L, Pellegrini F, Strippoli G, Tisljar M, Horvatic I, Bozic B, Crnjakovic Palmovic J, Bacalja J, Bulimbasic S, Galesic Ljubanovic D, Galesic K, Choi JS, Kim CS, Park JW, Bae EH, MA SK, Kim SW, Choi JS, Kim CS, Park JW, Bae EH, MA SK, Kim SW. Clinical Nephrology - Epidemiology I. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs216] [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: 11/13/2022] Open
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Fallowfield L, Patrick D, Body J, Lipton A, Tonkin KS, Qian Y, Jiang Q, Braun AH, Dansey RD, Chung K. Effect of denosumab versus zoledronic acid on health-related quality of life in patients with metastatic breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] Open
Abstract
272 Background: Patients with breast cancer and bone metastases often experience skeletal-related events (SREs) and pain, which can impact health-related quality of life (HRQoL). Denosumab is superior to zoledronic acid (ZA) in preventing SREs and more effective in delaying moderate or severe pain in patients with advanced breast cancer. We now describe the effect of denosumab or ZA treatment on HRQoL in these patients. Methods: Patients enrolled in this double-blind, double-dummy study were randomized to receive denosumab (120 mg SC) or ZA (4 mg IV) every 4 weeks. Patients completed the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire at baseline (BL), day 8, and each monthly visit to assess overall HRQoL. Higher scores (range 0 to 108) reflect a better HRQoL. Changes in HRQoL were summarized through month 18, when 30% of patients had died or dropped out due to disease progression or withdrawal of consent. Increases or decreases of ≥ 5 points in the FACT-G total score were considered clinically meaningful. Pain was evaluated by the Brief Pain Inventory–Short Form (BPI-SF). HRQoL was assessed in subgroups with no/mild pain or moderate/severe pain at BL. Results: The BL mean (SD) FACT-G score was similar for denosumab (n = 956) 72.7 (16.4) and ZA (n = 952) 73.6 (16.5) groups and increased from BL to month18 for both groups reflecting improved HRQoL. An average of 3.2% more (range 0.9% to 6.8%) denosumab-treated patients than ZA-treated patients experienced a ≥ 5-point increase in HRQoL from months 1 to 18. Fewer denosumab than ZA-treated patients reported a ≥ 5-point decrease in HRQoL (average 2.7% fewer; range 0.6% to 5.8%). Among patients with no/mild pain at BL, an average of 4.1% more (range -0.6% to 9.3%) denosumab-treated patients had a ≥ 5-point increase in FACT-G score from month 4 to 18. In this same subgroup, fewer denosumab-treated patients had a ≥ 5-point decrease in HRQoL over 18 months (average 2.4% fewer; range -4.4% to 6.3%). Similar patterns in FACT-G scores were noted for the subgroup with moderate/severe pain at BL. Conclusions: In patients with advanced breast cancer, a greater proportion treated with denosumab than ZA had a meaningful improvement in HRQoL regardless of BL pain level.
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Affiliation(s)
- L. Fallowfield
- Cancer Research UK, Brighton, United Kingdom; University of Washington, Seattle, WA; Brugman University Hospital, ULB, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - D. Patrick
- Cancer Research UK, Brighton, United Kingdom; University of Washington, Seattle, WA; Brugman University Hospital, ULB, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - J. Body
- Cancer Research UK, Brighton, United Kingdom; University of Washington, Seattle, WA; Brugman University Hospital, ULB, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - A. Lipton
- Cancer Research UK, Brighton, United Kingdom; University of Washington, Seattle, WA; Brugman University Hospital, ULB, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - K. S. Tonkin
- Cancer Research UK, Brighton, United Kingdom; University of Washington, Seattle, WA; Brugman University Hospital, ULB, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - Y. Qian
- Cancer Research UK, Brighton, United Kingdom; University of Washington, Seattle, WA; Brugman University Hospital, ULB, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - Q. Jiang
- Cancer Research UK, Brighton, United Kingdom; University of Washington, Seattle, WA; Brugman University Hospital, ULB, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - A. H. Braun
- Cancer Research UK, Brighton, United Kingdom; University of Washington, Seattle, WA; Brugman University Hospital, ULB, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - R. D. Dansey
- Cancer Research UK, Brighton, United Kingdom; University of Washington, Seattle, WA; Brugman University Hospital, ULB, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - K. Chung
- Cancer Research UK, Brighton, United Kingdom; University of Washington, Seattle, WA; Brugman University Hospital, ULB, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
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Fallowfield L, von Moos R, Patrick D, Cleeland C, Henry D, Hirsh V, Zarogoulidis K, Ying W, Cong Z, Yeh H. 7004 ORAL Pain Outcomes in a Randomized Phase 3 Clinical Trial of Denosumab Vs Zoledronic Acid (ZA) in Patients With Solid Tumours and Bone Metastases. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Fallowfield L, Patrick D, Body JJ, Lipton A, Tonkin KS, Qian Y, Zhao Y, Jiang Q, Braun A, Dansey R, Chung K. Abstract P1-13-05: The Effect of Treatment with Denosumab or Zoledronic Acid on Health-Related Quality of Life in Patients with Metastatic Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p1-13-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
Background: Patients with breast cancer and bone metastases often experience skeletal-related events (SREs) and pain, which may impact health-related quality of life (HRQoL). Denosumab is a fully human monoclonal antibody against RANKL shown to be superior in delaying/preventing SREs and more effective in delaying moderate or severe pain in patients with advanced breast cancer compared with zoledronic acid (ZA). Previously reported results from this study population showed that both denosumab and ZA patients showed improvement or maintenance in HRQoL relative to baseline (BL), and a greater proportion of denosumab-treated patients had a clinically meaningful improvement in HRQoL. We now describe the effect of denosumab and ZA treatment on HRQoL among patients with varying degrees of pain at BL.
Methods: Enrolled patients received subcutaneous (SC) denosumab 120 mg or intravenous (IV) ZA 4 mg every 4 weeks in a double-blind, double-dummy fashion. Pain was evaluated using the Brief Pain Inventory — Short Form (BPI). Patients were divided into 2 subgroups based on the level of pain reported at BL: no/mild pain or moderate/severe pain. Patients completed the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire at BL, day 8, and before each monthly visit to assess overall HRQoL. Higher scores (range 0 to 108) represent better HRQoL. Improvement, maintenance, and worsening of HRQoL were assessed through month 18, when 30% of patients had dropped out due to death, disease progression, or withdrawal of consent. A change of ≥5 points (increase or decrease) in the FACT-G total score was considered a meaningful improvement.
Results: Among patients who reported no/mild pain at baseline, more denosumab-treated patients had a ≥5-point increase in their FACT-G score from month 4 onwards. Over the 18 month period, an average of 4.1% more (range: −0.6% to 9.3%) denosumab-treated patients experienced meaningful improvement in HRQoL than ZA-treated patients. There were also fewer denosumab-treated patients experiencing ≥5-point decrease in HRQoL over 18 months (average of 2.4% fewer [range:-4.4% to 6.3% fewer]). Similar patterns were also noted for patients with moderate/severe pain at baseline. An average of 3.0% more (range:-1.7% to 7.9%) denosumab-treated patients had ≥5-point increase in FACT-G scores compared with ZA-treated patients over 18 months. A lower proportion of denosumab-treated patients (3.5% fewer [range: −1.1% to 11.5% fewer]) than ZA-treated patients had a decrease ≥5-points in their FACT-G score over 18 months.
Conclusion: In patients with breast cancer and bone metastases, a greater proportion treated with denosumab than ZA had a meaningful improvement in HRQoL regardless of their pain level at BL.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-13-05.
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Affiliation(s)
- L Fallowfield
- University of Sussex, Brighton, United Kingdom; University of Washington, Seattle; CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - D Patrick
- University of Sussex, Brighton, United Kingdom; University of Washington, Seattle; CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - J-J Body
- University of Sussex, Brighton, United Kingdom; University of Washington, Seattle; CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - A Lipton
- University of Sussex, Brighton, United Kingdom; University of Washington, Seattle; CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - KS Tonkin
- University of Sussex, Brighton, United Kingdom; University of Washington, Seattle; CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - Y Qian
- University of Sussex, Brighton, United Kingdom; University of Washington, Seattle; CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - Y Zhao
- University of Sussex, Brighton, United Kingdom; University of Washington, Seattle; CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - Q Jiang
- University of Sussex, Brighton, United Kingdom; University of Washington, Seattle; CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - A Braun
- University of Sussex, Brighton, United Kingdom; University of Washington, Seattle; CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - R Dansey
- University of Sussex, Brighton, United Kingdom; University of Washington, Seattle; CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
| | - K. Chung
- University of Sussex, Brighton, United Kingdom; University of Washington, Seattle; CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Penn State Milton S. Hershey Medical Center, Hershey, PA; Cross Cancer Institute, Edmonton, AB, Canada; Amgen Inc., Thousand Oaks, CA
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Oteng B, Marra F, Lynd LD, Ogilvie G, Patrick D, Marra CA. Evaluating societal preferences for human papillomavirus vaccine and cervical smear test screening programme. Sex Transm Infect 2010; 87:52-7. [DOI: 10.1136/sti.2009.041392] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Morán-Mendoza O, Marion SA, Elwood K, Patrick D, FitzGerald JM. Risk factors for developing tuberculosis: a 12-year follow-up of contacts of tuberculosis cases. Int J Tuberc Lung Dis 2010; 14:1112-1119. [PMID: 20819255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Many risk factors for the development of tuberculosis (TB) have been reported but have not been simultaneously assessed. OBJECTIVE To determine the risk of developing TB associated with each risk factor, after adjusting for all others. METHODS We performed a population-based, retrospective cohort study of the contacts of TB cases recorded in British Columbia, Canada. Known risk factors for the development of TB were assessed over a 12-year period; Cox regression was used to estimate the hazard ratios (HRs) of TB, adjusting for the other factors. RESULTS Among 33 146 TB contacts, 228 developed TB during the study period (TB rate 668 per 100,000 population, 95%CI 604-783). The main risk factors for TB development were malnutrition (HR 37.5), no treatment of latent TB infection (HR 25) or <6 months of treatment (HR 5.38), age 0-10 years (HR 7.87), being a household contact (HR 8.47) and having a tuberculin skin test induration of >or=5 mm (HR >or=4.99). Bacille Calmette-Guérin vaccination significantly reduced the risk of TB development (HR 0.32, 95%CI 0.20-0.50). CONCLUSIONS Among contacts of TB cases, we have identified the few factors that carry a very high risk for developing TB. These factors identify populations at highest risk and permit more effective TB control.
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Affiliation(s)
- O Morán-Mendoza
- Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
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Stopeck A, Fallowfield L, Patrick D, Cleeland CS, De Boer RH, Steger GG, Qian Y, Jiang Q, Dansey RD, Chung K. Effects of denosumab versus zoledronic acid (ZA) on pain in patients (pts) with metastatic breast cancer: Results from a phase III clinical trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1024] [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: 11/20/2022] Open
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Fallowfield L, Patrick D, Body J, Lipton A, Tonkin KS, Qian Y, Jiang Q, Dansey RD, Chung K. Effects of denosumab versus zoledronic acid (ZA) on health-related quality of life (HRQL) in metastatic breast cancer: Results from a randomized phase III trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1025] [Citation(s) in RCA: 5] [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: 11/20/2022] Open
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von Moos R, Patrick D, Fallowfield L, Cleeland CS, Henry DH, Qian Y, Dansey RD, Chung K. Effects of denosumab versus zoledronic acid (ZA) on pain in patients (pts) with advanced cancer (excluding breast and prostate) or multiple myeloma (MM): Results from a randomized phase III clinical trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9043] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
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17
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Adams E, Lewis-Jones I, Alfirevic Z, MacDonald R, Dawood F, Mallaiah S, Djabatey E, Parkinson D, Farquharson R, Patrick D, Fowler G, Turner M, Hapangama D, Wauchob T, Kingsland C, Weeks A, Kingston R, Kirwan J. 18 Liverpool consultants reply. West J Med 2009. [DOI: 10.1136/bmj.b4981] [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: 11/03/2022]
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18
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Patrick D, Blondel-Hill E, Vrbova L, Fuertes E, Marra F, Henry B, Watson R, Dreher K, Purych D. P80 Evaluation of a population-based program for the wise use of antibiotics. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70299-7] [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: 11/29/2022]
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19
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Fuertes E, Marra F, Henry B, Wong H, Patrick D. P81 Trends in antibiotic utilization in Vancouver associated with a community education program on antibiotic use. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE Deficits in social functioning are a core feature of schizophrenia. METHOD A literature search of English language articles published between January 1990 and December 2006 was undertaken to identify: i) scales used most frequently to assess social functioning in schizophrenia; and ii) the most frequently used social functioning scales in randomized, controlled trials of antipsychotics. A further search (without time limits) examined their psychometric properties. RESULTS A total of 301 articles employed social functioning scales in the assessment of schizophrenia. These contained 87 potentially relevant measures. Only 14 randomized, controlled studies of antipsychotic agents were identified that examined social functioning. Scales varied greatly in terms of measurement approach, number and types of domains covered and scoring systems. A striking lack of data on psychometric properties was observed. CONCLUSION Limited consensus on the definition and measurement of social functioning exists. The Personal and Social Performance Scale is proposed as a useful tool in future research.
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Affiliation(s)
- T Burns
- Department of Psychiatry, University of Oxford, Oxford, UK.
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21
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Edgar BL, Galanis E, Kay C, Skowronski D, Naus M, Patrick D. The burden of varicella and zoster in British Columbia 1994-2003: baseline assessment prior to universal vaccination. Can Commun Dis Rep 2007; 33:1-15. [PMID: 18163240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- B L Edgar
- Epidemiology Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
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22
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Roscoe D, Bryce E, Roberts F, Patrick D, Naus M, Henry B, Cronk D, McManus K. P7.05 Teaching Infection Control: Get Caught in our Web. J Hosp Infect 2006. [DOI: 10.1016/s0195-6701(06)60134-5] [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: 11/16/2022]
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23
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Sergienko E, Cox P, Hofmann J, Patrick D. L2: Cross Border Epidemiology: When Pandemic Influenza Comes to the Northwest, 2004 – 2005. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s150b] [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)
- E Sergienko
- CDC EIS Officer, Washington State Department of Health
| | - P Cox
- CDC EIS Officer, Washington State Department of Health
| | - J Hofmann
- CDC EIS Officer, Washington State Department of Health
| | - D Patrick
- CDC EIS Officer, Washington State Department of Health
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24
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Patrick D. The Tourniquet Manual—Principles and Practice. Br J Anaesth 2004. [DOI: 10.1093/bja/aeh587] [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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25
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MacDonald DM, Fyfe M, Paccagnella A, Trinidad A, Louie K, Patrick D. Escherichia coli O157:H7 outbreak linked to salami, British Columbia, Canada, 1999. Epidemiol Infect 2004; 132:283-9. [PMID: 15061503 PMCID: PMC2870104 DOI: 10.1017/s0950268803001651] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
An outbreak of E. coli O157:H7 infections was identified in November 1999 with a fivefold increase in the occurrence of laboratory-confirmed cases of E. coli O157:H7 infection. A matched case-control study was conducted. Samples of food from cases and from retailers were analysed for the presence of E. coli O157:H7. A total of 143 cases were identified over a 12-week period with the same pulsed-field gel electrophoresis (PFGE) pattern. The case-control study found that Company A salami was significantly associated with illness (Mantel-Haenszel matched odds ratio 10.0%, 95% CI 1.4-434, P=0.01). Company A salami tested positive for E. coli O157:H7 and isolates had the same PFGE pattern as case isolates. An immediate voluntary national recall of Company A dry fermented meat products took place. Findings from the investigation of this outbreak suggest that the hold-and-test option may not be adequate to prevent shiga-toxigenic Escherichia coli (STEC) infection in salami consumers.
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Affiliation(s)
- D M MacDonald
- Health Canada, Population and Public Health Branch, Field Epidemiology Training Program, Ottawa, Canada
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26
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Moore D, Bigham M, Patrick D. Modelling the costs and effects of a universal infant immunization program using conjugated pneumococcal vaccine in British Columbia. Can Commun Dis Rep 2003; 29:97-104. [PMID: 12794969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- D Moore
- Community Medicine Residency Program, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC
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27
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Jang D, Sellors J, Howard M, Mahony J, Frost E, Patrick D, Bouchard C, Dubois J, Scholar L, Chernesky M. Correlation between culture testing of swabs and ligase chain reaction of first void urine from patients recently treated for Chlamydia trachomatis. Sex Transm Infect 2003; 79:237-9. [PMID: 12794211 PMCID: PMC1744653 DOI: 10.1136/sti.79.3.237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We assessed the correlation between ligase chain reaction (LCR) on first void urine (FVU) and cultures of urethral and cervical swabs to detect chlamydia during three post-treatment follow up visits for 10 men and 19 women with genital chlamydial infections who had been treated with azithromycin or doxcycline.
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Affiliation(s)
- D Jang
- The Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada.
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28
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Amir M, McKenna S, Martini M, Bushnell D, Whalley D, Patrick D. Does change in depression status predict change in hrQoL? Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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29
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Tyndall MW, Patrick D, Spittal P, Li K, O'Shaughnessy MV, Schechter MT. Risky sexual behaviours among injection drugs users with high HIV prevalence: implications for STD control. Sex Transm Infect 2002; 78 Suppl 1:i170-5. [PMID: 12083439 PMCID: PMC1765822 DOI: 10.1136/sti.78.suppl_1.i170] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Injection drug use is inextricably linked to commercial sex work and the transmission of sexually transmitted disease (STD). In many communities prevention efforts have been stalled owing to the marginal existence of this community. This study describes the sexual activities, condom use, reported STDs, and commercial sex work in a large cohort of injection drug users. Seventy two per cent of male and 92% of female subjects in the cohort were sexually active. Among female subjects, 57% reported more than 100 lifetime partners. Condoms were generally not used with regular partners, used about half the time with casual partners, and used about 80% of the time with paying partners. Female sex workers were more likely to have unstable housing and to report incarceration in the previous six months. Reducing the transmission of STDs and HIV in drug using communities is a public health priority. While existing prevention programmes should be strengthened, innovative approaches to STD surveillance, diagnosis, and prevention are needed.
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Affiliation(s)
- M W Tyndall
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada.
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30
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Goonewardene LA, Okine E, Patrick N, Patrick D, Day PA, Scheer HD, Suleiman A. Effects of feeding high energy or high energy-protein diets to goats. Can J Anim Sci 2002. [DOI: 10.4141/a01-014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Growth, efficiency and carcass traits were evaluated for goats fed barley or a concentrate mix (CM). Goats on the CM showed higher (P < 0.01) average daily gain (ADG) (27.5%), end of test weight (11.6%), hot carcass weight (HCW) (14.9%) and rib-eye area (REA) (14.7%), lower (P < 0.02) concentrate to gain ratio (CG) ratio (22.5%) and no differences (P > 0.05) in concentrate intake (CI) and dressing percent (DP), compared to those on barley. Although feeding the CM improved ADG, CG, HCW and REA, it may be relatively more economical to finish goats on whole barley grain. Key words: Goat, high energy, high protein, growth, rib-eye area
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Abstract
Acrocephalopolysyndactyly Type II (Carpenter Syndrome) is determined by autosomal recessive inheritance. Only some 40 cases have been described. Variable clinical signs have been described including prolonged retention of primary teeth and hypodontia. This paper describes the oral and dental findings in a family containing two affected brothers. The family pedigree is informative, as the mother has had children by three partners. The two affected individuals are full brothers. The first affected brother has delayed dental development, severe hypodontia and small tooth crown size. Mesio-distal and bucco-lingual dimensions were measured on the study models and compared with population data. The younger brother also has delayed dental development but only mild hypodontia. Their half sister has severe hypodontia but no signs of Carpenter Syndrome. This family study demonstrates two affected individuals with typical clinical features and a pedigree compatible with autosomal recessive inheritance. Small tooth crown size has been shown by standardized measurement and evidence advanced that hypodontia is not part of the syndrome but a coincidental finding which segregates independently. We have also shown that the marked delay in emergence of teeth is associated more with problems of tooth eruption, possibly related to the bony abnormalities, than to a generalized delay in dental development.
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Ochnio JJ, Patrick D, Ho M, Talling DN, Dobson SR. Past infection with hepatitis A virus among Vancouver street youth, injection drug users and men who have sex with men: implications for vaccination programs. CMAJ 2001; 165:293-7. [PMID: 11517645 PMCID: PMC81329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND In Canada, inactivated hepatitis A vaccines are targeted selectively at those at increased risk for infection or its complications. In order to evaluate the need for routine hepatitis A vaccination programs in Vancouver for street youth, injection drug users (IDUs) and men who have sex with men (MSM), we determined the prevalence of antibodies against hepatitis A virus (HAV) and risk factors for HAV in these groups. METHODS The frequency of past HAV infection was measured in a sample of Vancouver street youth, IDUs and MSM attending outreach and STD clinics and needle exchange facilities by testing their saliva for anti-HAV immunoglobulin G. A self-administered, structured questionnaire was used to gather sociodemographic data. Stepwise logistic regression was used to evaluate the association between presumed risk factors and groups and past HAV infection. RESULTS Of 494 study participants, 235 self-reported injection drug use, 51 were self-identified as MSM and 111 met street youth criteria. Positive test results for anti-HAV were found in 6.3% of street youth (95% confidence interval [CI] 2.6%-12.6%), 42.6% (95% CI 36.2%-48.9%) of IDUs and 14.7% (95% CI 10.4%-19.1%) of individuals who denied injection drug use. Among men who denied injection drug use, the prevalence was 26.3% (10/38) for MSM and 12% (21/175) for heterosexuals. Logistic regression showed that past HAV infection was associated with increased age and birth in a country with high rates of hepatitis infection. Injection drug use among young adults (25-34 years old) was a significant risk factor for a positive anti-HAV test (p = 0.009). MSM were also at higher risk for past HAV infection, although this association was nominally significant (p = 0.07). INTERPRETATION Low rates of past HAV infection among Vancouver street youth indicate a low rate of virus circulation in this population, which is vulnerable to hepatitis A outbreaks. An increased risk for HAV infection in IDUs and MSM supports the need to develop routine vaccination programs for these groups also.
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Affiliation(s)
- J J Ochnio
- Vaccine Evaluation Center, British Columbia's Children's Hospital and University of British Columbia.
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Huber HE, Robinson RG, Watkins A, Nahas DD, Abrams MT, Buser CA, Lobell RB, Patrick D, Anthony NJ, Dinsmore CJ, Graham SL, Hartman GD, Lumma WC, Williams TM, Heimbrook DC. Anions modulate the potency of geranylgeranyl-protein transferase I inhibitors. J Biol Chem 2001; 276:24457-65. [PMID: 11274181 DOI: 10.1074/jbc.m100325200] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We have identified and characterized potent and specific inhibitors of geranylgeranyl-protein transferase type I (GGPTase I), as well as dual inhibitors of GGPTase I and farnesyl-protein transferase. Many of these inhibitors require the presence of phosphate anions for maximum activity against GGPTase I in vitro. Inhibitors with a strong anion dependence were competitive with geranylgeranyl pyrophosphate (GGPP), rather than with the peptide substrate, which had served as the original template for inhibitor design. One of the most effective anions was ATP, which at low millimolar concentrations increased the potency of GGPTase I inhibitors up to several hundred-fold. In the case of clinical candidate l-778,123, this increase in potency was shown to result from two major interactions: competitive binding of inhibitor and GGPP, and competitive binding of ATP and GGPP. At 5 mm, ATP caused an increase in the apparent K(d) for the GGPP-GGPTase I interaction from 20 pm to 4 nm, resulting in correspondingly tighter inhibitor binding. A subset of very potent GGPP-competitive inhibitors displayed slow tight binding to GGPTase I with apparent on and off rates on the order of 10(6) m(-)1 s(-)1 and 10(-)3 s(-)1, respectively. Slow binding and the anion requirement suggest that these inhibitors may act as transition state analogs. After accounting for anion requirement, slow binding, and mechanism of competition, the structure-activity relationship determined in vitro correlated well with the inhibition of processing of GGPTase I substrate Rap1a in vivo.
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Affiliation(s)
- H E Huber
- Department of Cancer Research, Merck Research Laboratories, 770 Sumneytown Pike, West Point, PA 19486, USA.
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McKenna SP, Doward LC, Kohlmann T, Mercier C, Niero M, Paes M, Patrick D, Ramirez N, Thorsen H, Whalley D. International development of the Quality of Life in Depression Scale (QLDS). J Affect Disord 2001; 63:189-99. [PMID: 11246095 DOI: 10.1016/s0165-0327(00)00184-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Quality of Life in Depression Scale (QLDS) employs the needs-based model of quality of life (QoL) and was developed in the UK and The Netherlands as an outcome measure for clinical trials. This paper describes the production and psychometric assessment of nine new language versions for Canada (French and English), Denmark, France, Germany, Italy, Morocco, Spain and the US. METHODS Three adaptation stages were employed; production of conceptually equivalent translations, field-test interviews and assessment of reliability and construct validity by survey of patients with major depression. RESULTS Few problems were experienced with producing conceptually equivalent translations, except in Morocco. Patients in the field-test interviews found the instrument to have appropriate content and to be easy to complete. Internal consistency and test-retest reliability were excellent for all language versions and scores were found to relate appropriately to measures of depression severity and health status. LIMITATIONS Further investigation is required of the ability of the measure to assess individuals at the extremes of the QoL continuum. Data collected with the Arabic QLDS should not be combined with those from other countries. CONCLUSIONS The QLDS is the first instrument designed to assess QoL in depression based on a coherent model of the construct. Each language version has been shown to be well accepted by respondents and to have excellent psychometric properties. As the instrument is now available in a large number of languages, the QLDS is the QoL instrument of choice for inclusion in clinical trials of interventions for depression.
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Affiliation(s)
- S P McKenna
- Galen Research, Manchester Science Park, Enterprise House, Lloyd Street North, Manchester M15 6SE, UK.
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Nicoll-Griffith DA, Silva JM, Chauret N, Day S, Leblanc Y, Roy P, Yergey JA, Dixit R, Patrick D. Application of rat hepatocyte culture to predict in vivo metabolic auto-induction: studies with DFP, a cyclooxygenase-2 inhibitor. Drug Metab Dispos 2001; 29:159-65. [PMID: 11159806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
The drug candidate DFP [5,5-dimethyl-3-(2-isopropoxy)-4-(4-methanesulfonylphenyl)-2(5H)-furanone] is a selective cyclooxygenase-2 inhibitor under evaluation for analgesic and anti-inflammatory therapy. The in vitro metabolic pathways (rat microsomes) involve hydroxylation of the isopropyl side chain at either of two positions, the methyl or the methine, thus producing a hydroxylated metabolite (DFHP) or a dealkylated metabolite (DFH). DFH formation was the major pathway. Using hepatic microsomes from rats treated with agents that induce specific CYP isozymes, it was shown that the dexamethasone-inducible rat CYP3A isozyme(s) play a major role in DFH formation. The roles of CYP3A1 and -3A2 were confirmed with genetically engineered rat CYP enzymes. The potential for induction of rat CYP3A by DFP was evaluated by incubating DFP in rat hepatocyte cultures and measuring the CYP3A levels. Both CYP3A immunoreactive protein and enzyme activity were induced in a dose-dependent manner. The induction was confirmed in vivo by dosing rats with DFP at 100 mg/kg for 4 days. Microsomes prepared from the excised livers showed that DFP gave approximately 55% of the induction observed with dexamethasone, as determined by Western blot. In vitro metabolic auto-induction of DFP was assessed by measuring the metabolism of DFP in hepatocytes treated with DFP. DFH formation was significantly enhanced in the DFP-treated cells. In vivo, treating rats with DFP at doses of 10 to 100 mg/(kg.day) for 13 weeks indicated that DFP induced its own metabolism. The C(max) and plasma drug area under the curve values during the thirteenth week were significantly lower than that on the first day, and the effect was dose-dependent.
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Affiliation(s)
- D A Nicoll-Griffith
- Merck Frosst Centre for Therapeutic Research, P.O. Box 1005, Pointe Claire-Dorval, Québec, Canada, H9R 4P8.
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Harb J, Fyfe M, Patrick D, Trinidad A, Hockin J, Masoud N, Louie K, Kurzac C. Case-control study assessing the association between yersiniosis and exposure to salami. Can Commun Dis Rep 2000; 26:161-4. [PMID: 11057008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- J Harb
- Field Epidemiology Training Program, Centre for Surveillance Coordination, Health Canada, Vancouver
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Harb J, Lem M, Fyfe M, Patrick D, Ochnio J, Dobson S, Hockin J. Hepatitis A in the northern interior of British Columbia: an outbreak among members of a first nations community. Can Commun Dis Rep 2000; 26:157-61. [PMID: 11057007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- J Harb
- Field Epidemiology Training Program, Centre for Surveillance Coordination, Health Canada, Vancouver, B.C
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Anne-Claire J, Denis Q, Patrick D, Christophe C, Philippe M, Sylvain K, Carmen G. S.P.I.C. pedagogical simulator for gynecologic laparoscopy. Stud Health Technol Inform 2000; 70:139-45. [PMID: 10977527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Laparoscopic surgery has numerous advantages, but this technique is difficult and requires specific training. This paper presents a simulator for gynecologic laparoscopic surgery called S.P.I.C. (Pedagogical Simulator for Gynecologic Laparoscopic Surgery), specifically designed for teaching. It includes a rail with 3 trocars already in place, and a computer monitor. Training using the simulator is divided into tasks and steps in order of increasing difficulty. Each step consists of training exercises and evaluations. Learning with the simulator is guided by software that allows instructors to personalize their lessons. This prototype has allowed us to put into place training for spatial localization and manipulation of surgical instruments in the abdominal cavity. An evaluation at a clinical site has allowed us to determine the improvements to be made on this prototype. Training with a simulator is part of a resident's regular curriculum and is not meant to replace on site hospital experience. Some imperfections in imaging still exist, due to inevitable technical limitations. Our initial choice was to emphasize realism and "real time", rather than the "aesthetic quality" of the images. Furthermore, by limiting our graphic expectations, we have been able to create a simulator at a reasonable overall price. The S.P.I.C. training tool remains experimental and is still in the process of being developed.
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Patrick D, Chiang YP. Postscript: the remaining questions. Med Care 2000; 38:II209-10. [PMID: 10982108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- D Patrick
- University of Washington, Seattle, USA
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Abstract
OBJECTIVE To examine treatment for depression among older adults in a large staff model health maintenance organization (HMO). DESIGN A 4-year prospective cohort study (1989-1993). SETTING Four primary care clinics of a large staff model HMO in Seattle, Washington. PATIENTS A total of 2558 Medicare enrollees aged 65 and older. MAIN OUTCOME MEASURES Treatment of depression was defined as primary care visits resulting in depression diagnoses, use of antidepressant medications, or specialty mental health services. MAIN RESULTS The older adults in our sample had low rates of treatment for depression, ranging from 4 to 7% in the entire sample and from 12 to 25% among those with probable depressive disorders. Predictors of treatment included female gender, severity, and persistence of depressive symptoms, and severity of comorbid medical illness. Even when patients were treated for depression, the intensity of treatment was very low. Overall likelihood of treatment for depression increased somewhat from 1989 to 1993, but among those treated, the rate of adequate antidepressant use remained below 30%. CONCLUSIONS There is still considerable need to improve care for older adults with depression in primary care.
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Affiliation(s)
- J Unützer
- Center for Health Services Research, UCLA Neuropsychiatric Institute, Los Angeles, California 90024, USA
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Rekart M, Patrick D, Jolly A, Wong T, Morshed M, Jones H, Montgomery C, Knowles L, Chakraborty N, Maginley J. Mass treatment/prophylaxis during an outbreak of infectious syphilis in Vancouver, British Columbia. Can Commun Dis Rep 2000; 26:101-5. [PMID: 10932390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- M Rekart
- Communicable Disease Epidemiology, BCCDC, Vancouver
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Kohal RJ, De LaRosa M, Patrick D, Hürzeler MB, Caffesse RG. Clinical and histologic evaluation of submerged and nonsubmerged hydroxyapatite-coated implants: a preliminary study in dogs. Int J Oral Maxillofac Implants 1999; 14:824-34. [PMID: 10612919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
A clinical and histologic study was performed to evaluate the differences in the healing of submerged and nonsubmerged hydroxyapatite-coated 2-piece implants. Three foxhounds were used for this evaluation. Mandibular premolars 1, 2, 3, and 4 were extracted. Three months later, 2 submerged implants were placed on one side of the mandible, and 2 nonsubmerged implants were placed on the other side of the mandible. After 3 months of healing, the submerged implants were exposed, and a third implant was placed on each side of the mandible in a nonsubmerged procedure. Clinical parameters were recorded, the animals were sacrificed 6 months after placement of the first implants, and histologic and histometric analyses were performed. Results of the evaluation of the clinical parameters showed only minor differences among the different treatment groups. Regarding the percentage of bone-to-implant contact of the different treatment groups, the submerged implants showed a bone-to-implant contact of 63.4%, the nonsubmerged implants showed 70.3% contact, and the late nonsubmerged implants demonstrated a bone-to-implant contact of 58.7%. The average distance from the implant neck to the first bone-to-implant contact (fBIC) for submerged implants was 0.58 mm, for nonsubmerged implants it was 1.09 mm, and it was 1.13 mm for late nonsubmerged implants. The vertical distance between the gingival margin and the apical extent of the junctional epithelium (aJE) varied from 1.14 mm to 1.28 mm in the different groups. The distance from the aJE to fBIC was 1.00 mm for the submerged group, 1.08 mm for the nonsubmerged group, and 1.00 mm for the late nonsubmerged group. Generally, it can be concluded that the clinical and the histologic behavior of submerged or nonsubmerged 2-piece implants utilized in this experiment do not differ.
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Affiliation(s)
- R J Kohal
- Department of Prosthodontics, Albert-Ludwigs-University, Freiburg, Germany
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Chan CC, Boyce S, Brideau C, Charleson S, Cromlish W, Ethier D, Evans J, Ford-Hutchinson AW, Forrest MJ, Gauthier JY, Gordon R, Gresser M, Guay J, Kargman S, Kennedy B, Leblanc Y, Leger S, Mancini J, O'Neill GP, Ouellet M, Patrick D, Percival MD, Perrier H, Prasit P, Rodger I. Rofecoxib [Vioxx, MK-0966; 4-(4'-methylsulfonylphenyl)-3-phenyl-2-(5H)-furanone]: a potent and orally active cyclooxygenase-2 inhibitor. Pharmacological and biochemical profiles. J Pharmacol Exp Ther 1999; 290:551-60. [PMID: 10411562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
The discoveries that cyclooxygenase (COX)-2 is an inducible form of COX involved in inflammation and that COX-1 is the major isoform responsible for the production of prostaglandins (PGs) in the gastrointestinal tract have provided a rationale for the development of specific COX-2 inhibitors as a new class of anti-inflammatory agents with improved gastrointestinal tolerability. In the present study, the preclinical pharmacological and biochemical profiles of rofecoxib [Vioxx, also known as MK-0966, 4-(4'-methylsulfonylphenyl)-3-phenyl-2-(5H)-furanone], an orally active COX-2 inhibitor, are described. Rofecoxib is a potent inhibitor of the COX-2-dependent production of PGE(2) in human osteosarcoma cells (IC(50) = 26 +/- 10 nM) and Chinese hamster ovary cells expressing human COX-2 (IC(50) = 18 +/- 7 nM) with a 1000-fold selectivity for the inhibition of COX-2 compared with the inhibition of COX-1 activity (IC(50) > 50 microM in U937 cells and IC(50) > 15 microM in Chinese hamster ovary cells expressing human COX-1). Rofecoxib is a time-dependent inhibitor of purified human recombinant COX-2 (IC(50) = 0.34 microM) but caused inhibition of purified human COX-1 in a non-time-dependent manner that could only be observed at a very low substrate concentration (IC(50) = 26 microM at 0.1 microM arachidonic acid concentration). In an in vitro human whole blood assay, rofecoxib selectively inhibited lipopolysaccharide-induced, COX-2-derived PGE(2) synthesis with an IC(50) value of 0.53 +/- 0.02 microM compared with an IC(50) value of 18.8 +/- 0.9 microM for the inhibition of COX-1-derived thromboxane B(2) synthesis after blood coagulation. Using the ratio of the COX-1 IC(50) values over the COX-2 IC(50) values in the human whole blood assay, selectivity ratios for the inhibition of COX-2 of 36, 6.6, 2, 3, and 0.4 were obtained for rofecoxib, celecoxib, meloxicam, diclofenac, and indomethacin, respectively. In several in vivo rodent models, rofecoxib is a potent inhibitor of carrageenan-induced paw edema (ID(50) = 1.5 mg/kg), carrageenan-induced paw hyperalgesia (ID(50) = 1.0 mg/kg), lipopolysaccharide-induced pyresis (ID(50) = 0.24 mg/kg), and adjuvant-induced arthritis (ID(50) = 0.74 mg/kg/day). Rofecoxib also has a protective effect on adjuvant-induced destruction of cartilage and bone structures in rats. In a (51)Cr excretion assay for detection of gastrointestinal integrity in either rats or squirrel monkeys, rofecoxib has no effect at doses up to 200 mg/kg/day for 5 days. Rofecoxib is a novel COX-2 inhibitor with a biochemical and pharmacological profile clearly distinct from that of current nonsteroidal anti-inflammatory drugs and represents a new therapeutic class of anti-inflammatory agents for the treatment of the symptoms of osteoarthritis and rheumatoid arthritis with improved gastrointestinal tolerability.
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Affiliation(s)
- C C Chan
- Departments of Pharmacology, Biochemistry and Molecular Biology, and Medicinal Chemistry, Merck Frosst Centre for Therapeutic Research, Kirkland, Quebec, Canada.
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Abstract
Despite the prevalence of disabilities among persons living in rural areas, scarce data exist on their health care needs. While rural residents generally experience barriers to access to primary health care, these problems are further exacerbated for people with disabilities. This article summarizes findings from the published literature on access to primary health care among people with disabilities living in rural locations. A comprehensive computerized literature search turned up 86 articles meeting the study criteria, focused on the following rural populations affected by disabilities: children and adolescents, working-age adults, the elderly the mentally ill, and people with AIDS. For each of these populations, substantial problems in accessing appropriate health care have been documented. The literature consistently emphasizes the failure of local health care systems in nonmetropolitan areas to adequately address the complex medical and related needs of individuals with disabilities. In the absence of specialized expertise, facilities, and primary care providers trained specifically to care for disabled persons, local programs rely heavily on the use of indigenous paraprofessionals and alternative models of care. Further research is needed to identify and test the efficacy of innovative service delivery strategies to improve health care access for this population.
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Affiliation(s)
- D M Lishner
- WAMI Rural Health Research Center, University of Washington, Seattle 98195, USA
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Abstract
The studies presented in this paper were undertaken to investigate the effects of L-753,037, a balanced endothelin receptor antagonist with similar affinity for the ET(A) and ET(B) receptors (Ki = 0.03 to 0.12 nM and 0.1 to 3.33 nM, respectively), when administered to pregnant female rats by oral gavage, on the development, growth, maturation, and reproductive performance of the F1 generation. Following embryonic exposure to L-753,037, profound craniofacial, cardiovascular, and viscerocranial malformations were noted in the F1 generation. All of the affected organs are derived, in part, from cranial neural crest cells predominantly originating from the posterior midbrain through the hindbrain and destined for the pharyngeal arches. In contrast, cranial structures derived from the paraxial mesoderm (i.e., basisphenoid) were of normal shape and size. There were no apparent effects on enteric neural crest cell derivatives. Based on the phenotype of affected fetuses and their similarity to fetuses with gene knockouts of ET-1 or the ET(A) receptor, the observed alterations are considered to be a pharmacologically mediated class effect on cranial neural crest cells. The phenotype observed suggests that ET(A) receptor antagonism may have specific effects on cranial neural crest cell migration and/or proliferation.
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Affiliation(s)
- S Spence
- Department of Safety Assessment, Merck Research Laboratories, West Point, PA 19486, USA.
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Goonewardene LA, Day PA, Patrick N, Scheer HD, Patrick D, Suleiman A. A preliminary evaluation of growth and carcass traits in Alpine and Boer goat crosses. Can J Anim Sci 1998. [DOI: 10.4141/a97-041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Birth weights of Boer (BO) sired kids were 9% higher than Alpine (AL) sired kids. Weaning, 160 d weight and preweaning average daily gain (ADG) were similar for the AL × AL, AL × SA and BO × AL. Breed of dam was significant (P < 0.02) for birth, weaning, 100-d weight, and preweaning ADG. Similar dressing percentage (DP) and ribeye muscle area (REA) were observed among AL × AL, AL × SP, and BO × SP crosses. Key words: Crossbreeding, Boer, Alpine, growth, carcass, ultrasound
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Doward LC, McKenna SP, Kohlmann T, Niero M, Patrick D, Spencer B, Thorsen H. The international development of the RGHQoL: a quality of life measure for recurrent genital herpes. Qual Life Res 1998; 7:143-53. [PMID: 9523496 DOI: 10.1023/a:1008857426633] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper describes the international development and psychometric testing of the Recurrent Genital Herpes Quality of Life Questionnaire (RGHQoL), a condition-specific quality of life (QoL) instrument. The theoretical foundation for the measure is the needs-based model of QoL and the content of the instrument was derived from in-depth qualitative interviews with relevant patients in the UK. Versions of the RGHQoL were required for the UK, USA, Italy, Germany, France and Denmark for use in international clinical trials. The results indicate that the final 20 item measure has good reliability, internal consistency and validity for all language versions. A small responsiveness study in Denmark suggested that the measure is sensitive to changes in QoL associated with the initiation of suppression treatment for recurrent genital herpes (RGH). It is concluded that the RGHQoL is a valuable instrument for inclusion in clinical trials. The psychometric properties of the instrument are such that it may also be used to monitor the progress of individual patients.
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Davis KL, Marin DB, Kane R, Patrick D, Peskind ER, Raskind MA, Puder KL. The Caregiver Activity Survey (CAS): development and validation of a new measure for caregivers of persons with Alzheimer's disease. Int J Geriatr Psychiatry 1997; 12:978-88. [PMID: 9395929 DOI: 10.1002/(sici)1099-1166(199710)12:10<978::aid-gps659>3.0.co;2-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Most instruments that measure the impairments associated with Alzheimer's disease assess symptom severity. Little attention has been paid to the illness's impact on the time formal and informal caregivers spend caring for Alzheimer's individuals. A tool that measures the time spent caregiving would help to determine the economic impact of the illness. The Caregiver Activity Survey (CAS) was developed to measure the time caregivers spend aiding Alzheimer's patients with their day-to-day activities. METHODS The test-retest reliability of the CAS was assessed during a 3-week study with 42 Alzheimer's patients and their caregivers. The CAS was validated with the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog), the Mini Mental State Exam (MMSE) and the Physical Self Maintenance Scale (PSMS). RESULTS The final version of the CAS consists of six items (communicating with the person, using transportation, eating, dressing, looking after one's appearance and supervising the person). The six-item CAS total score has high test-retest reliability, with ICC = 0.88 between weeks 1 and 3. The scale has strong convergent validity with the ADAS-Cog (r = 0.61), MMSE (r = -0.57) and PSMS (r = 0.43). Efforts to include a dimension that reflects caregiver burden were not successful, in part due to the reluctance of caregivers to acknowledge that caregiving is bothersome. CONCLUSIONS The CAS provides a new tool that measures time spent caring for Alzheimer's individuals. The instrument may be used to augment existing clinical assessments that measure the efficacy of potentially therapeutic agents for persons with Alzheimer's disease.
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Affiliation(s)
- K L Davis
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029-6574, USA
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Kotsanos JG, Vignati L, Huster W, Andrejasich C, Boggs MB, Jacobson AM, Marrero D, Mathias SD, Patrick D, Zalani S, Anderson J. Health-related quality-of-life results from multinational clinical trials of insulin lispro. Assessing benefits of a new diabetes therapy. Diabetes Care 1997; 20:948-58. [PMID: 9167105 DOI: 10.2337/diacare.20.6.948] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare health-related quality of life (HRQOL) in patients with diabetes receiving insulin lispro with patients receiving regular human insulin (Humulin R). RESEARCH DESIGN AND METHODS We performed two randomized comparative studies over a 6-month period (3 months per treatment). Primary analyses used crossover baseline to 3-month changes in HRQOL scores. Ninety-three principal investigators in Canada, France, Germany, and the U.S. participated in these studies. One HRQOL crossover study included 468 patients with type I diabetes; the other HRQOL crossover study included 474 patients with type II diabetes. In both studies, patients were taking insulin at least 2 months before enrollment. Primary outcomes included two generic HRQOL domains, energy/fatigue and health distress, and two diabetes-specific domains, treatment satisfaction and treatment flexibility. Thirty secondary outcomes included both generic and diabetes-specific measures. Secondary outcome domains were controlled for multiplicity in the analyses. RESULTS Primary analyses showed that treatment satisfaction scores (P < 0.001) and treatment flexibility scores (P = 0.001) were higher for insulin lispro in type I diabetic patients. No other significant treatment differences were detected using the data from these 6-month crossover studies. CONCLUSIONS Treatment satisfaction and treatment flexibility were significantly improved in patients with type I diabetes using insulin lispro. Other HRQOL findings were comparable for insulin lispro and regular human insulin. Insulin lispro appears to have a measurable impact on lifestyle benefits in patients with type I diabetes, as demonstrated by increased treatment satisfaction and treatment flexibility.
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Affiliation(s)
- J G Kotsanos
- Eli Lilly and Company, Lilly Corporate Center 46285, USA
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Russo J, Roy-Byrne P, Reeder D, Alexander M, Dwyer-O'Connor E, Dagadakis C, Ries R, Patrick D. Longitudinal assessment of quality of life in acute psychiatric inpatients: reliability and validity. J Nerv Ment Dis 1997; 185:166-75. [PMID: 9091598 DOI: 10.1097/00005053-199703000-00006] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study examined the reliability, validity, and responsiveness of Lehman's Quality of Life Interview (QOLI) as an outcome measure on 981 acutely ill psychiatric inpatients assessed longitudinally at admission and discharge. Patients were stratified into five diagnostic (DX) (depressed bipolar, depressed unipolar, schizophrenia, mania, and other diagnoses) and two substance use disorder (SA) strata (with and without concurrent substance abuse/dependence) based on DSM-III-R criteria. There was good replication of the factor structure, excellent internal consistency, overall and within DX and SA groups. Intercorrelations showed that the functional and satisfaction indices measure unique aspects of the quality of life. The construct consistency of the QOLI was dependent upon psychiatric diagnosis and life domain. Intercorrelations of functional and satisfaction indices for patients with depression were greater than for manic patients. We demonstrated strong consistency of construct validity for family and social relation domains, but not safety or leisure activities. Construct validity was shown to hold longitudinally. Analyses of DX and SA group differences on satisfaction and functional indices of the 8 life domains supported discriminative validity: Depressed patients reported the most dissatisfaction, followed by schizophrenic patients, and manic patients reported the greatest satisfaction in most life domains. Patients with concurrent substance abuse generally reported less satisfaction and lower quality of life than patients without a dual diagnosis. Examination of longitudinal changes in satisfaction indicated the QOLI is responsive to changes in global life, leisure activities, living situation, and social relations from hospital admission to discharge (an average of 2 weeks). This study supports the use of the QOLI as an outcome measure to assess quality of life in acutely ill hospitalized psychiatric patients.
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Affiliation(s)
- J Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle 98104, USA
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