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Stevens E. My Hayley Story: A Thank You to Those Who Teach. J Pain Symptom Manage 2024; 67:e255-e258. [PMID: 37088115 DOI: 10.1016/j.jpainsymman.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/07/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Erin Stevens
- Department of Internal Medicine, Division of Palliative Medicine (E.S.), The Ohio State University, Columbus, Ohio, USA; The James Comprehensive Cancer Center (E.S.), The Ohio State University, Columbus, Ohio, USA.
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Martin DA, Telliez JB, Pleasic-Williams S, Zhang Y, Tierney B, Blatnik M, Gale JD, Banfield C, Zhou Y, Lejeune A, Zwillich SH, Stevens E, Tiwari N, Kieras E, Karanam A. Target Occupancy and Functional Inhibition of JAK3 and TEC Family Kinases by Ritlecitinib in Healthy Adults: An Open-Label, Phase 1 Study. J Clin Pharmacol 2024; 64:67-79. [PMID: 37691236 DOI: 10.1002/jcph.2347] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
Ritlecitinib is a small molecule in clinical development that covalently and irreversibly inhibits Janus kinase 3 (JAK3) and the TEC family of kinases (BTK, BMX, ITK, TXK, and TEC). This phase 1, open-label, parallel-group study assessed target occupancy and functional effects of ritlecitinib on JAK3 and TEC family kinases in healthy participants aged 18-60 years who received 50 or 200 mg single doses of ritlecitinib on day 1. Blood samples to assess ritlecitinib pharmacokinetics, target occupancy, and pharmacodynamics were collected over 48 hours. Target occupancy was assessed using mass spectroscopy. Functional inhibition of JAK3-dependent signaling was measured by the inhibition of the phosphorylation of its downstream target signal transducer and activator of transcription 5 (pSTAT5), following activation by interleukin 15 (IL-15). The functional inhibition of Bruton's tyrosine kinase (BTK)-dependent signaling was measured by the reduction in the upregulation of cluster of differentiation 69 (CD69), an early marker of B-cell activation, following treatment with anti-immunoglobulin D. Eight participants received one 50 mg ritlecitinib dose and 8 participants received one 200 mg dose. Ritlecitinib plasma exposure increased in an approximately dose-proportional manner from 50 to 200 mg. The maximal median JAK3 target occupancy was 72% for 50 mg and 64% for 200 mg. Ritlecitinib 50 mg had >94% maximal target occupancy of all TEC kinases, except BMX (87%), and 200 mg had >97% for all TEC kinases. For BTK and TEC, ritlecitinib maintained high target occupancy throughout a period of 48 hours. Ritlecitinib reduced pSTAT5 levels following IL-15- and BTK-dependent signaling in a dose-dependent manner. These target occupancy and functional assays demonstrate the dual inhibition of the JAK3- and BTK-dependent pathways by ritlecitinib. Further studies are needed to understand the contribution to clinical effects of inhibiting these pathways.
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Brasky TM, Newton AM, Conroy S, Adib A, Adley NC, Strassels SA, Hays JL, Cooper ZD, Wagener TL, Stevens E, Plascak JJ, Krok-Schoen JL. Marijuana and Cannabidiol Use Prevalence and Symptom Management Among Patients with Cancer. Cancer Res Commun 2023; 3:1917-1926. [PMID: 37772996 PMCID: PMC10515742 DOI: 10.1158/2767-9764.crc-23-0233] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023]
Abstract
Symptoms such as pain, nausea, and anxiety are common in individuals with cancer. Treatment of these issues is often challenging. Cannabis products may be helpful in reducing the severity of these symptoms. While some studies include data on the prevalence of cannabis use among patients with cancer, detailed data remain limited, and none have reported the prevalence of cannabidiol (CBD) use in this population. Adult patients with cancer attending eight clinics at a large, NCI-designated Comprehensive Cancer Center completed a detailed, cannabis-focused questionnaire between 2021 and 2022. Eligible participants were diagnosed with invasive cancer and treated in the past 12 months. Summary statistics were calculated to describe the sample regarding cannabis use. Approximately 15% (n = 142) of consented patients (n = 934) reported current cannabis use (defined as use within the past 12 months). Among which, 75% reported cannabis use in the past week. Among current cannabis users, 39% (n = 56; 6% overall) used CBD products. Current users reported using cannabis a median of 4.5 (interquartile range: 0.6–7.0) days/week, 2.0 (1.0–3.0) times per use/day, and for 3 years (0.8–30.0). Use patterns varied by route of administration. Patients reported moderate to high relief of symptoms with cannabis use. This study is the most detailed to date in terms of cannabis measurement and provides information about the current state of cannabis use in active cancer. Future studies should include complete assessments of cannabis product use, multiple recruitment sites, and diverse patient populations. SIGNIFICANCE Clinicians should be aware that patients are using cannabis products and perceive symptom relief with its use.
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Affiliation(s)
- Theodore M. Brasky
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Alison M. Newton
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sara Conroy
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Anita Adib
- Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, Ohio
| | - Neema C. Adley
- Department of Neuroscience, The Ohio State University College of Arts and Sciences, Columbus, Ohio
| | | | - John L. Hays
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ziva D. Cooper
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, California
| | - Theodore L. Wagener
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Erin Stevens
- Department of Internal Medicine, The Ohio State University College of Medicine; Columbus, Ohio
| | - Jesse J. Plascak
- Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jessica L. Krok-Schoen
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, Ohio
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Sumner G, Keller S, Huleatt J, Staack RF, Wagner L, Azadeh M, Bandukwala A, Cao L, Du X, Salinas GF, Garofolo F, Harris S, Hopper S, Irwin C, Ji Q, Joseph J, King L, Kinhikar A, Lu Y, Luo R, Mabrouk O, Malvaux L, Marshall JC, McGuire K, Mikol V, Neely R, Qiu X, Saito Y, Salaun B, Scully I, Smeraglia J, Solstad T, Stoop J, Tang H, Teixeira P, Wang Y, Wright M, Mendez L, Beaver C, Eacret J, Au-Yeung A, Decman V, Dessy F, Eck S, Goihberg P, Alcaide EG, Gonneau C, Grugan K, Hedrick MN, Kar S, Sehra S, Stevens E, Stevens C, Sun Y, McCush F, Williams L, Fischer S, Wu B, Jordan G, Burns C, Cludts I, Coble K, Grimaldi C, Henderson N, Joyce A, Lotz G, Lu Y, Luo L, Neff F, Sperinde G, Stubenrauch KG, Wang Y, Ware M, Xu W. 2022 White Paper on Recent Issues in Bioanalysis: Enzyme Assay Validation, BAV for Primary End Points, Vaccine Functional Assays, Cytometry in Tissue, LBA in Rare Matrices, Complex NAb Assays, Spectral Cytometry, Endogenous Analytes, Extracellular Vesicles Part 2 - Recommendations on Biomarkers/CDx, Flow Cytometry, Ligand-Binding Assays Development & Validation; Emerging Technologies; Critical Reagents Deep Characterization. Bioanalysis 2023; 15:861-903. [PMID: 37584363 DOI: 10.4155/bio-2023-0151] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
The 16th Workshop on Recent Issues in Bioanalysis (16th WRIB) took place in Atlanta, GA, USA on September 26-30, 2022. Over 1000 professionals representing pharma/biotech companies, CROs, and multiple regulatory agencies convened to actively discuss the most current topics of interest in bioanalysis. The 16th WRIB included 3 Main Workshops and 7 Specialized Workshops that together spanned 1 week in order to allow exhaustive and thorough coverage of all major issues in bioanalysis, biomarkers, immunogenicity, gene therapy, cell therapy and vaccines. Moreover, in-depth workshops on ICH M10 BMV final guideline (focused on this guideline training, interpretation, adoption and transition); mass spectrometry innovation (focused on novel technologies, novel modalities, and novel challenges); and flow cytometry bioanalysis (rising of the 3rd most common/important technology in bioanalytical labs) were the special features of the 16th edition. As in previous years, WRIB continued to gather a wide diversity of international, industry opinion leaders and regulatory authority experts working on both small and large molecules as well as gene, cell therapies and vaccines to facilitate sharing and discussions focused on improving quality, increasing regulatory compliance, and achieving scientific excellence on bioanalytical issues. This 2022 White Paper encompasses recommendations emerging from the extensive discussions held during the workshop and is aimed to provide the bioanalytical community with key information and practical solutions on topics and issues addressed, in an effort to enable advances in scientific excellence, improved quality and better regulatory compliance. Due to its length, the 2022 edition of this comprehensive White Paper has been divided into three parts for editorial reasons. This publication (Part 2) covers the recommendations on LBA, Biomarkers/CDx and Cytometry. Part 1 (Mass Spectrometry and ICH M10) and Part 3 (Gene Therapy, Cell therapy, Vaccines and Biotherapeutics Immunogenicity) are published in volume 15 of Bioanalysis, issues 16 and 14 (2023), respectively.
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Affiliation(s)
| | | | | | - Roland F Staack
- Roche Pharma Research & Early Development, Roche Innovation Center, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | | - Qin Ji
- AbbVie, North Chicago, IL, USA
| | | | | | | | - Yang Lu
- US FDA, Silver Spring, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Priscila Teixeira
- Roche Pharma Research & Early Development, Roche Innovation Center, Munich, Germany
| | - Yixin Wang
- Bristol-Myers Squibb, Lawrenceville, NJ, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gregor Jordan
- Roche Pharma Research & Early Development, Roche Innovation Center, Munich, Germany
| | | | | | | | | | - Neil Henderson
- Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Gregor Lotz
- Roche Pharma Research & Early Development, Roche Innovation Center, Munich, Germany
| | | | | | - Florian Neff
- Roche Pharma Research & Early Development, Roche Innovation Center, Munich, Germany
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5
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Li W, Crouse KK, Alley J, Frisbie RK, Fish SC, Andreyeva TA, Reed LA, Thorn M, DiMaggio G, Donovan CB, Bennett D, Garren J, Oziolor E, Qian J, Newman L, Vargas AP, Kumpf SW, Steyn SJ, Schnute ME, Thorarensen A, Hegen M, Stevens E, Collinge M, Lanz TA, Vincent F, Vincent MS, Berstein G. A Novel C-C Chemoattractant Cytokine (Chemokine) Receptor 6 (CCR6) Antagonist (PF-07054894) Distinguishes between Homologous Chemokine Receptors, Increases Basal Circulating CCR6 + T Cells, and Ameliorates Interleukin-23-Induced Skin Inflammation. J Pharmacol Exp Ther 2023; 386:80-92. [PMID: 37142443 DOI: 10.1124/jpet.122.001452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023] Open
Abstract
Blocking chemokine receptor C-C chemoattractant cytokine (chemokine) receptor (CCR) 6-dependent T cell migration has therapeutic promise in inflammatory diseases. PF-07054894 is a novel CCR6 antagonist that blocked only CCR6, CCR7, and C-X-C chemoattractant cytokine (chemokine) receptor (CXCR) 2 in a β-arrestin assay panel of 168 G protein-coupled receptors. Inhibition of CCR6-mediated human T cell chemotaxis by (R)-4-((2-(((1,4-Dimethyl-1H-pyrazol-3-yl)(1-methylcyclopentyl)methyl)amino)-3,4-dioxocyclobut-1-en-1-yl)amino)-3-hydroxy-N,N-dimethylpicolinamide (PF-07054894) was insurmountable by CCR6 ligand, C-C motif ligand (CCL) 20. In contrast, blockade of CCR7-dependent chemotaxis in human T cells and CXCR2-dependent chemotaxis in human neutrophils by PF-07054894 were surmountable by CCL19 and C-X-C motif ligand 1, respectively. [3H]-PF-07054894 showed a slower dissociation rate for CCR6 than for CCR7 and CXCR2 suggesting that differences in chemotaxis patterns of inhibition could be attributable to offset kinetics. Consistent with this notion, an analog of PF-07054894 with fast dissociation rate showed surmountable inhibition of CCL20/CCR6 chemotaxis. Furthermore, pre-equilibration of T cells with PF-07054894 increased its inhibitory potency in CCL20/CCR6 chemotaxis by 10-fold. The functional selectivity of PF-07054894 for inhibition of CCR6 relative to CCR7 and CXCR2 is estimated to be at least 50- and 150-fold, respectively. When administered orally to naïve cynomolgus monkeys, PF-07054894 increased the frequency of CCR6+ peripheral blood T cells, suggesting that blockade of CCR6 inhibited homeostatic migration of T cells from blood to tissues. PF-07054894 inhibited interleukin-23-induced mouse skin ear swelling to a similar extent as genetic ablation of CCR6. PF-07054894 caused an increase in cell surface CCR6 in mouse and monkey B cells, which was recapitulated in mouse splenocytes in vitro. In conclusion, PF-07054894 is a potent and functionally selective CCR6 antagonist that blocks CCR6-mediated chemotaxis in vitro and in vivo. SIGNIFICANCE STATEMENT: The chemokine receptor, C-C chemoattractant cytokine (chemokine) receptor 6 (CCR6) plays a key role in the migration of pathogenic lymphocytes and dendritic cells into sites of inflammation. (R)-4-((2-(((1,4-Dimethyl-1H-pyrazol-3-yl)(1-methylcyclopentyl)methyl)amino)-3,4-dioxocyclobut-1-en-1-yl)amino)-3-hydroxy-N,N-dimethylpicolinamide (PF-07054894) is a novel CCR6 small molecule antagonist that illustrates the importance of binding kinetics in achieving pharmacological potency and selectivity. Orally administered PF-07054894 blocks homeostatic and pathogenic functions of CCR6, suggesting that it is a promising therapeutic agent for the treatment of a variety of autoimmune and inflammatory diseases.
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Affiliation(s)
- Wei Li
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Kimberly K Crouse
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Jennifer Alley
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Richard K Frisbie
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Susan C Fish
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Tatyana A Andreyeva
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Lori A Reed
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Mitchell Thorn
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Giovanni DiMaggio
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Carol B Donovan
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Donald Bennett
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Jeonifer Garren
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Elias Oziolor
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Jesse Qian
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Leah Newman
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Amanda P Vargas
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Steven W Kumpf
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Stefan J Steyn
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Mark E Schnute
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Atli Thorarensen
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Martin Hegen
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Erin Stevens
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Mark Collinge
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Thomas A Lanz
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Fabien Vincent
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Michael S Vincent
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
| | - Gabriel Berstein
- Inflammation and Immunology Research Unit (W.L., K.K.C., J.A., S.C.F., T.A.A., M.H., M.S.V., G.B.), Biostatistics (D.B., J.G.), and Medicine Design (S.J.S., M.E.S., A.T.), Pfizer, Inc., Cambridge, Massachusetts, and Primary Pharmacology Group (R.K.F., F.V.), Clinical Biomarkers (M.T., E.S.), and Drug Safety Research and Development (L.A.R., G.D., C.B.D., E.O., J.Q., L.N., A.P.V., S.W.K., M.C., T.A.L.), Pfizer, Inc., Groton, Connecticut
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Stevens E, Scott EME. Delirium Among Patients With Cancer in the Intensive Care Unit: Prognostic Sign or Opportunity for Intervention. JCO Oncol Pract 2023:OP2300061. [PMID: 37075269 DOI: 10.1200/op.23.00061] [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: 04/21/2023] Open
Affiliation(s)
- Erin Stevens
- Division of Palliative Medicine, The Ohio State University, Columbus, OH
- Department of Internal Medicine, The Ohio State University, Columbus, OH
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Erin M E Scott
- Division of Palliative Medicine, The Ohio State University, Columbus, OH
- Department of Internal Medicine, The Ohio State University, Columbus, OH
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Stevens E, Lampert BC, Whitson BA, Rush LJ, Mokadam NA, Barrett TA. Total artificial heart implantation: supportive care preparedness planning framework. BMJ Support Palliat Care 2023:spcare-2023-004210. [PMID: 36990682 DOI: 10.1136/spcare-2023-004210] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/08/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The total artificial heart (TAH) is an implanted device approved as a modality to stabilize patients with severe biventricular heart failure or persistent ventricular arrhythmias for evaluation and bridge to transplantation. According to the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), about 450 patients received a TAH between 2006 and 2018. Patients being evaluated for a TAH are often critically ill and a TAH offers the best chance at survival. Given the prognostic uncertainty of these patients, there is a crucial need for preparedness planning to help patients and their caregivers plan for living and supporting a loved one with a TAH. AIM To describe an approach to preparedness planning and highlight the importance of palliative care. METHODS We reviewed the current needs and approaches to preparedness planning for a TAH. We categorized our findings and suggest a guide to maximize conversations with patients and their decision makers. RESULTS We identified four critical areas to address: the decision maker, minimal acceptable outcome/maximal acceptable burden, living with the device, and dying with the device. We suggest using a framework of mental and physical outcomes and locations of care as a way to identify minimal acceptable outcome and maximal acceptable burden. CONCLUSION Decision making for a TAH is complex. There is an urgency and patients do not always have capacity. Identifying legal decision makers and social support is critical. The surrogate decision makers should be included in preparedness planning including discussions about end-of-life care and treatment discontinuation. Having palliative care as members of the interdisciplinary mechanical circulatory support team can assist in these preparedness conversations.
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Affiliation(s)
- Erin Stevens
- Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Brent C Lampert
- Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Laura J Rush
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Stevens E, Rosko AE, Huang Y, Funderburg A, Dvorak K, Von Ah D, Krok-Schoen JL. The association between religiosity, mental health, and cognitive functioning among older adults with hematologic malignancies. J Geriatr Oncol 2023:101446. [PMID: 36792415 DOI: 10.1016/j.jgo.2023.101446] [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] [Received: 09/06/2022] [Revised: 12/20/2022] [Accepted: 02/02/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Erin Stevens
- Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, OH, United States of America; The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America.
| | - Ashley E Rosko
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America; Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, OH, United States of America; Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, United States of America
| | - Ying Huang
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America; Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, OH, United States of America; Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, United States of America
| | - Allesia Funderburg
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America; Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, OH, United States of America; Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, United States of America
| | - Kaitlyn Dvorak
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America; Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, OH, United States of America; Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, United States of America
| | - Diane Von Ah
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
| | - Jessica L Krok-Schoen
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America; Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States of America
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McGee J, Palmer Kelly E, Kelly-Brown J, Stevens E, Waterman BL, Pawlik TM. Assessing the Impact of Provider Training and Perceived Barriers on the Provision of Spiritual Care: a Mixed Methods Study. J Cancer Educ 2023; 38:301-308. [PMID: 34767182 DOI: 10.1007/s13187-021-02115-x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
The current study evaluated formal training around spiritual care for healthcare providers and the relationships between that training, perceived barriers to spiritual care, and frequency of inquiry around spiritual topics. A mixed methods explanatory sequential design was used. Quantitative methods included an online survey administered to providers at The Ohio State University Comprehensive Cancer Center. Main and interactive effects of formal training and barriers to spiritual care on frequency of inquiry around spiritual topics were assessed with two-way ANOVA. Qualitative follow-up explored provider strategies to engage spiritual topics. Among 340 quantitative participants, most were female (82.1%) or White (82.6%) with over one-half identifying as religious (57.5%). The majority were nurses (64.7%) and less than 10% of all providers (n = 26) indicated formal training around spiritual care. There were main effects on frequency of inquiry around spiritual topics for providers who indicated "personal discomfort" as a barrier (p < 0.001), but not formal training (p = 0.526). Providers who indicated "personal discomfort" as a barrier inquired about spirituality less frequently, regardless of receiving formal training (M = 8.0, SD = 1.41) or not (M = 8.76, SD = 2.96). There were no interactive effects between training and "may offend patients" or "personal discomfort" (p = 0.258 and 0.125, respectively). Qualitative analysis revealed four strategies with direct and indirect approaches: (1) permission-giving, (2) self-awareness/use-of-self, (3) formal assessment, and (4) informal assessment. Training for providers should emphasize self-awareness to address intrapersonal barriers to improve the frequency and quality of spiritual care for cancer patients.
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Affiliation(s)
- Julia McGee
- The Ohio State University, Columbus, OH, USA
| | - Elizabeth Palmer Kelly
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Erin Stevens
- Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brittany L Waterman
- Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Michael DR, Nimmo DG, Stevens E, Schlen T, Wassens S. Finding Ngabi (Hemiaspis damelii): factors affecting the use of modified floodplain wetlands by an endangered snake. Wildl Res 2023. [DOI: 10.1071/wr22147] [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: 03/12/2023]
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Krok-Schoen J, Rosko A, Huang Y, Funderburg A, Dvorak K, Stevens E. THE ASSOCIATION BETWEEN RELIGIOSITY AND COGNITIVE FUNCTIONING AMONG OLDER ADULTS WITH HEMATOLOGICAL CANCERS. Innov Aging 2022. [PMCID: PMC9770699 DOI: 10.1093/geroni/igac059.937] [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: 12/24/2022] Open
Abstract
Religiosity is positively associated physical health outcomes, yet longitudinal research on this association among older adults with cancer is limited. Participants were enrolled in a longitudinal study assessing chemotherapy’s impact on the health of older adults with hematological cancers. Religiosity was assessed by the Duke University Religion Index (DUREL), with higher scores indicating higher religiosity. Cognitive functioning was assessed by the Blessed Dementia Scale, with higher scores indicating more impairment. Participants (n=97) had a median age of 70 years (range:60-88) and were 58% male and 97% white. DUREL scores were unchanged with a mean score of 22 (range:5-27). Cognitive functioning significantly improved with a median score of 4 (range:0-22) at baseline to 0 (range:0-20) at end-of-treatment. Religiosity was not significantly correlated with cognitive functioning over time. Future research should explore the trajectory of cognitive functioning and other sources of coping (social support, palliative/supportive care) among older adults with hematological cancers.
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Affiliation(s)
| | - Ashley Rosko
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Ying Huang
- The Ohio State University, Division of Hematology, Columbus, Ohio, United States
| | - Allesia Funderburg
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Katy Dvorak
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Erin Stevens
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
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Hong LJ, Rubinsak L, Benoit MF, Teoh D, Chandavarkar U, Brockmeyer A, Stevens E, Ioffe Y, Temkin SM. Gynecologic Oncology and Inclusion of Women Into the Surgical Workforce: The Canary in This Coal Mine. Front Oncol 2022; 12:789910. [PMID: 35463315 PMCID: PMC9020218 DOI: 10.3389/fonc.2022.789910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Women make up a majority of the gynecologic oncology workforce. Increasing the numbers of women in leadership has been proposed as a path towards professional gender equity. This study examined whether leadership gender and departmental infrastructure impact the work environment for women gynecologic oncologists. Methods Members of a 472-member private Facebook group “Women of Gynecologic Oncology” (WGO) who self-identified as women gynecologic oncologists provided demographics, practice infrastructure, personal experience with workplace bullying, gender discrimination, microaggressions using a REDcap survey platform. Results Of 250 (53%) respondents to this survey, most were younger than age 50 years (93.6%); White (82.2%) and non-Hispanic (94.3%); married (84.7%); and parenting (75.2%). Practice environments included academic (n=152, 61.0%), hospital employed (n=57, 22.9%), and private practice (n=31, 12.4%), and 89.9% supervised trainees. A significant percent of respondents had experienced bullying (52.8%), gender discrimination (57%) and microaggressions (83%). Age, race, ethnicity, practice setting, or mentorship were not statistically significantly associated with these experiences. Reported perpetrators were varied and included colleagues (84%), patients (44%), staff (41%), administrators (18%), and trainees (16%). Prevalence of bullying (55.0 vs 47.7%, p=0.33), gender discrimination (59.1 vs 52.3%, p=0.33) and microaggressions (83.3 vs 83.0%, p=1.00) were similar irrespective of departmental leadership gender. Conclusions Women gynecologic oncologists report a high prevalence of workplace bullying, gender discrimination and microaggressions regardless of the gender of their immediate leadership. Proactive and deliberate structural interventions to improve the work environment for surgeons who are women are urgently needed.
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Affiliation(s)
- Linda J Hong
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Lisa Rubinsak
- Division of Gynecologic Oncology, Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States
| | - Michelle F Benoit
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Washington, Seattle, WA, United States
| | - Deanna Teoh
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, United States
| | - Uma Chandavarkar
- Department of Oncology, Sutter Medical Group, Sacramento, CA, United States
| | - Amy Brockmeyer
- Division of Gynecologic Oncology and Gynecology, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, United States
| | - Erin Stevens
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Prevea Health, Green Bay, WI, United States
| | - Yevgeniya Ioffe
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Loma Linda University School of Medicine, Loma Linda, CA, United States
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Wall SA, Funderburg A, Huang Y, Elder P, Stevens E, Folefac E, Presley C, Rosko A. Pre-Transplant Geriatric Assessment (GA) with Intervention Among Allogeneic Transplant Recipients. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nipp RD, Qian CL, Knight HP, Ferrone CR, Kunitake H, Castillo CFD, Lanuti M, Qadan M, Ricciardi R, Lillemoe KD, Temel B, Hashmi AZ, Scott E, Stevens E, Williams GR, Fong ZV, O'Malley TA, Franco-Garcia E, Horick NK, Jackson VA, Greer JA, El-Jawahri A, Temel JS. Effects of a perioperative geriatric intervention for older adults with Cancer: A randomized clinical trial. J Geriatr Oncol 2022; 13:410-415. [PMID: 35074322 PMCID: PMC9058195 DOI: 10.1016/j.jgo.2022.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/27/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Older adults with gastrointestinal cancers undergoing surgery often experience poor outcomes, such as prolonged postoperative hospital length of stay (LOS), intensive care unit (ICU) use, hospital readmissions, and complications. Involvement of geriatricians in the care of older adults with cancer can improve outcomes. We conducted a randomized trial of a perioperative geriatric intervention (PERI-OP) in older patients with gastrointestinal cancer undergoing surgery. METHODS From 9/2016-4/2019, we randomly assigned patients age ≥ 65 with gastrointestinal cancer planning to undergo surgical resection to receive PERI-OP or usual care. Patients assigned to PERI-OP met with a geriatrician preoperatively in the outpatient setting and postoperatively as an inpatient consultant. The primary outcome was postoperative hospital LOS. Secondary outcomes included postoperative ICU use, 90-day hospital readmission rates, and complication rates. We conducted intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS ITT analyses included 137/160 patients who underwent surgery (usual care = 68/78, intervention = 69/82). PP analyses included the 68 usual care patients and the 30/69 intervention patients who received the preoperative and postoperative intervention components. ITT analyses demonstrated no significant differences between intervention and usual care in postoperative hospital LOS (7.23 vs 8.21 days, P = 0.374), ICU use (23.2% vs 32.4%, P = 0.257), 90-day hospital readmission rates (21.7% vs 25.0%, P = 0.690), or complication rates (17.4% vs 20.6%, P = 0.668). In PP analyses, intervention patients had shorter postoperative hospital LOS (5.90 vs 8.21 days, P = 0.024), but differences in ICU use (13.3% vs 32.4%, P = 0.081), 90-day hospital readmission rates (16.7% vs 25.0%, P = 0.439), and complication rates (6.7% vs 20.6%, P = 0.137) remained non-significant. CONCLUSIONS In this randomized trial, PERI-OP did not have a significant impact on postoperative hospital LOS, ICU use, hospital readmissions, or complications. However, the subgroup who received PERI-OP as planned experienced encouraging results. Future studies of PERI-OP should include efforts, such as telehealth, to ensure the intervention is delivered as planned.
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Wall SA, Huang Y, Keiter A, Funderburg A, Kloock C, Yuhasz N, Gure TR, Folefac E, Stevens E, Presley CJ, Williams NO, Krok-Schoen JL, Naughton MJ, Rosko AE. Integration of a Geriatric Assessment With Intervention in the Care of Older Adults With Hematologic Malignancies. Front Oncol 2021; 11:775050. [PMID: 34956894 PMCID: PMC8692664 DOI: 10.3389/fonc.2021.775050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 11/15/2022] Open
Abstract
The incidence of hematologic malignancies (HMs) is highest in the seventh decade of life and coincides with increasing occult, age-related vulnerabilities. Identification of frailty is useful in prognostication and treatment decision-making for older adults with HMs. This real-world analysis describes 311 older adults with HMs evaluated in a multidisciplinary oncogeriatric clinic. The accumulation of geriatric conditions [1-unit increase, hazards ratio (HR) = 1.13, 95% CI 1.00-1.27, p = 0.04] and frailty assessed by the Rockwood Clinical Frailty Scale (CFS, mild/moderate/severe frailty vs. very fit/well, HR = 2.59, 95% CI 1.41-4.78, p = 0.002) were predictive of worse overall survival. In multivariate analysis, HM type [acute leukemia, HR = 3.84, 95% CI 1.60-9.22, p = 0.003; myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN)/bone marrow failure, HR = 2.65, 95% CI 1.10-6.35, p = 0.03], age (per 5-year increase, HR = 1.46, 95% CI 1.21-1.76, p < 0.001), hemoglobin (per 1 g/dl decrease, HR = 1.21, 95% CI 1.05-1.40, p = 0.009), deficit in activities of daily living (HR = 2.20, 95% CI 1.11-4.34, p = 0.02), and Mini Nutrition Assessment score (at-risk of malnutrition vs. normal, HR = 2.00, 95% CI 1.07-3.73, p = 0.03) were independently associated with risk of death. The most commonly prescribed geriatric interventions were in the domains of audiology (56%) and pharmacy (54%). The Rockwood CFS correlated with prescribed interventions in nutrition (p = 0.01) and physical function (p < 0.001) domains. Geriatric assessment with geriatric intervention can be practically integrated into the routine care of older adults with HMs.
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Affiliation(s)
- Sarah A. Wall
- Division of Hematology, The Ohio State University, Columbus, OH, United States
- The James Comprehensive Cancer Center, Columbus, OH, United States
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, United States
| | - Ashleigh Keiter
- Division of Hematology, The Ohio State University, Columbus, OH, United States
| | | | - Colin Kloock
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Nicholas Yuhasz
- The James Comprehensive Cancer Center, Columbus, OH, United States
| | - Tanya R. Gure
- Division of Geriatric Medicine, The Ohio State University, Columbus, OH, United States
| | - Edmund Folefac
- The James Comprehensive Cancer Center, Columbus, OH, United States
- Division of Medical Oncology, The Ohio State University, Columbus, OH, United States
| | - Erin Stevens
- Division of Palliative Medicine, The Ohio State University, Columbus, OH, United States
| | - Carolyn J. Presley
- The James Comprehensive Cancer Center, Columbus, OH, United States
- Division of Medical Oncology, The Ohio State University, Columbus, OH, United States
| | - Nicole O. Williams
- The James Comprehensive Cancer Center, Columbus, OH, United States
- Division of Medical Oncology, The Ohio State University, Columbus, OH, United States
| | | | - Michelle J. Naughton
- Division of Cancer Control and Prevention, The Ohio State University, Columbus, OH, United States
| | - Ashley E. Rosko
- Division of Hematology, The Ohio State University, Columbus, OH, United States
- The James Comprehensive Cancer Center, Columbus, OH, United States
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Stevens E, Xu M, Funderburg A, Huang Y, Rosko A, Presley C, Wall S. Geriatric Syndromes Stratified by Degree of Cognitive Impairment in Older Adults with Cancer. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00456-2] [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: 11/25/2022]
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Rosko A, Huang Y, Funderburg A, Burd C, Presley C, Wall S, Naughton M, Mims A, Woyach J, Stevens E, Dvorak K, Loborec J. The Relationship of Relative Dose Intensity with Chemotherapy Toxicity and Geriatric Metrics in Older Adults with Hematologic Malignancy. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00360-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Woffenden H, Vijayan D, Stevens E, Ghini F, Cunha M, Suggett N. 173 Long Term Analysis of The Evolution of Practice and Results of Abdominal Wall Reconstruction by A Single Surgeon. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.585] [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]
Abstract
Abstract
Background
It is estimated that at least 12-15% of abdominal operations lead to incisional hernias, and Worldwide, evidence shows high rates of recurrence after surgical repair ranging from 12.7% in the Danish hernia registry to 23% in the Swedish registry.
Method
This is a retrospective analysis of the practice of a single surgeon at a tertiary centre. An electronic database provided all hernia surgeries done by the surgeon. A total of 185 patients with complete data were included who had open hernia repair. Electronic patient records were analysed to collect the data.
Results
185 patients, with a median age of 57 years (IQR 68 – 49), and BMI of 31.14 (IQR 36.02 – 27.52), had a hernia recurrence rate of 15.6% (29/185). More than 80% of the cases were complex hernias with a European Hernia classification of M3 and/ or W3, with dense intestinal adhesions and multiple previous repairs. Variability in techniques and mesh evolved over this period, from anterior component separation to transversus abdominis release to achieve closure of the abdomen. Polypropylene meshes were used for non-contaminated or less complex cases. The use of biologics in the early years has been superseded by biosynthetic.
Conclusions
The creation of the abdominal wall unit and subsequent MDT at this centre resulted in a rise of total procedures, complexity of cases and patients with significant co-morbidities. Specialised abdominal wall surgeons are associated with better results when performing complex abdominal wall reconstructions.
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Affiliation(s)
- H Woffenden
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - D Vijayan
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - E Stevens
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - F Ghini
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - M Cunha
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - N Suggett
- Queen Elizabeth Hospital, Birmingham, United Kingdom
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Kelly EP, Myers B, Kelly-Brown J, Waterman BL, Stevens E, Pawlik TM. Spiritual Motivations to Practice Medicine: A Survey of Cancer Care Providers. Am J Hosp Palliat Care 2021; 39:1046-1051. [PMID: 34607493 DOI: 10.1177/10499091211049802] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is increased interest in the role of spirituality in the cancer care context, but how it may inspire individuals to pursue a career as a healthcare provider is unknown. We sought to determine the relationship between intrinsic religiosity, religious identity, provider role, and spiritual motivations to practice medicine. METHODS A cross-sectional survey was administered to healthcare providers at a large, Midwest Comprehensive Cancer Center. The relationship between provider type, intrinsic religiosity, religious identity, and spiritual motivations to practice medicine was assessed with binary logistic regression. RESULTS Among 340 participants, most were female (82.1%) or Caucasian (82.6%) and identified as being religious (57.5%); median age was 35 years (IQR: 31-48). Providers included nurses (64.7%), physicians (17.9%), and "other" (17.4%). Compared with physicians, nurses were less likely to agree that they felt responsible for reducing pain and suffering in the world (OR: 0.12, p = 0.03). Similarly, "other" providers were less likely than physicians to believe that the practice of medicine was a calling (OR: 0.28, p = 0.02). Providers with a high self-reported intrinsic religiosity demonstrated a much greater likelihood to believe that the practice of medicine is a calling (OR:1.75, p = 0.001), as well as believe that personal R&S beliefs influence the practice of medicine (OR:3.57, p < 0.001). Provider religious identity was not associated with spiritual motivations to practice medicine (all p > 0.05). CONCLUSION Intrinsic religiosity had the strongest relationship with spiritual motivations to practice medicine. Understanding these motivations may inform interventions to avoid symptoms of provider burnout in cancer care.
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Affiliation(s)
| | - Brian Myers
- The Ohio State University, Columbus, OH, USA
| | | | - Brittany L Waterman
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erin Stevens
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Hong L, Rubinsak L, Benoit M, Chandavarkar U, Brockmeyer A, Teoh D, Stevens E, Ioffe Y, Temkin S. Workplace bullying, harassment and microaggressions: the results of a Women of Gynecologic Oncology (WGO) survey. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00661-2] [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: 10/20/2022]
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21
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Nipp RD, Temel B, Fuh CX, Kay P, Landay S, Lage D, Franco-Garcia E, Scott E, Stevens E, O'Malley T, Mohile S, Dale W, Traeger L, Hashmi AZ, Jackson V, Greer JA, El-Jawahri A, Temel JS. Pilot Randomized Trial of a Transdisciplinary Geriatric and Palliative Care Intervention for Older Adults With Cancer. J Natl Compr Canc Netw 2021; 18:591-598. [PMID: 32380460 DOI: 10.6004/jnccn.2019.7386] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/04/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Oncologists often struggle with managing the unique care needs of older adults with cancer. This study sought to determine the feasibility of delivering a transdisciplinary intervention targeting the geriatric-specific (physical function and comorbidity) and palliative care (symptoms and prognostic understanding) needs of older adults with advanced cancer. METHODS Patients aged ≥65 years with incurable gastrointestinal or lung cancer were randomly assigned to a transdisciplinary intervention or usual care. Those in the intervention arm received 2 visits with a geriatrician, who addressed patients' palliative care needs and conducted a geriatric assessment. We predefined the intervention as feasible if >70% of eligible patients enrolled in the study and >75% of eligible patients completed study visits and surveys. At baseline and week 12, we assessed patients' quality of life (QoL), symptoms, and communication confidence. We calculated mean change scores in outcomes and estimated intervention effect sizes (ES; Cohen's d) for changes from baseline to week 12, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect. RESULTS From February 2017 through June 2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age, 72.3 years; cancer types: 56.5% gastrointestinal, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 79.6% attended both. Overall, 89.7% completed all study surveys. Compared with usual care, intervention patients had less QoL decrement (-0.77 vs -3.84; ES = 0.21), reduced number of moderate/severe symptoms (-0.69 vs +1.04; ES = 0.58), and improved communication confidence (+1.06 vs -0.80; ES = 0.38). CONCLUSIONS In this pilot trial, enrollment exceeded 55%, and >75% of enrollees completed all study visits and surveys. The transdisciplinary intervention targeting older patients' unique care needs showed encouraging ES estimates for enhancing patients' QoL, symptom burden, and communication confidence.
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Affiliation(s)
- Ryan D Nipp
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Brandon Temel
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Charn-Xin Fuh
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Paul Kay
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Sophia Landay
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Daniel Lage
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Esteban Franco-Garcia
- 2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erin Scott
- 2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erin Stevens
- 2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Terrence O'Malley
- 2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.,3Partners Continuing Care, Partners HealthCare System, Boston, Massachusetts
| | - Supriya Mohile
- 4Department of Medicine, Division of Hematology and Oncology, University of Rochester Medical Center, Rochester, New York
| | - William Dale
- 5Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Lara Traeger
- 6Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Ardeshir Z Hashmi
- 7Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio
| | - Vicki Jackson
- 2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph A Greer
- 6Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Areej El-Jawahri
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Jennifer S Temel
- 1Department of Medicine, Division of Hematology and Oncology, and
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22
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McGovern MM, McTague MF, Stevens E, Medina JCN, Franco-Garcia E, Heng M. Impact of Age on Consent in a Geriatric Orthopaedic Trauma Patient Population. Geriatr Orthop Surg Rehabil 2021; 12:21514593211003065. [PMID: 33868766 PMCID: PMC8020399 DOI: 10.1177/21514593211003065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Physicians may inappropriately focus the discussion of treatment options to health care proxies instead of patients. Our study explores the consenting process in a decision-making capable orthogeriatric trauma patient population to determine if there is a relationship between increased patient age and surgical consent by health care proxy. Methods: Patients aged 65 and older who underwent operative orthopaedic fracture fixation between 1 of 2 Level 1 Trauma Centers were retrospectively reviewed. Decision-making capable status was defined as an absence of patient history of cognitive impairment and a negative patient pre-surgical Confusion Assessment Method (CAM) and Mini-Cog Assessment screen. Provider of surgical consent was the main outcome and was determined by signature on the consent form. Results: 510 patients were included, and 276 (54.1%) patients were deemed capable of consent. In 27 (9.8%) of 276 decision-capable patients, physicians obtained consent from health care proxies. 20 of these 27 patients (74.1%) were 80 years of age or older. However, in patients aged 70 to 79, only 7 health care proxies provided consent. (p = 0.07). For every unit increase in age, the log odds of proxy consent increased by .0008 (p < 0.001). Age (p < 0.001), income level (p = 0.03), and physical presence of proxy at consult (p < 0.001) were factors associated with significantly increased utilization of health care proxy provided consent. Language other than English was a significant predictor of proxy-provided consent (p = 0.035). 48 (22%) decision-making incapable patients provided their own surgical consent. Discussion: The positive linear association between age and health care proxy provided consent in cognitively intact geriatric orthopaedic patients indicates that increased patient age impacts the consenting process. Increased physician vigilance and adoption of institutional consenting guidelines can reinforce appropriate respect of geriatric patients’ consenting capacity.
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Affiliation(s)
- Madeline M McGovern
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael F McTague
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA
| | - Erin Stevens
- Department of Internal Medicine, Division of Palliative Medicine, Ohio State University, Columbus, Ohio, USA
| | - Juan Carlos Nunez Medina
- Division of Palliative Care & Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Esteban Franco-Garcia
- Division of Palliative Care & Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Marilyn Heng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA
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23
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Weber B, Brown J, Divakaran S, Stevens E, Hainer J, Bibbo C, Taqueti V, Blankstein R, Dorbala S, Massarotti E, Costenbader K, Liao K, Dicarli M. Coronary vasomotor dysfunction is associated with worse outcomes in patients with inflammatory disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3161] [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
Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis (PsO) are common inflammatory conditions with excess cardiovascular (CV) risk compared to the general population. This excess CV risk is associated with traditional risk factors, glucocorticoid treatment, and systemic inflammation. Systemic inflammation perturbs endothelial function and has been linked to coronary vasomotor dysfunction. It is not clear if coronary vasomotor dysfunction would be associated with worse clinical outcomes in systemic autoimmune inflammatory conditions.
Purpose
We tested the hypothesis that impaired coronary flow reserve (CFR), which in the absence of flow-limiting obstructive coronary artery disease (CAD) reflects vasomotor dysfunction, among patients with SLE, RA, and PsO is associated with worse clinical outcomes.
Methods
We included patients with RA, SLE, and PsO who underwent clinically indicated rest/stress myocardial perfusion positron emission tomography (PET) at a large academic medical center from 2006 to 2019. Patients with an abnormal myocardial perfusion study (summed stress score >3) or left ventricular ejection fraction <40% were excluded. CFR was calculated as the ratio of myocardial blood flow (MBF, ml/min/g) at peak stress compared to the MBF at rest and adjusted for baseline heart rate and blood pressure.
Results
Among the 175 patients (median age 65.1 years, 80% female) in the cohort, 24% had SLE, 35% PsO, and 41% RA. There was no difference in mean CFR between patients with RA, SLE, or PsO. Over a median follow-up of 8.5 years after PET, there were 47 deaths. Patients in the lowest and middle tertile (CFR <2.18) had a higher all-cause mortality when compared with the highest (Figure 1), and this association remained significant after adjusting for age and a composite clinical score incorporating sex, symptoms, and CV risk factors (lowest vs. highest tertile: HR 2.8; 95% confidence interval 1.2–6.5; p=0.01). CV risk factors such as diabetes, hypertension, obesity, tobacco use, and a family history of CAD were not significantly different across CFR tertiles, suggesting that inflammatory-disease specific risk factors may contribute to coronary vasomotor dysfunction.
Conclusions
In patients with systemic inflammatory disease, coronary vasomotor dysfunction was associated with worse outcomes independent of traditional CV risk factors and may have utility as a marker of CV risk among patients with inflammatory disease.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. 5T32HL094301-02 NIH T32 Training Grant, “Noninvasive Cardiovascular Imaging Research Training Program”
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Affiliation(s)
- B Weber
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - J.M Brown
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Divakaran
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - E Stevens
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - J Hainer
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - C Bibbo
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - V Taqueti
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - R Blankstein
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Dorbala
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - E Massarotti
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - K Costenbader
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - K Liao
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - M Dicarli
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
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Kistler EA, Stevens E, Scott E, Philpotts LL, Greer JA, Greenwald JL. Triggered Palliative Care Consults: A Systematic Review of Interventions for Hospitalized and Emergency Department Patients. J Pain Symptom Manage 2020; 60:460-475. [PMID: 32061721 DOI: 10.1016/j.jpainsymman.2020.02.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 02/05/2023]
Abstract
CONTEXT Palliative care improves the quality of care and may reduce utilization, but delays or the absences of such services are common and costly in inpatient and emergency department settings. Triggered palliative care consults (PCCs) offer one way to identify patients who would benefit from palliative care and to connect them with services early in their course. Consensus reports recommend use of triggers to identify patients for PCC, but no standards exist to guide trigger design or implementation. OBJECTIVES To conduct a systematic review of published trigger tools for PCC. METHODS Studies included quality improvement and prospective analyses of triggers for PCC for adults in the emergency department and inpatient settings since 2008. Paired reviewers evaluated the studies for inclusion criteria and extracted data related to study demographics, trigger processes, trigger criteria, and study bias. RESULTS The search yielded 5773 citations. Twenty studies were included for final analysis with more than 17,000 patients represented. Trigger processes and composition were heterogeneous, although frequently used categories, such as cancer, dementia, and chronic comorbidities, were identified. Three-quarters of the studies were deemed to have moderate or high risk of bias. CONCLUSION We present a range of trigger tools spanning different hospital settings and patient populations. Common themes in implementation and content arose, but the limitations of these studies are notable, and further rigorous randomized comparisons are needed to generate standards of care. In addition, future studies should focus on developing triggers that identify patients requiring primary-level vs. specialty-level palliative care.
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Affiliation(s)
- Emmett A Kistler
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Erin Stevens
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin Scott
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lisa L Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeffrey L Greenwald
- Department of Medicine, Core Educator Faculty, Massachusetts General Hospital, Boston, Massachusetts, USA
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25
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Stevens E. Intergenerational iatrogenesis: A story of diagnosis, medication, therapy and familial harm. Psychother Politics Int 2020. [DOI: 10.1002/ppi.1527] [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: 11/08/2022]
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26
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Fry J, Alarcon R, Baeßler S, Balascuta S, Palos LB, Bailey T, Bass K, Birge N, Blose A, Borissenko D, Bowman J, Broussard L, Bryant A, Byrne J, Calarco J, Caylor J, Chang K, Chupp T, Cianciolo T, Crawford C, Ding X, Doyle M, Fan W, Farrar W, Fomin N, Frlež E, Gericke M, Gervais M, Glück F, Greene G, Grzywacz R, Gudkov V, Hamblen J, Hayes C, Hendrus C, Ito T, Jezghani A, Li H, Makela M, Macsai N, Mammei J, Mammei R, Martinez M, Matthews D, McCrea M, McGaughey P, McLaughlin C, Mueller P, Petten DV, Penttilä S, Perryman D, Picker R, Pierce J, Počanić D, Qian Y, Ramsey J, Randall G, Riley G, Rykaczewski K, Salas-Bacci A, Samiei S, Scott E, Shelton T, Sjue S, Smith A, Smith E, Stevens E, Wexler J, Whitehead R, Wilburn W, Young A, Zeck B. The Nab experiment: A precision measurement of unpolarized neutron beta decay. EPJ Web Conf 2019. [DOI: 10.1051/epjconf/201921904002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neutron beta decay is one of the most fundamental processes in nuclear physics and provides sensitive means to uncover the details of the weak interaction. Neutron beta decay can evaluate the ratio of axial-vector to vector coupling constants in the standard model, λ = gA/gV, through multiple decay correlations. The Nab experiment will carry out measurements of the electron-neutrino correlation parameter a with a precision of δa/a = 10−3 and the Fierz interference term b to δb = 3 × 10−3 in unpolarized free neutron beta decay. These results, along with a more precise measurement of the neutron lifetime, aim to deliver an independent determination of the ratio λ with a precision of δλ/λ = 0.03% that will allow an evaluation of Vud and sensitively test CKM unitarity, independent of nuclear models. Nab utilizes a novel, long asymmetric spectrometer that guides the decay electron and proton to two large area silicon detectors in order to precisely determine the electron energy and an estimation of the proton momentum from the proton time of flight. The Nab spectrometer is being commissioned at the Fundamental Neutron Physics Beamline at the Spallation Neutron Source at Oak Ridge National Lab. We present an overview of the Nab experiment and recent updates on the spectrometer, analysis, and systematic effects.
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27
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Loizeau AJ, D'Agata EMC, Shaffer ML, Hanson LC, Anderson RA, Tsai T, Habtemariam DA, Bergman EH, Carroll RP, Cohen SM, Scott EME, Stevens E, Whyman JD, Bennert EH, Mitchell SL. The trial to reduce antimicrobial use in nursing home residents with Alzheimer's disease and other dementias: study protocol for a cluster randomized controlled trial. Trials 2019; 20:594. [PMID: 31615540 PMCID: PMC6794759 DOI: 10.1186/s13063-019-3675-y] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infections are common in nursing home (NH) residents with advanced dementia but are often managed inappropriately. Antimicrobials are extensively prescribed, but frequently with insufficient evidence to support a bacterial infection, promoting the emergence of multidrug-resistant organisms. Moreover, the benefits of antimicrobials remain unclear in these seriously ill residents for whom comfort is often the goal of care. Prior NH infection management interventions evaluated in randomized clinical trials (RCTs) did not consider patient preferences and lack evidence to support their effectiveness in 'real-world' practice. METHODS This report presents the rationale and methodology of TRAIN-AD (Trial to reduce antimicrobial use in nursing home residents with Alzheimer's disease and other dementias), a parallel group, cluster RCT evaluating a multicomponent intervention to improve infection management for suspected urinary tract infections (UTIs) and lower respiratory tract infections (LRIs) among NH residents with advanced dementia. TRAIN-AD is being conducted in 28 facilities in the Boston, USA, area randomized in waves using minimization to achieve a balance on key characteristics (N = 14 facilities/arm). The involvement of the facilities includes a 3-month start-up period and a 24-month implementation/data collection phase. Residents are enrolled during the first 12 months of the 24-month implementation period and followed for up to 12 months. Individual consent is waived, thus almost all eligible residents are enrolled (target sample size, N = 410). The intervention integrates infectious disease and palliative care principles and includes provider training delivered through multiple modalities (in-person seminar, online course, management algorithms, and prescribing feedback) and an information booklet for families. Control facilities employ usual care. The primary outcome, abstracted from the residents' charts, is the number of antimicrobial courses prescribed for UTIs and LRIs per person-year alive. DISCUSSION TRAIN-AD is the first cluster RCT testing a multicomponent intervention to improve infection management in NH residents with advanced dementia. Its findings will provide an evidence base to support the benefit of a program addressing the critical clinical and public health problem of antimicrobial misuse in these seriously ill residents. Moreover, its hybrid efficacy-effectiveness design will inform the future conduct of cluster RCTs evaluating nonpharmacological interventions in the complex NH setting in a way that is both internally valid and adaptable to the 'real-world'. TRIAL REGISTRATION ClinicalTrials.gov, NCT03244917 . Registered on 10 August 2017.
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Affiliation(s)
- Andrea J Loizeau
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA.
| | - Erika M C D'Agata
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Michele L Shaffer
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Laura C Hanson
- Division of Geriatric Medicine, Palliative Care Program, Chapel Hill, NC, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Timothy Tsai
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Daniel A Habtemariam
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Elaine H Bergman
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Ruth P Carroll
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Simon M Cohen
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Erin M E Scott
- Division of Palliative Care and Geriatrics, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erin Stevens
- Division of Palliative Care and Geriatrics, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy D Whyman
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Susan L Mitchell
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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28
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Stevens E. SCoPEd: How counselling and psychotherapy found itself in the midst of an identity‐crisis. Psychother Politics Int 2019. [DOI: 10.1002/ppi.1492] [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: 11/10/2022]
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Kay P, El-Jawahri A, Fuh CX, Temel B, Landay S, Lage D, Franco-Garcia E, Scott E, Stevens E, O'Malley T, Mohile SG, Dale W, Traeger L, Jackson V, Greer J, Temel JS, Nipp RD. Pilot randomized trial of a transdisciplinary geriatric intervention for older adults with cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11549] [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: 11/20/2022] Open
Abstract
11549 Background: Oncologists often struggle with managing the unique care needs of older adults with cancer. We sought to determine the feasibility of delivering a transdisciplinary geriatric intervention designed to address the geriatric (physical function & comorbidity) and palliative care (symptoms & prognostic understanding) needs of older adults with cancer. Methods: We randomly assigned patients age ≥65 with newly diagnosed incurable gastrointestinal (GI) or lung cancer to receive a transdisciplinary geriatric intervention or usual care. Intervention patients received two visits with a geriatrician who was trained to address patients’ palliative care needs in addition to conducting a geriatric assessment. We defined the intervention as feasible if > 70% of patients enrolled in the study and > 75% completed study visits and surveys. At baseline and week 12, we assessed patients’ quality of life (QOL, Functional Assessment of Cancer Therapy General), symptoms (Edmonton Symptom Assessment System), and communication confidence (Perceived Efficacy in Patient Physician Interactions). As this was a pilot study, we calculated mean change scores in outcomes and estimated intervention effect sizes (ES). Results: From 2/2017-6/2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age = 72.3 [range 65.2-91.8]; 45.2% female; cancer types: 56.5% GI, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 76.2% attended both. Overall, 77.8% completed all study surveys. Compared to usual care, intervention patients had less decrement in QOL scores (-0.77 vs -3.84, ES = .21), greater reduction in the number of moderate/severe symptoms (-0.69 vs +1.04, ES = .58), and more improvement in communication confidence (+1.06 vs -0.80, ES = .38). Conclusions: In this trial of older adults with advanced cancer, more than half enrolled in the study and over 75% of those who enrolled completed all study visits and surveys. Our effect size estimates suggest that a transdisciplinary intervention targeting patients’ geriatric and palliative care needs may be a promising approach to improve patients’ QOL, symptom burden, and communication confidence. Clinical trial information: NCT02868112.
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Affiliation(s)
- Paul Kay
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | | | | | | | | | - Erin Scott
- Massachusetts General Hospital, Boston, MA
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Stevens E, Williams B, Kock N, Kitching M, Simpson MP. Cord injury after spinal anaesthesia in a patient with previously undiagnosed Klippel-Feil syndrome. Anaesth Rep 2019; 7:7-10. [PMID: 32051936 DOI: 10.1002/anr3.12001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 12/23/2022] Open
Abstract
This report presents an obstetric patient with no significant past medical history who underwent spinal anaesthesia for a category-three caesarean section. On examination, she had asymmetrical scapular alignment and a mild scoliosis of the lumbar spine with no functional limitation. Postoperatively the patient developed neuropathic pain symptoms in the right leg which failed to resolve with conventional analgesia. Cervical and lumbar spine magnetic resonance imaging was performed resulting in a diagnosis of a low-lying tethered spinal cord terminating at the level of L5 and congenital fusion of the C7/T1 vertebrae. A tethered spinal cord is a rare condition, which in this case had been completely asymptomatic. However, we suggest that the patient displayed musculoskeletal signs not previously widely reported, which could have indicated the presence of a potential underlying neural tube defect. Based on the imaging findings and the presence of Sprengel's deformity, the patient was diagnosed with Klippel-Feil syndrome.
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Affiliation(s)
- E Stevens
- Department of Anaesthetics East and North Hertfordshire NHS Trust Stevenage United Kingdom
| | - B Williams
- Department of Anaesthetics East and North Hertfordshire NHS Trust Stevenage United Kingdom
| | - N Kock
- Department of Neurology East and North Hertfordshire NHS Trust Stevenage United Kingdom
| | - M Kitching
- Department of Anaesthetics East and North Hertfordshire NHS Trust Stevenage United Kingdom
| | - M P Simpson
- Department of Anaesthetics East and North Hertfordshire NHS Trust Stevenage United Kingdom
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Rodgers H, Shaw L, Bhattarai N, Cant R, Drummond A, Ford GA, Forster A, Francis R, Hills K, Howel D, Laverty AM, McKevitt C, McMeekin P, Price C, Stamp E, Stevens E, Vale L. 137A trial to evaluate an eXTended RehAbilitation service for Stroke patients (EXTRAS): main patient results. Age Ageing 2019. [DOI: 10.1093/ageing/afz001.03] [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: 11/12/2022] Open
Affiliation(s)
- H Rodgers
- Newcastle University
- Northumbria Healthcare NHS Foundation Trust
- Newcastle upon Tyne Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | - C Price
- Newcastle University
- Northumbria Healthcare NHS Foundation Trust
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Triolo TM, Fouts A, Pyle L, Yu L, Gottlieb PA, Steck AK, Greenbaum CJ, Atkinson M, Baidal D, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Clements M, Colman P, DiMeglio L, Gitelman S, Goland R, Gottlieb P, Herold K, Knip M, Krischer J, Lernmark A, Moore W, Moran A, Muir A, Palmer J, Peakman M, Philipson L, Raskin P, Redondo M, Rodriguez H, Russell W, Spain L, Schatz D, Sosenko J, Wentworth J, Wherrett D, Wilson D, Winter W, Ziegler A, Anderson M, Antinozzi P, Benoist C, Blum J, Bourcier K, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Insel R, Kaufman F, Kay T, Leschek E, Mahon J, Marks J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Pugliese A, Roep B, Roncarolo M, Savage P, Simell O, Sherwin R, Siegelman M, Skyler J, Steck A, Thomas J, Trucco M, Wagner J, Krischer JP, Leschek E, Rafkin L, Bourcier K, Cowie C, Foulkes M, Insel R, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Rafkin L, Sosenko JM, Kenyon NS, Santiago I, Krischer JP, Bundy B, Abbondondolo M, Dixit S, Pasha M, King K, Adcock H, Atterberry L, Fox K, Englert N, Mauras J, Permuy K, Sikes T, Adams T, Berhe B, Guendling L, McLennan L, Paganessi C, Murphy M, Draznin M, Kamboj S, Sheppard V, Lewis L, Coates W, Amado D, Moore G, Babar J, Bedard D, Brenson-Hughes J, Cernich M, Clements R, Duprau S, Goodman L, Hester L, Huerta-Saenz A, Asif I, Karmazin T, Letjen S, Raman D, Morin W, Bestermann E, Morawski J, White A, Brockmyer R, Bays S, Campbell A, Boonstra M, Stapleton N, Stone A, Donoho H, Everett H, Hensley M, Johnson C, Marshall N, Skirvin P, Taylor R, Williams L, Burroughs C, Ray C, Wolverton D, Nickels C, Dothard P, Speiser M, Pellizzari L, Bokor K, Izuora S, Abdelnour P, Cummings S, Cuthbertson D, Paynor M, Leahy M, Riedl S, Shockley R, Saad T, Briones S, Casella C, Herz K, Walsh J, Greening F, Deemer M, Hay S, Hunt N, Sikotra L, Simons D, Karounos R, Oremus L, Dye L, Myers D, Ballard W, Miers R, Eberhard C, Sparks K, Thraikill K, Edwards J, Fowlkes S, Kemp A, Morales L, Holland L, Johnson P, Paul A, Ghatak K, Fiske S, Phelen H, Leyland T, Henderson D, Brenner E, Oppenheimer I, Mamkin C, Moniz C, Clarson M, Lovell A, Peters V, Ford J, Ruelas D, Borut D, Burt M, Jordan S, Castilla P, Flores M, Ruiz L, Hanson J, Green-Blair R, Sheridan K, Garmeson J, Wintergerst G, Pierce A, Omoruyi M, Foster S, Kingery A, Lunsford I, Cervantes T, Parker P, Price J, Urben I, Guillette H, Doughty H, Haydock V, Parker P, Bergman S, Duncum C, Rodda A, Perelman R, Calendo C, Barrera E, Arce-Nunez Y, Geyer S, Martinez M, De la Portilla I, Cardenas L, Garrido M, Villar R, Lorini E, Calandra G, D’Annuzio K, Perri N, Minuto C, Hays B, Rebora R, Callegari O, Ali J, Kramer B, Auble S, Cabrera P, Donohoue R, Fiallo-Scharer M, Hessner P, Wolfgram A, Henderson C, Kansra N, Bettin R, McCuller A, Miller S, Accacha J, Corrigan E, Fiore R, Levine T, Mahoney C, Polychronakos V, Henry M, Gagne H, Starkman M, Fox D, Chin F, Melchionne L, Silverman I, Marshall L, Cerracchio J, Cruz A, Viswanathan J, Heyman K, Wilson S, Chalew S, Valley S, Layburn A, Lala P, Clesi M, Genet G, Uwaifo A, Charron T, Allerton W, Hsiao B, Cefalu L, Melendez-Ramirez R, Richards C, Alleyn E, Gustafson M, Lizanna J, Wahlen S, Aleiwe M, Hansen H, Wahlen C, Karges C, Levy A, Bonaccorso R, Rapaport Y, Tomer D, Chia M, Goldis L, Iazzetti M, Klein C, Levister L, Waldman E, Keaton N, Wallach M, Regelmann Z, Antal M, Aranda C, Reynholds A, Vinik P, Barlow M, Bourcier M, Nevoret J, Couper S, Kinderman A, Beresford N, Thalagne H, Roper J, Gibbons J, Hill S, Balleaut C, Brennan J, Ellis-Gage L, Fear T, Gray L, Law P, Jones C, McNerney L, Pointer N, Price K, Few D, Tomlinson N, Leech D, Wake C, Owens M, Burns J, Leinbach A, Wotherspoon A, Murray K, Short G, Curry S, Kelsey J, Lawson J, Porter S, Stevens E, Thomson S, Winship L, Liu S, Wynn E, Wiltshire J, Krebs P, Cresswell H, Faherty C, Ross L, Denvir J, Drew T, Randell P, Mansell S, Lloyd J, Bell S, Butler Y, Hooton H, Navarra A, Roper G, Babington L, Crate H, Cripps A, Ledlie C, Moulds R, Malloy J, Norton B, Petrova O, Silkstone C, Smith K, Ghai M, Murray V, Viswanathan M, Henegan O, Kawadry J, Olson L, Maddox K, Patterson T, Ahmad B, Flores D, Domek S, Domek K, Copeland M, George J, Less T, Davis M, Short A, Martin J, Dwarakanathan P, O’Donnell B, Boerner L, Larson M, Phillips M, Rendell K, Larson C, Smith K, Zebrowski L, Kuechenmeister M, Miller J, Thevarayapillai M, Daniels H, Speer N, Forghani R, Quintana C, Reh A, Bhangoo P, Desrosiers L, Ireland T, Misla C, Milliot E, Torres S, Wells J, Villar M, Yu D, Berry D, Cook J, Soder A, Powell M, Ng M, Morrison Z, Moore M, Haslam M, Lawson B, Bradley J, Courtney C, Richardson C, Watson E, Keely D, DeCurtis M, Vaccarcello-Cruz Z, Torres K, Muller S, Sandberg H, Hsiang B, Joy D, McCormick A, Powell H, Jones J, Bell S, Hargadon S, Hudson M, Kummer S, Nguyen T, Sauder E, Sutton K, Gensel R, Aguirre-Castaneda V, Benavides, Lopez D, Hemp S, Allen J, Stear E, Davis T, O’Donnell R, Jones A, Roberts J, Dart N, Paramalingam L, Levitt Katz N, Chaudhary K, Murphy S, Willi B, Schwartzman C, Kapadia D, Roberts A, Larson D, McClellan G, Shaibai L, Kelley G, Villa C, Kelley R, Diamond M, Kabbani T, Dajani F, Hoekstra M, Sadler K, Magorno J, Holst V, Chauhan N, Wilson P, Bononi M, Sperl A, Millward M, Eaton L, Dean J, Olshan H, Stavros T, Renna C, Milliard, Brodksy L, Bacon J, Quintos L, Topor S, Bialo B, Bancroft A, Soto W, Lagarde H, Tamura R, Lockemer T, Vanderploeg M, Ibrahim M, Huie V, Sanchez R, Edelen R, Marchiando J, Palmer T, Repas M, Wasson P, Wood K, Auker J, Culbertson T, Kieffer D, Voorhees T, Borgwardt L, DeRaad K, Eckert E, Isaacson H, Kuhn A, Carroll M, Xu P, Schubert G, Francis S, Hagan T, Le M, Penn E, Wickham C, Leyva K, Rivera J, Padilla I, Rodriguez N, Young K, Jospe J, Czyzyk B, Johnson U, Nadgir N, Marlen G, Prakasam C, Rieger N, Glaser E, Heiser B, Harris C, Alies P, Foster H, Slater K, Wheeler D, Donaldson M, Murray D, Hale R, Tragus D, Word J, Lynch L, Pankratz W, Badias F, Rogers R, Newfield S, Holland M, Hashiguchi M, Gottschalk A, Philis-Tsimikas R, Rosal S, Franklin S, Guardado N, Bohannon M, Baker A, Garcia T, Aguinaldo J, Phan V, Barraza D, Cohen J, Pinsker U, Khan J, Wiley L, Jovanovic P, Misra M, Bassi M, Wright D, Cohen K, Huang M, Skiles S, Maxcy C, Pihoker K, Cochrane J, Fosse S, Kearns M, Klingsheim N, Beam C, Wright L, Viles H, Smith S, Heller M, Cunningham A, Daniels L, Zeiden J, Field R, Walker K, Griffin L, Boulware D, Bartholow C, Erickson J, Howard B, Krabbenhoft C, Sandman A, Vanveldhuizen J, Wurlger A, Zimmerman K, Hanisch L, Davis-Keppen A, Bounmananh L, Cotterill J, Kirby M, Harris A, Schmidt C, Kishiyama C, Flores J, Milton W, Martin C, Whysham A, Yerka T, Bream S, Freels J, Hassing J, Webster R, Green P, Carter J, Galloway D, Hoelzer S, Roberts S, Said P, Sullivan H, Freeman D, Allen E, Reiter E, Feinberg C, Johnson L, Newhook D, Hagerty N, White L, Levandoski J, Kyllo M, Johnson C, Gough J, Benoit P, Iyer F, Diamond H, Hosono S, Jackman L, Barette P, Jones I, Sills S, Bzdick J, Bulger R, Ginem J, Weinstock I, Douek R, Andrews G, Modgill G, Gyorffy L, Robin N, Vaidya S, Crouch K, O’Brien C, Thompson N, Granger M, Thorne J, Blumer J, Kalic L, Klepek J, Paulett B, Rosolowski J, Horner M, Watkins J, Casey K, Carpenter C, Michelle Kieffer MH, Burns J, Horton C, Pritchard D, Soetaert A, Wynne C, Chin O, Molina C, Patel R, Senguttuvan M, Wheeler O, Lane P, Furet C, Steuhm D, Jelley S, Goudeau L, Chalmers D, Greer C, Panagiotopoulos D, Metzger D, Nguyen M, Horowitz M, Linton C, Christiansen E, Glades C, Morimoto M, Macarewich R, Norman K, Patin C, Vargas A, Barbanica A, Yu P, Vaidyanathan W, Nallamshetty L, Osborne R, Mehra S, Kaster S, Neace J, Horner G, Reeves C, Cordrey L, Marrs T, Miller S, Dowshen D, Oduah V, Doyle S, Walker D, Catte H, Dean M, Drury-Brown B, Hackman M, Lee S, Malkani K, Cullen K, Johnson P, Parrimon Y, Hampton M, McCarrell C, Curtis E, Paul, Zambrano Y, Paulus K, Pilger J, Ramiro J, Luvon Ritzie AQ, Sharma A, Shor A, Song X, Terry A, Weinberger J, Wootten M, Lachin JM, Foulkes M, Harding P, Krause-Steinrauf H, McDonough S, McGee PF, Owens Hess K, Phoebus D, Quinlan S, Raiden E, Batts E, Buddy C, Kirpatrick K, Ramey M, Shultz A, Webb C, Romesco M, Fradkin J, Leschek E, Spain L, Savage P, Aas S, Blumberg E, Beck G, Brillon D, Gubitosi-Klug R, Laffel L, Vigersky R, Wallace D, Braun J, Lernmark A, Lo B, Mitchell H, Naji A, Nerup J, Orchard T, Steffes M, Tsiatis A, Veatch R, Zinman B, Loechelt B, Baden L, Green M, Weinberg A, Marcovina S, Palmer JP, Weinberg A, Yu L, Babu S, Winter W, Eisenbarth GS, Bingley P, Clynes R, DiMeglio L, Eisenbarth G, Hays B, Leschek E, Marks J, Matheson D, Rafkin L, Rodriguez H, Spain L, Wilson D, Redondo M, Gomez D, McDonald A, Pena S, Pietropaolo M, Shippy K, Batts E, Brown T, Buckner J, Dove A, Hammond M, Hefty D, Klein J, Kuhns K, Letlau M, Lord S, McCulloch-Olson M, Miller L, Nepom G, Odegard J, Ramey M, Sachter E, St. Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Pat Gallagher M, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Pugliese A, Sanders-Branca N, Ray Arce LA, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Peterson Eck S, Finney L, Albright Fischer T, Martin A, Jacqueline Muzamhindo C, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Jo Ricci M, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Teresa Muscato M, Viscardi M, Bingley P, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del A, Rio A, Logan H, Collier C, Rishton G, Whalley A, Ali S, Ramtoola T, Quattrin L, Mastrandea A, House M, Ecker C, Huang C, Gougeon J, Ho D, Pacuad D, Dunger J, May C, O’Brien C, Acerini B, Salgin A, Thankamony R, Williams J, Buse G, Fuller M, Duclos J, Tricome H, Brown D, Pittard D, Bowlby A, Blue T, Headley S, Bendre K, Lewis K, Sutphin C, Soloranzo J, Puskaric H, Madison M, Rincon M, Carlucci R, Shridharani B, Rusk E, Tessman D, Huffman H, Abrams B, Biederman M, Jones V, Leathers W, Brickman P, Petrie D, Zimmerman J, Howard L, Miller R, Alemzadeh D, Mihailescu R, Melgozza-Walker N, Abdulla C, Boucher-Berry D, Ize-Ludlow R, Levy C, Swenson, Brousell N, Crimmins D, Edler T, Weis C, Schultz D, Rogers D, Latham C, Mawhorter C, Switzer W, Spencer P, Konstantnopoulus S, Broder J, Klein L, Knight L, Szadek G, Welnick B, Thompson R, Hoffman A, Revell J, Cherko K, Carter E, Gilson J, Haines G, Arthur B, Bowen W, Zipf P, Graves R, Lozano D, Seiple K, Spicer A, Chang J, Fregosi J, Harbinson C, Paulson S, Stalters P, Wright D, Zlock A, Freeth J, Victory H, Maheshwari A, Maheshwari T, Holmstrom J, Bueno R, Arguello J, Ahern L, Noreika V, Watson S, Hourse P, Breyer C, Kissel Y, Nicholson M, Pfeifer S, Almazan J, Bajaj M, Quinn K, Funk J, McCance E, Moreno R, Veintimilla A, Wells J, Cook S, Trunnel J, Henske S, Desai K, Frizelis F, Khan R, Sjoberg K, Allen P, Manning G, Hendry B, Taylor S, Jones W, Strader M, Bencomo T, Bailey L, Bedolla C, Roldan C, Moudiotis B, Vaidya C, Anning S, Bunce S, Estcourt E, Folland E, Gordon C, Harrill J, Ireland J, Piper L, Scaife K, Sutton S, Wilkins M, Costelloe J, Palmer L, Casas C, Miller M, Burgard C, Erickson J, Hallanger-Johnson P, Clark W, Taylor A, Lafferty S, Gillett C, Nolan M, Pathak L, Sondrol T, Hjelle S, Hafner J, Kotrba R, Hendrickson A, Cemeroglu T, Symington M, Daniel Y, Appiagyei-Dankah D, Postellon M, Racine L, Kleis K, Barnes S, Godwin H, McCullough K, Shaheen G, Buck L, Noel M, Warren S, Weber S, Parker I, Gillespie B, Nelson C, Frost J, Amrhein E, Moreland A, Hayes J, Peggram J, Aisenberg M, Riordan J, Zasa E, Cummings K, Scott T, Pinto A, Mokashi K, McAssey E, Helden P, Hammond L, Dinning S, Rahman S, Ray C, Dimicri S, Guppy H, Nielsen C, Vogel C, Ariza L, Morales Y, Chang R, Gabbay L, Ambrocio L, Manley R, Nemery W, Charlton P, Smith L, Kerr B, Steindel-Kopp M, Alamaguer D, Liljenquist G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes. Diabetes Care 2019; 42:192-199. [PMID: 30061316 PMCID: PMC6341285 DOI: 10.2337/dc18-0288] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings. RESEARCH DESIGN AND METHODS Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years. RESULTS At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects. CONCLUSIONS Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.
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Affiliation(s)
- Taylor M. Triolo
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Alexandra Fouts
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Liping Yu
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Peter A. Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
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Ceuppens JL, Vermylen JD, Colaert J, Desmyter J, Gautama K, Stevens E, The AL, Vanham G, Vermylen C, Verstraete M. Immunological Alterations in Haemophiliacs Treated with Lyophilized Factor VIII Cryoprecipitate from Volunteer Donors. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe studied immune function in Belgian haemophiliacs treated with Factor VIII from volunteer donors. No patient had clinical evidence of immune deficiency. We found a decrease in T-helper cells (p <0.0005), in the ratio of T-helper over T-cytotoxic/ suppressor cells (1.72 ± 0.47 versus 2.24 ± 0.82 in controls, p <0.005) and in lymphocyte responsiveness to mitogens (p <0.05).These findings could not be linked to the amount of F VIII received over the last year, the time since last F VIII administration, circulating immune complexes (54% positive patients, 7% positive controls, p <0.005), increased ALT levels, antibodies to cytomegalo-virus (85% of the patients, 45% of the controls, p <0.005), antibodies to Epstein-Barr virus, nor to the presence of HLA-DR 5 which was found in 56% of the haemophiliacs (20% of the overall Belgian population, p <0.005).Either F VIII induces long lasting immunological alterations unrelated to AIDS, or haemophilia is itself associated with such changes.
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Affiliation(s)
- J L Ceuppens
- The Divisions of Clinical Immunology and of Bleeding and Vascular Disorders (Department of Medicine), the Laboratory of Medical Virology, University of Leuven, and the Blood Transfusion Centre, Leuven, Belgium
| | - J D Vermylen
- The Divisions of Clinical Immunology and of Bleeding and Vascular Disorders (Department of Medicine), the Laboratory of Medical Virology, University of Leuven, and the Blood Transfusion Centre, Leuven, Belgium
| | - J Colaert
- The Divisions of Clinical Immunology and of Bleeding and Vascular Disorders (Department of Medicine), the Laboratory of Medical Virology, University of Leuven, and the Blood Transfusion Centre, Leuven, Belgium
| | - J Desmyter
- The Divisions of Clinical Immunology and of Bleeding and Vascular Disorders (Department of Medicine), the Laboratory of Medical Virology, University of Leuven, and the Blood Transfusion Centre, Leuven, Belgium
| | - K Gautama
- The Divisions of Clinical Immunology and of Bleeding and Vascular Disorders (Department of Medicine), the Laboratory of Medical Virology, University of Leuven, and the Blood Transfusion Centre, Leuven, Belgium
| | - E Stevens
- The Divisions of Clinical Immunology and of Bleeding and Vascular Disorders (Department of Medicine), the Laboratory of Medical Virology, University of Leuven, and the Blood Transfusion Centre, Leuven, Belgium
| | - A L The
- The Divisions of Clinical Immunology and of Bleeding and Vascular Disorders (Department of Medicine), the Laboratory of Medical Virology, University of Leuven, and the Blood Transfusion Centre, Leuven, Belgium
| | - G Vanham
- The Divisions of Clinical Immunology and of Bleeding and Vascular Disorders (Department of Medicine), the Laboratory of Medical Virology, University of Leuven, and the Blood Transfusion Centre, Leuven, Belgium
| | - C Vermylen
- The Divisions of Clinical Immunology and of Bleeding and Vascular Disorders (Department of Medicine), the Laboratory of Medical Virology, University of Leuven, and the Blood Transfusion Centre, Leuven, Belgium
| | - M Verstraete
- The Divisions of Clinical Immunology and of Bleeding and Vascular Disorders (Department of Medicine), the Laboratory of Medical Virology, University of Leuven, and the Blood Transfusion Centre, Leuven, Belgium
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Wentink MM, Meesters J, Berger MAM, de Kloet AJ, Stevens E, Band GPH, Kromme CH, Wolterbeek R, Goossens PH, Vliet Vlieland TPM. Adherence of stroke patients with an online brain training program: the role of health professionals’ support. Top Stroke Rehabil 2018; 25:359-365. [DOI: 10.1080/10749357.2018.1459362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- M. M. Wentink
- Sophia Rehabilitation, The Hague, The Netherlands
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - J. Meesters
- Sophia Rehabilitation, The Hague, The Netherlands
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - M. A. M. Berger
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - A. J. de Kloet
- Sophia Rehabilitation, The Hague, The Netherlands
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - E. Stevens
- Helen Dowling Institute, Bilthoven, The Netherlands
| | - G. P. H. Band
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - C. H. Kromme
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - R. Wolterbeek
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - P. H. Goossens
- Sophia Rehabilitation, The Hague, The Netherlands
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - T. P. M. Vliet Vlieland
- Sophia Rehabilitation, The Hague, The Netherlands
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
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Broussard LJ, Alarcon R, Baeßler S, Barrón Palos L, Birge N, Bode T, Bowman JD, Brunst T, Calarco JR, Caylor J, Chupp T, Cianciolo V, Crawford C, Dodson GW, DuBois J, Fan W, Farrar W, Fomin N, Frlež E, Fry J, Gericke MT, Glück F, Greene GL, Grzywacz RK, Gudkov V, Hendrus C, Hersman FW, Ito T, Li H, Macsai N, Makela MF, Mammei J, Mammei R, Martin J, Martinez M, McGaughey PL, Mertens S, Mirabal-Martinez J, Mueller P, Page SA, Penttilä SI, Picker R, Plaster B, Počanić D, Radford DC, Ramsey J, Rykaczewski KP, Salas-Bacci A, Scott EM, Sjue SKL, Smith A, Smith E, Sprow A, Stevens E, Wexler J, Whitehead R, Wilburn WS, Young AR, Zeck BA. Neutron decay correlations in the Nab experiment. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1742-6596/876/1/012005] [Citation(s) in RCA: 3] [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: 11/12/2022]
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Bilsland J, Bictash M, Nitzsche A, Cao L, Stevens E, McDonnell A, Ali Z, Whiting P. Application of induced pluripotent stem cell technology for disease modelling and drug discovery in peripheral sensory neurons. Neuromuscul Disord 2017. [DOI: 10.1016/s0960-8966(17)30220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Goossens W, Stevens E, Amery A. Selected Summaries. Acta Clin Belg 2016. [DOI: 10.1080/17843286.1977.11717840] [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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Eyckmans L, De Leeuw I, Verstraete M, Verstraete M, Stevens E. Book Reviews. Acta Clin Belg 2016. [DOI: 10.1080/17843286.1974.11716926] [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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Maxwell JR, Zhang Y, Brown WA, Smith CL, Byrne FR, Fiorino M, Stevens E, Bigler J, Davis JA, Rottman JB, Budelsky AL, Symons A, Towne JE. Differential Roles for Interleukin-23 and Interleukin-17 in Intestinal Immunoregulation. Immunity 2015; 43:739-50. [PMID: 26431947 DOI: 10.1016/j.immuni.2015.08.019] [Citation(s) in RCA: 247] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/28/2015] [Accepted: 08/20/2015] [Indexed: 12/12/2022]
Abstract
Interleukin-23 (IL-23) and IL-17 are cytokines currently being targeted in clinical trials. Although inhibition of both of these cytokines is effective for treating psoriasis, IL-12 and IL-23 p40 inhibition attenuates Crohn's disease, whereas IL-17A or IL-17 receptor A (IL-17RA) inhibition exacerbates Crohn's disease. This dichotomy between IL-23 and IL-17 was effectively modeled in the multidrug resistance-1a-ablated (Abcb1a(-/-)) mouse model of colitis. IL-23 inhibition attenuated disease by decreasing colonic inflammation while enhancing regulatory T (Treg) cell accumulation. Exacerbation of colitis by IL-17A or IL-17RA inhibition was associated with severe weakening of the intestinal epithelial barrier, culminating in increased colonic inflammation and accelerated mortality. These data show that IL-17A acts on intestinal epithelium to promote barrier function and provide insight into mechanisms underlying exacerbation of Crohn's disease when IL-17A or IL-17RA is inhibited.
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Affiliation(s)
- Joseph R Maxwell
- Department of Inflammation, Amgen, Inc., 1201 Amgen Court West, Seattle, WA 98117, USA
| | - Yu Zhang
- Department of Inflammation, Amgen, Inc., 1201 Amgen Court West, Seattle, WA 98117, USA
| | - William A Brown
- Department of Inflammation, Amgen, Inc., 1201 Amgen Court West, Seattle, WA 98117, USA
| | - Carole L Smith
- Department of Inflammation, Amgen, Inc., 1201 Amgen Court West, Seattle, WA 98117, USA
| | - Fergus R Byrne
- Department of Inflammation, Amgen, Inc., One Amgen Center Drive, Thousand Oaks, CA 91320, USA
| | - Mike Fiorino
- Department of Inflammation, Amgen, Inc., One Amgen Center Drive, Thousand Oaks, CA 91320, USA
| | - Erin Stevens
- Department of Clinical Immunology, Amgen, Inc., 1201 Amgen Court West, Seattle, WA 98117, USA
| | - Jeannette Bigler
- Department of Molecular Sciences and Computational Biology, Amgen, Inc., 1201 Amgen Court West, Seattle, WA 98117, USA
| | - John A Davis
- Department of Pharmacokinetics and Drug Metabolism, Amgen, Inc., 1201 Amgen Court West, Seattle, WA 98117, USA
| | - James B Rottman
- Department of Pathology, Amgen, Inc., 360 Binney Street, Cambridge, MA 02142, USA
| | - Alison L Budelsky
- Department of Inflammation, Amgen, Inc., 1201 Amgen Court West, Seattle, WA 98117, USA
| | - Antony Symons
- Department of Inflammation, Amgen, Inc., 1201 Amgen Court West, Seattle, WA 98117, USA
| | - Jennifer E Towne
- Department of Inflammation, Amgen, Inc., 1201 Amgen Court West, Seattle, WA 98117, USA.
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Sloan D, Nelson J, Ure D, Votaw G, Stevens E. Abstract POSTER-TECH-1131: Next generation protein multiplexing. Clin Cancer Res 2015. [DOI: 10.1158/1557-3265.ovcasymp14-poster-tech-1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
While a variety of technologies exist to measure proteins, such as ELISA’s, Mass Spec, and 2D Gel’s, the most promising for screening multiple proteins are biochip or microarray based technologies. However, even with biochip devices, measuring specific interactions between multiple protein combinations remains problematic. Proteins are complex and fragile bio-molecules and often interact in complex and unpredictable ways with other proteins and/or protein analysis equipment, causing non-specific (false) signals. Furthermore, many proteins of interest to the life science industry are present in samples at very different concentrations, limiting which proteins can be screened in a single multiplex test and sample dilution.
To address these problems, Inanovate has developed a new multiplexed protein quantification technology called Longitudinal Assay Screening (LAS), combining high sensitivity confocal imaging and microfluidics alongside protein based microarrays. Inanovate has completed testing and benchmarking of the first platform integrating LAS technology across a range of demonstration assays. Instead of depending on a 96-well micro-titer plate, the new LAS platform utilizes a glass slide based protein microarray and microfluidics for dispensing and binding samples and detection antibodies. In its most basic form, the protein microarray is composed of capture antibodies for the proteins being measured, as well as positive and negative quality control features for ensuring sample to sample, run to run, lot to lot, and user to user consistency. Conceptually very similar to a real-time PCR reaction, the LAS platform iteratively flows small volumes of sample and labeled detection antibodies across the protein microarray (housed on Inanovate’s fluidic cartridges) and fluorescently measures the formation of the sandwich between capture antibody, analyte of interest, and detection antibody in real-time.
Due to the time-resolved nature of the assay, the resulting data is a rate of reaction, instead of a simple final fluorescent reading. This ‘rate of reaction’ based analysis helps deliver the following core advantages of LAS technology, each of which has been demonstrated through the development and validation of a five-plex assay consisting of CRP, IL-6, IL-1a, IL-8 and IL-1b.
1. Large detection range: LAS enables the accurate quantitation of protein concentrations across a 7 log range in a single multiplex test. This eliminates the need for serial dilutions, making multiplexing faster, cheaper and helping preserve precious samples.
2. Multiplexing flexibility: Due to its large detection range, LAS allows users to run virtually any assay of interest in one test, enabling the development of biologically relevant multiplexes.
3. Improved accuracy: LAS produces and analyses real-time kinetic data on protein interactions (rate of reaction data), improving identification and discrimination of background and nonspecific signals, delivering more accurate quantitation at low analyte concentrations.
LAS technology holds the potential to become to proteomics what PCR was to genomics. It offers a new approach to multiplexed protein screening that helps address many of the problems presently affecting the utility of biochips in protein biomarker discovery, validation and clinical screening applications. The Poster will both summarize the technical components of the new LAS based platform and present data from the five-plex demonstration work plus recent work on serology assays.
Citation Format: Sloan D, Nelson J, Ure D, Votaw G, Stevens E. Next generation protein multiplexing [abstract]. In: Proceedings of the 10th Biennial Ovarian Cancer Research Symposium; Sep 8-9, 2014; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(16 Suppl):Abstract nr POSTER-TECH-1131.
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Affiliation(s)
- D Sloan
- 1Inanovate, Inc, Research Triangle Park, NC
| | - J Nelson
- 1Inanovate, Inc, Research Triangle Park, NC
| | - D Ure
- 1Inanovate, Inc, Research Triangle Park, NC
| | - G Votaw
- 1Inanovate, Inc, Research Triangle Park, NC
| | - E Stevens
- 1Inanovate, Inc, Research Triangle Park, NC
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Stevens E, Andreasen S, Bjørndal K, Homøe P. Tumors in the parotid are not relatively more often malignant in children than in adults. Int J Pediatr Otorhinolaryngol 2015; 79:1192-5. [PMID: 25953456 DOI: 10.1016/j.ijporl.2015.04.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Tumors of the parotid gland in children are rare and very little data has been published regarding the incidence of these tumors. We present a nationwide survey on this topic. METHODS Data regarding benign and malignant tumors in the parotid gland in children from January 1st, 1990 to December 31st, 2005 in Denmark was collected retrospectively from nationwide registries. This generated 61 patients for inclusion in this study. RESULTS 85% of the tumors were benign and the malignant tumors made up the last 15%. The most common of the malignant tumors was the acinic cell carcinoma (n=4) followed by the mucoepidermoid carcinoma (n=3) and adenoid cystic carcinoma (n=2). The overall female-to-male ratio was 1.18, with a ratio of 1.08 and 2.0 in the benign and malignant groups, respectively. At the end of follow-up (August 1st, 2014) two patients had died, one with adenoid cystic carcinoma and one with mucoepidermoid carcinoma. Both patients had perineural invasion and involved resection margins at presentation. The incidence was 0.12 and 0.53 per 100,000 children of the malignant and benign tumors, respectively. CONCLUSION Pleomorphic adenomas were the predominant neoplasm in the parotid gland in children. The most frequent of the malignant tumors was the acinic cell carcinoma, which is in contrast to previous studies. The proportion of malignant-to-benign parotid gland tumors is in contrast to earlier study reports not higher in children than in adults.
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Affiliation(s)
- E Stevens
- Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Lykkebækvej 1, 4600 Køge, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3b, 2200 Copenhagen N, Denmark.
| | - S Andreasen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Lykkebækvej 1, 4600 Køge, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3b, 2200 Copenhagen N, Denmark; Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - K Bjørndal
- Department of ENT Head and Neck Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
| | - P Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Lykkebækvej 1, 4600 Køge, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3b, 2200 Copenhagen N, Denmark.
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Best S, Tate T, Noble B, Smith R, Tuft J, Tracey N, McCullugh A, Eley J, Black J, Stockton M, Cheesley A, Berry L, Burton C, Dechamps A, Stevens E, Penny A, McEnhill L, McNair A, Cupid B, Maeso B, Chapman D, McIlfatrick S, Nelson A, Sivell S, Baillie J, VanGodwin J, Candy B, Beaumont N, Cowan K. RESEARCH PRIORITY SETTING IN PALLIATIVE AND END OF LIFE CARE: THE JAMES LIND ALLIANCE APPROACH CONSULTING PATIENTS, CARERS AND CLINICIANS. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND AND OBJECTIVES Our aim was to determine whether the use of routine cystoscopy increases lower urinary tract injury detection (bladder and/or ureter) after robotic surgery performed by gynecologic oncologists. METHODS A retrospective chart review of patients who presented for robotic hysterectomy from 2009-2012 was performed at 2 separate academic medical centers, one that performed routine cystoscopy and one that did not. Statistical analysis was performed with t tests and χ2 tests. RESULTS We identified 140 cases without cystoscopy and 109 cases with routine cystoscopy. There were no intraoperative or postoperative urinary injuries detected in either group. There were no significant differences in age and body mass index. In the non-cystoscopy group, a larger specimen size (P<.001), less blood loss (P=.013), and a longer mean operative time were observed (P<.0001). In the routine cystoscopy group, more lymphadenectomies were performed with hysterectomy (P=.007) and more patients underwent hysterectomy for ovarian cancer (P=.0192). There were no differences in surgical indications or secondary procedures including bilateral salpingo-oophorectomy, radical hysterectomy, ureterolysis, and pelvic organ prolapse-related procedures. The minimum follow-up period was 30 days in both groups. CONCLUSION Routine use of cystoscopy did not appear to affect the detection rate of intraoperative lower urinary tract injury during robotic gynecologic surgery because this rate was zero in both groups. However, cystoscopy is relatively simple to perform and can be efficiently incorporated into robotic surgery to avoid the severe morbidity and possible litigation surrounding a urinary tract injury.
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Affiliation(s)
- My-Linh T Nguyen
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
| | - Erin Stevens
- Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Christopher J LaFargue
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
| | - Michael Karsy
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
| | - Tarah L Pua
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
| | - Constantine Gorelick
- Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Sean S Tedjarati
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
| | - Tana S Pradhan
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
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Stevens E, Rivas E, Belaya K, Sframeli M, Maxwell S, Torelli S, Martin P, Cossins J, Beeson D, Muntoni F. P60 Shared defective glycosylation pathways link congenital myasthenic syndromes with the dystroglycanopathies. Neuromuscul Disord 2014. [DOI: 10.1016/s0960-8966(14)70076-8] [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: 11/24/2022]
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Martin DA, Churchill M, Flores-Suarez LF, Cardiel MH, Wallace D, Martin R, Phillips K, Kaine JL, Dong H, Salinger D, Stevens E, Russell CB, Chung JB. A phase Ib multiple ascending dose study evaluating safety, pharmacokinetics, and early clinical response of brodalumab, a human anti-IL-17R antibody, in methotrexate-resistant rheumatoid arthritis. Arthritis Res Ther 2013; 15:R164. [PMID: 24286136 PMCID: PMC3979125 DOI: 10.1186/ar4347] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/01/2013] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the safety, pharmacokinetics, and clinical response of brodalumab (AMG 827), a human, anti-IL-17 receptor A (IL-17RA) monoclonal antibody in subjects with moderate-to-severe rheumatoid arthritis (RA). METHODS This phase Ib, randomized, placebo-controlled, double-blind multiple ascending dose study enrolled subjects with moderate to severe RA (≥ 6/66 swollen and ≥ 8/68 tender joints). Subjects were randomized 3:1 to receive brodalumab (50 mg, 140 mg, or 210 mg subcutaneously every two weeks for 6 doses per group; or 420 mg or 700 mg intravenously every 4 weeks for two doses per group) or placebo. Endpoints included incidence of adverse events (AEs) and pharmacokinetics. Exploratory endpoints included pharmacodynamics, and improvements in RA clinical metrics. RESULTS Forty subjects were randomized to investigational product; one subject discontinued due to worsening of RA (placebo). The study was not designed to assess efficacy. AEs were reported by 70% (7/10) of placebo subjects and 77% (22/30) of brodalumab subjects. Three serious AEs were reported in two subjects; there were no opportunistic infections. Brodalumab treatment resulted in inhibition of IL-17 receptor signaling and receptor occupancy on circulating leukocytes. No treatment effects were observed with individual measures of RA disease activity. On day 85 (week 13) 37% (11/30) of brodalumab subjects and 22% (2/9) of placebo subjects achieved ACR20; 7% (2/30) brodalumab subjects and 11% (1/9) of placebo subjects achieved ACR50; and 0% (0/30) brodalumab subjects and 0% (0/9) of placebo subjects achieved ACR70. CONCLUSIONS Multiple dose administration of brodalumab was tolerated in subjects with active RA. There was no evidence of a clinical response to brodalumab in subjects with RA. TRIAL REGISTRATION ClinicalTrials.gov, NCT00771030.
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MESH Headings
- Abdominal Pain/chemically induced
- Adult
- Aged
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antirheumatic Agents/therapeutic use
- Area Under Curve
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/metabolism
- Cough/chemically induced
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Administration Schedule
- Drug Resistance
- Female
- Headache/chemically induced
- Humans
- Injections, Subcutaneous
- Male
- Metabolic Clearance Rate
- Methotrexate/therapeutic use
- Middle Aged
- Receptors, Interleukin-17/antagonists & inhibitors
- Receptors, Interleukin-17/immunology
- Treatment Outcome
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Affiliation(s)
- David A Martin
- Amgen Inc, 1201 Amgen Court West, Seattle, WA 98119, USA
| | - Melvin Churchill
- Arthritis Center of Nebraska, 3901 Pine Lake Road, Lincoln, NE 68516, USA
| | | | | | - Daniel Wallace
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Richard Martin
- Division of Rheumatology, College of Medicine, Michigan State University, 775 Ball Avenue NE, Grand Rapids, MI 49503, USA
| | - Kristine Phillips
- Scleroderma Program, Division of Rheumatology, School of Medicine, University of Michigan, 7C27 NIB, 300 N Ingalls Street, Ann Arbor, MI 48109, USA
| | - Jeffrey L Kaine
- Sarasota Arthritis Center, 3500 S Tamiami Trail, Sarasota, FL 34239, USA
| | - Hua Dong
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA 91320, USA
- Present address: Gilead Sciences, 333 Lakeside Drive, Foster City, CA 94404, USA
| | - David Salinger
- Amgen Inc, 1201 Amgen Court West, Seattle, WA 98119, USA
| | - Erin Stevens
- Amgen Inc, 1201 Amgen Court West, Seattle, WA 98119, USA
| | | | - James B Chung
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA 91320, USA
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von Walstrom G, Stevens E, Fatehi M, Salame G, Lee Y, Gorelick C, Economos K. Clinical utility of a chemoresponse assay for gynecologic malignancies. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stevens E, Gartman C, Sarafraz-Yazdi E, Michl J. Evaluation of PNC-27-mediated toxicity in an intraperitoneal mouse model of human ovarian cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.052] [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: 11/24/2022]
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Loreck E, Stevens E. An Evidence-Based Approach to Streamlining Electronic Diet Orders. J Acad Nutr Diet 2013. [DOI: 10.1016/j.jand.2013.06.187] [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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Guitarte C, Stevens E, Abulafia O, Lee Y. Glassy cell carcinoma of the cervix: A systematic review and meta-analysis. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.421] [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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Stevens E, Henretta M. Beyond the dark side of the moon: Evaluating the quality of web-based information at the end of life. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.401] [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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