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Xia Y, Kim S, Lowery E, Maloney J, DeCamp M, McCarthy D, Ardehali A. Normothermic Regional Perfusion in Donation after Circulatory Death Heart Donors May Not Have a Detrimental Effect on Lung Transplant Outcomes. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Xia Y, Kim S, Maloney J, DeCamp M, Lowery E, McCarthy D, Ardehali A. Ex-Vivo Lung Perfusion May Have a Detrimental Impact on Lung Transplants from Donation after Circulatory Death Donors. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Strand N, Wie C, Peck J, Maita M, Singh N, Dumbroff J, Tieppo Francio V, Murphy M, Chang K, Dickerson DM, Maloney J. Correction to: Small Fiber Neuropathy. Curr Pain Headache Rep 2022; 26:439. [PMID: 35460493 DOI: 10.1007/s11916-022-01050-w] [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: 11/25/2022]
Affiliation(s)
- N Strand
- Division of Pain Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA.
| | - C Wie
- Division of Pain Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - J Peck
- Performing Arts Medicine Department, Shenandoah University, Winchester, USA
| | - M Maita
- Division of Pain Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - N Singh
- OrthoAlabama Spine and Sports, Birmingham, AL, USA
| | - J Dumbroff
- Mount Sinai Morningside and West Department of Anesthiology, New York, NY, USA
| | - V Tieppo Francio
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - M Murphy
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - K Chang
- Department of Anesthiology and Critical Care, Emory University, Atlanta, GA, USA
| | - D M Dickerson
- NorthShore University Healthsystem, Evanston, IL, USA
- University of Chicago Medicine, Chicago, IL, USA
| | - J Maloney
- Division of Pain Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
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Strand N, Wie C, Peck J, Maita M, Singh N, Dumbroff J, Tieppo Francio V, Murphy M, Chang K, Dickerson DM, Maloney J. Small Fiber Neuropathy. Curr Pain Headache Rep 2022; 26:429-438. [PMID: 35384587 DOI: 10.1007/s11916-022-01044-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Accepted: 02/28/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW This narrative review aims to summarize advances in the field of small fiber neuropathy made over the last decade, with emphasis on novel research highlighting the distinctive features of SFN. RECENT FINDINGS While the management of SFNs is ideally aimed at treating the underlying cause, most patients will require pain control via multiple, concurrent therapies. Herein, we highlight the most up-to-date information for diagnosis, medication management, interventional management, and novel therapies on the horizon. Despite the prevalence of small fiber neuropathies, there is no clear consensus on guidelines specific for the treatment of SFN. Despite the lack of specific guidelines for SFN treatment, the most recent general neuropathic pain guidelines are based on Cochrane studies and randomized controlled trials (RCTs) which have individually examined therapies used for the more commonly studied SFNs, such as painful diabetic neuropathy and HIV neuropathy. The recommendations from current guidelines are based on variables such as number needed to treat (NNT), safety, ease of use, and effect on quality of life.
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Affiliation(s)
- N Strand
- Division of Pain Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA.
| | - C Wie
- Division of Pain Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - J Peck
- Performing Arts Medicine Department, Shenandoah University, Winchester, USA
| | - M Maita
- Division of Pain Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - N Singh
- OrthoAlabama Spine and Sports, Birmingham, AL, USA
| | - J Dumbroff
- Mount Sinai Morningside and West Department of Anesthesiology, New York, NY, USA
| | - V Tieppo Francio
- Department of Rehabilitation on Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - M Murphy
- Department of Rehabilitation on Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - K Chang
- Department of Anesthesiology and Critical Care, Emory University, Atlanta, GA, USA
| | - D M Dickerson
- NorthShore University HealthSystem, Evanston, IL, USA
- University of Chicago Medicine, Chicago,, IL, USA
| | - J Maloney
- Division of Pain Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
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Baltensperger A, Mirsky D, Maloney J, Neuberger I, Fenton L, Bernard T, Borgstede J, Stence N. Cost and Utility of Routine Contrast-Enhanced Neck MRA in a Pediatric MRI Stroke Evaluation Protocol. AJNR Am J Neuroradiol 2019; 40:2143-2145. [PMID: 31727745 DOI: 10.3174/ajnr.a6315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Cervical arterial dissection is one of the frequent causes of pediatric arterial ischemic stroke. Out of concern for missing cervical arterial dissection in patients in whom pediatric stroke is suspected, our tertiary children's hospital added contrast-enhanced 3D neck MR angiography to every pediatric stoke work-up. This research investigated whether the routine use of contrast-enhanced neck MRA in our MR imaging stroke protocol ever detected a cervical arterial abnormality when the DWI, SWI/gradient recalled-echo, or circle of Willis MRA findings from the brain MR imaging were reported as normal. MATERIALS AND METHODS The institutional PACS data base was searched for stroke protocol MRIs that included DWI, gradient recalled-echo or SWI, circle of Willis MRA, and 3D contrast-enhanced neck MRA in patients younger than 18 years of age with examinations performed between September 2010 and June 2017. RESULTS In only a single case (0.15%) were the DWI, SWI/gradient recalled-echo, or circle of Willis MRA findings all separately reported as normal and the contrast-enhanced neck MRA findings reported as abnormal. To reach these findings, we screened 681 patients, which would have resulted in an estimated >$200,000 in Medicare charges and $80,000 in of out-of-pocket cost to patients. CONCLUSIONS In our large series, the addition of a routine contrast-enhanced neck MRA to our pediatric stroke MR imaging protocol was of extremely low yield. We believe the use of neck MRA should reasonably be limited to cases in which abnormalities are initially detected on standard brain sequences or to patients with atypical presentation or recurrent pathology.
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Affiliation(s)
| | - D Mirsky
- Section of Child Neurology, Department of Radiology (D.M., J.M., I.N., L.F., N.S.)
| | - J Maloney
- Section of Child Neurology, Department of Radiology (D.M., J.M., I.N., L.F., N.S.)
| | - I Neuberger
- Section of Child Neurology, Department of Radiology (D.M., J.M., I.N., L.F., N.S.)
| | - L Fenton
- Section of Child Neurology, Department of Radiology (D.M., J.M., I.N., L.F., N.S.)
| | - T Bernard
- From the Department of Pediatrics (A.B., T.B.)
| | - J Borgstede
- Section of Pediatric Radiology, and Department of Radiology (J.B.), University of Colorado School of Medicine, Aurora, Colorado
| | - N Stence
- Section of Child Neurology, Department of Radiology (D.M., J.M., I.N., L.F., N.S.)
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Bradley V, Hiersteiner D, Rotholz D, Maloney J, Li H, Bonardi A, Bershadsky J. Personal characteristics and outcomes of individuals with developmental disabilities who need support for self-injurious behaviour. J Intellect Disabil Res 2018; 62:1043-1057. [PMID: 30022570 DOI: 10.1111/jir.12518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/09/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND For people with intellectual and developmental disabilities, self-injurious behaviour (SIB) can have serious negative effects on both health and quality of life. This descriptive analysis will provide information on the characteristics and outcomes of a subsample of individuals who are identified as needing some or extensive support for SIB in the National Core Indicators Adult Consumer Survey sample. METHODS The data for this analysis come from states that participated in the 2015-2016 data collection cycle of National Core Indicators Adult Consumer Survey which is a face-to-face survey of adults receiving services through state developmental disability agencies. RESULTS The characteristics and outcomes of individuals who need at least some support for SIB differ from those of individuals with intellectual and developmental disabilities who do not need support for SIB. Individuals with SIB support needs, for example, tend to live in more structured settings, have fewer relationships, less inclusion in their communities and poorer employment outcomes. CONCLUSIONS The exploratory descriptive analysis concludes with suggested recommendations for more standardised definitions of SIB in public systems, enhanced behaviour plan protocols and the need for additional research.
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Affiliation(s)
- V Bradley
- Human Services Research Institute, Cambridge, MA, USA
| | - D Hiersteiner
- Human Services Research Institute, Cambridge, MA, USA
| | - D Rotholz
- Department of Pediatrics, Center for Disability Resources, School of Medicine, Columbia, SC, USA
| | - J Maloney
- Human Services Research Institute, Cambridge, MA, USA
| | - H Li
- Human Services Research Institute, Cambridge, MA, USA
| | - A Bonardi
- Human Services Research Institute, Cambridge, MA, USA
| | - J Bershadsky
- Human Services Research Institute, Cambridge, MA, USA
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Tilles S, Nelson H, Prenner B, Maloney J, Smith IM, Nolte H. ADVERSE EVENT PROFILE OF SQ HOUSE DUST MITE SUBLINGUAL IMMUNOTHERAPY TABLET AFTER TREATMENT INTERRUPTION. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bernstein D, Maloney J, Smith IM, Nolte H. SAFETY OF FIRST DOSE OF SQ HOUSE DUST MITE SUBLINGUAL IMMUNOTHERAPY TABLET IN CLINICAL TRIALS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Maloney J, Hulstrøm V, Smith IM, Nolte H. SQ HOUSE DUST MITE SUBLINGUAL IMMUNOTHERAPY TABLET IS WELL TOLERATED IN SUBJECTS WITH ALLERGIC ASTHMA. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lushaj E, Maloney J, Cornwell R, Meyer K, De Oliveira N. Body Mass Index Does Not Impact Long-Term Survival of Patients with Idiopathic Pulmonary Fibrosis Undergoing Lung Transplantation. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1181] [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] Open
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Raine D, Begg G, Moore J, Taylor E, Buck R, Honarbakhsh S, Yew Ding W, Redfearn D, Opel A, Opel A, Thomas D, Prakash K, Thomas D, Khokhar A, Honarbakhsh S, Tairova S, Getman N, McAloon C, Honarbakhsh S, Shah M, Al-Lawati K, Al-Lawati K, Ensam B, Collins G, Akbar S, Merghani A, Furniss G, Yones E, Vijayashankar SS, Vijayashankar SS, Shariat H, Moss A, Yeoh A, Sadiq A, Taylor R, Edwards T, Nizam ud Din K, Langley P, Shepherd E, Murray S, Lord S, Bourke J, Plein S, Lip G, Tayebjee MH, Owen N, White S, O'Neill M, Hughes L, Carroll S, Moss-Morris R, Baker V, Kirkby C, Patel K, Robinson G, Antoniou S, Richmond L, Ullah W, Hunter R, Finlay M, Earley M, Whitbread M, Schilling R, Cooper R, Modi S, Somani R, Ng A, Hobson N, Caldwell J, Hadjivassilev S, Ang R, Finlay M, Dhinoja M, Earley M, Sporton S, Schilling R, Hunter R, Hadjivassilev S, Earley M, Lambiase P, Turley A, Child N, Linker N, Owens W, James S, Milner J, Tayebjee M, Sibley J, Griffiths A, Meredith T, Basher Y, Betts T, Rajappan K, Lambiase P, Lowe M, Hunter R, Schilling R, Finlay M, Rakhimbaeva G, Akramova N, Getman T, Hamborg T, O'Hare J, Randeva H, Osman F, Srinivasan N, Kirkby C, Firman E, Tobin L, Murphy C, Lowe M, Hunter R, Finlay M, Schilling R, Lambiase P, Mohan P, Salahia G, Lim H, Lim HS, Batchvarov V, Brennan P, Cox A, Muir A, Behr E, Hamill S, Laventure C, Newell S, Gordon B, Bashir K, Chuen J, Foster W, Yusuf S, Osman F, Hayat S, Panagopoulos D, Davies E, Tomlinson D, Haywood G, Mullan J, Kelland N, Horwood A, Connell N, Odams S, Maloney J, Shetty A, Kyriacou A, Sahu J, Lee J, Uzun O, Wong A, Ashtekar S, Uzun O, Wong A, Ashtekar S, Hashemi J, Gazor S, Redfearn D, Song A, Jenkins J, Glancy J, Wilson D, Sammut E, Diab I, Cripps T, Gill A, Abbas S, Enye J, Wahab A, Elshafie S, Ling K, Carey P, Chatterjee D, Timbrell S, Tufail W, Why H, Martos R, Thornley A, James S, Turley A, Bates M, Linker N, Hassan E, Quick J, Cowell R, Ho E. POSTERS (1)59MULTIPOLAR CONTACT MAPPING GUIDED ABLATION OF TEMPORALLY STABLE HIGH FREQUENCY AND COMPLEX FRACTIONATED ATRIAL ELECTROGRAM SITES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION60INTRA-CARDIAC AND PERIPHERAL LEVELS OF BIOCHEMICAL MARKERS OF FIBROSES IN PATIENTS UNDERGOING CATHETER ABLATION FOR ATRIAL FIBRILATION61THE DON'T WAIT TO ANTICOAGULATE PROJECT (DWAC) BY THE WEST OF ENGLAND ACADEMIC HEALTH SCIENCE NETWORK (AHSN) OPTIMISES STROKE PREVENTION FOR PATIENTS WITH ATRIAL FIBRILLATION (AF) WITHIN PRIMARY CARE IN LINE WITH NICE CG180 IN THE WEST OF ENGLAND62ILLNESS AND TREATMENT REPRESENTATIONS, COPING AND DISTRESS: VICIOUS CYCLES OF EVERYDAY EXPERIENCES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION63THE NEEDS OF THE ADOLESCENT LIVING WITH AN INHERITED CARDIAC CONDITION: THE PATIENTS' PERSPECTIVE64SAFETY AND EFFICACY OF PARAMEDIC TREATMENT OF REGULAR SUPRAVENTRICULAR TACHYCARDIA (PARA-SVT)65NATURAL PROGRESSION OF QRS DURATION FOLLOWING IMPLATABLE CARDIOVERTER DEFIBRILLATORS (ICD) - IMPLANTATION66COMPARISON OF EFFICACY OF VOLTAGE DIRECTED CAVOTRICUSPID ISTHMUS ABLATION USING MINI VS CONVENTIONAL ELETRODES67CRYOBALLOON ABLATION (CRYO) FOR ATRIAL FIBRILLATION (AF) CANNOT BE GUIDED BY TEMPERATURE END-POINTS ALONE68MODERATOR BAND ECTOPY UNMASKED BY ADENOSINE AS A CAUSE OF ECTOPIC TRIGGERED IDIOPATHIC VF69EARLY CLINICAL EXPERIENCE WITH TARGETED SITE SELECTION FOR THE WiCS-LV ELECTRODE FOR CRT70DOES VECTOR MAPPING PRIOR TO IMPLANTABLE LOOP RECORDER INSERTION IMPROVE THE DETECTION OF ARRHYTHMIA?71THE ROLE OF SPECKLE TRACKING STRAIN IMAGING IN ASSESSING LEFT VENTRICULAR RESPONSE TO CARDIAC RESYNCHRONISATION THERAPY IN RESPONDERS AND NON-RESPONDERS72EVALUATING PATIENTS' EXPERIENCE AND SATISFACTION OF THE ATRIAL FIBRILLATION ABLATION PROCEDURE: A RETROSPECTIVE ANALYSIS73TROUBLESHOOTING LV LEAD IMPLANTATION - NOVEL “UNIRAIL TECHNIQUE”74SUBCLINICAL ATHEROSCELEROSIS AND COGNITIVE IMPAIRMENT75EFFECT OF LOZARTANE ON DEVELOPMENT OF THE ELECTRICAL INSTABILITY OF THE MYOCARDIUM76THE INTERPLAY BETWEEN BODY COMPOSITION AND LEFT VENTRICULAR REMODELLING IN CARDIAC RESYNCHRONISATION THERAPY77FAMILY SCREENING IN IDIOPATHIC VENTRICULAR FIBRILLATION78MANAGEMENT OF ATRIAL FIBRILLATION IN A LARGE TEACHING HOSPITAL79THE EFFECT OF LEFT VENTRICULAR LEAD POSITION ON SURVIVAL IN PATIENTS WITH BINVENTRICULAR PACEMAKRS/DEFIBRILLATORS80ACUTE DEVICE IMPLANT-RELATED COMPLICATIONS DO NOT INCREASE LATE MORTALITY81ABORTED CARIDAC ARREST AS THE SENTINEL PRESENTATION IN A COHORT OF PATIENTS WITH THE CONCEALED BRUGADA PHENOTYPE82POST-CARDIAC DEVICE IMPLANTATION MOBILISATION ADVICE: A NATIONAL SURVEY83DO RISK SCORES DEVELOPED TO PROTECT ONE-YEAR MORTALITY ACTUALLY HELP IN ACCURATELY SELECTING PATIENTS RECEIVING PRIMARY PREVENTION ICD?84ATRIAL TACHYCARDIA ARISING FROM THE NON-CORONARY AORTIC CUSP85THE EFFECT OF DIFFERENT ATRIAL FIBRILLATION ABLATION STRATEGIES ON SURFACE ECG P WAVE DURATION86PRESCRIBING DRONEDARONE: HOW IS IT DONE ACROSS THE UK AND IS IT SAFE?87A CASE OF WIDE COMPLEX TACHYCARDIA88TRANSITION TO DEDICATED DAY CASE DEVICES - SAFETY AND EFFICACY IN A LARGE VOLUME CENTRE89SEQUENTIAL REGIONAL DOMINANT FREQUENCY MAPPING DURING ATRIAL FIBRILLATION: A NOVEL TEQUNIQUE90ELECTIVE CARDIOVERSION ENERGY PROTOCOLS: A RETROSPECTIVE COMPARISON OF ESCALATION STRATEGIES91THE INCIDENCE OF CLINCALLY RELEVANT HAEMATOMAS WITH PERIOPERATIVE USE OF NEWER P2Y12 INHIBITORS AND INTERRUPTED NOAC THERAPY IN CARDIAC IMPLANTABLE ELECTRONIC DEVICE INSERTION92AN AUDIT OF THE OUTCOMES FOR CHEMICAL AND DIRECT CURRENT CARDIOVERSION FOR ATRIAL FIBRILLATION AT OUR DGH OVER A 3 YEAR DURATION93REAL LIFE ACUTE MANAGEMET OF HAEMODYNAMICALLY TOLERATED MONOMORPHIC VENTRICULAR TACHYCARDIA. ARE WE MAKING EVIDENCE BASED ON DECISIONS?94A SERVICE EVALUATION TO ASSESS THE EFFICACY AND SAFETY OF NOVEL ORAL ANTICOAGULANTS VERSUS WARFARIN FOR ELECTIVE CARDIVERSION IN PATIENTS WITH NON VALVULAR AF IN A NURSE LED CARDIOVERSION SERVICE95PICK UP RATE OF IMPLANTED LOOP RECORDER AT A DISTRICT HOSPITAL. Europace 2016. [DOI: 10.1093/europace/euw273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Maloney J, Durham S, Skoner D, Dahl R, Bufe A, Bernstein D, Murphy K, Waserman S, Berman G, White M, Kaur A, Nolte H. Safety of sublingual immunotherapy Timothy grass tablet in subjects with allergic rhinitis with or without conjunctivitis and history of asthma. Allergy 2015; 70:302-9. [PMID: 25495666 DOI: 10.1111/all.12560] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with asthma may be more susceptible to adverse events (AEs) with sublingual immunotherapy tablet (SLIT-tablet) treatment, such as severe systemic reactions and asthma-related events. Using data from eight trials of grass SLIT-tablet in subjects with allergic rhinitis with/without conjunctivitis (AR/C), AE frequencies were determined in adults and children with and without reported asthma. METHODS Data from randomized, double-blind, placebo-controlled trials of Timothy grass SLIT-tablet MK-7243 (2800 BAU/75 000 SQ-T, Merck/ALK-Abelló) were pooled for post hoc analyses. Subjects with uncontrolled and severe asthma were excluded from the trials. Frequencies for treatment-emergent AEs (TEAEs), local allergic swelling (mouth or throat), systemic allergic reactions, and asthma-related treatment-related AEs (TRAEs) were calculated. RESULTS Among adults (n = 3314) and children (n = 881), 24% and 31%, respectively, had reported asthma. No serious local allergic swellings or serious systemic allergic reactions occurred in subjects with asthma treated with SLIT-tablet. There was no evidence of increased TEAEs, systemic allergic reactions, or severe local allergic swellings in adults or children with asthma treated with grass SLIT-tablet versus subjects without asthma in or outside of pollen season. There were 6/120 asthma-related TRAEs assessed as severe with grass SLIT-tablet and 2/60 with placebo, without a consistent trend among subjects with and without asthma (5 and 3 events, respectively). CONCLUSIONS In the AR/C subjects with reported well-controlled mild asthma included in these studies, grass SLIT-tablet did not increase TEAE frequency, severe local allergic swelling, or systemic allergic reactions versus subjects without asthma. There was no indication that treatment led to acute asthma worsening.
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Affiliation(s)
- J. Maloney
- Merck & Co., Inc.; Whitehouse Station NJ USA
| | - S. Durham
- Royal Brompton and Harefield Hospitals National Health Service Trust and Imperial College; London UK
| | - D. Skoner
- Allegheny General Hospital; Pittsburgh PA USA
- Temple University School of Medicine; Philadelphia PA USA
| | - R. Dahl
- Allergy Centre; Odense University Hospital; Odense Denmark
| | - A. Bufe
- Experimental Pneumonology; Ruhr-University Bochum; Bochum Germany
| | - D. Bernstein
- Bernstein Clinical Research Center; Cincinnati OH USA
| | - K. Murphy
- Boys Town National Research Hospital; Boys Town NE USA
| | | | - G. Berman
- Allergy & Asthma Specialists; Minneapolis MN USA
| | - M. White
- Institute for Asthma & Allergy; Wheaton MD USA
| | - A. Kaur
- Merck & Co., Inc.; Whitehouse Station NJ USA
| | - H. Nolte
- Merck & Co., Inc.; Whitehouse Station NJ USA
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Maloney J, Pfuhlmann B, Arensman E, Coffey C, Gusmão R, Poštuvan V, Scheerder G, Sisask M, van der Feltz-Cornelis CM, Hegerl U, Schmidtke A. How to adjust media recommendations on reporting suicidal behavior to new media developments. Arch Suicide Res 2014; 18:156-69. [PMID: 24627947 DOI: 10.1080/13811118.2013.824833] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines the inclusion of preventive factors and new media developments in media recommendations on suicide reporting. Of the 193 member states of the United Nations screened for media recommendations, information was available for 74 countries. Similarities and differences in their contents were analyzed by cluster analysis. Results indicate that of these 74 countries, 38% have national suicide prevention programs, 38% have media recommendations, and 25% have press codes including suicide reporting. Less than 25% of the media recommendations advise against mentioning online forums, suicide notes, pacts, clusters, hotspots, details of the person, and positive consequences. No more than 15% refer to self-help groups, fictional and online reporting. We conclude that media recommendations need to be revised by adding these preventive factors and by including sections on new media reporting.
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Affiliation(s)
- J Maloney
- a University of Würzburg, Department of Psychiatry , Psychosomatics and Psychotherapy , Würzburg , Germany
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Maloney J, Pfuhlmann B, Arensman E, Coffey C, Gusmão R, Poštuvan V, Scheerder G, Sisask M, van der Feltz-Cornelis CM, Hegerl U, Schmidtke A. Media recommendations on reporting suicidal behaviour and suggestions for optimisation. Acta Psychiatr Scand 2013; 128:314-5. [PMID: 23590817 DOI: 10.1111/acps.12131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J Maloney
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany.
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Unterecker S, Riederer P, Proft F, Maloney J, Deckert J, Pfuhlmann B. Effects of gender and age on serum concentrations of antidepressants under naturalistic conditions. J Neural Transm (Vienna) 2012; 120:1237-46. [PMID: 23254926 DOI: 10.1007/s00702-012-0952-2] [Citation(s) in RCA: 22] [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] [Received: 08/22/2012] [Accepted: 12/04/2012] [Indexed: 11/27/2022]
Abstract
Therapeutic drug monitoring (TDM) data of antidepressant drugs are often evaluated using homogeneous samples of selected individuals without psychiatric or somatic comorbidity. These data may have limitations in transferability to everyday clinical practice. Hence, studies under naturalistic conditions are important to clarify the full clinical relevance of TDM of antidepressants. TDM analyses were retrospectively evaluated for a 3-year period from 2008 to 2010. The influence of gender and age on dose-corrected serum concentrations of antidepressants was examined in a standard clinical setting. 693 TDM analyses of amitriptyline and nortriptyline (AMI + NOR), 160 of citalopram (CIT), 152 of clomipramine and N-clomipramine (CLO + N-CLO), 272 of doxepine and N-doxepine (DOX + N-DOX), 359 of escitalopram (ESC), 198 of fluoxetine and N-fluoxetine (FLU + N-FLU), 92 of maprotiline (MAP), 888 of mirtazapine (MIR), and 77 of sertraline (SER) remained in the sample. Females had significantly higher dose-corrected serum concentrations of AMI + NOR (32 %), CIT (29 %), DOX + N-DOX (29 %), and MIR (20 %), and patients older than 60 years had significantly higher dose-corrected serum concentrations of AMI + NOR (21 %), CIT (40 %), DOX + N-DOX (48 %), MAP (46 %), MIR (24 %), and SER (67 %). Comparing the two extreme groups, females >60 years showed a remarkably higher dose-corrected serum concentration of AMI + NOR (52 %), CIT (78 %), DOX + N-DOX (86 %), and MIR (41 %) in contrast to males ≤60 years. Gender and age have a significant influence on the serum concentrations of different antidepressant drugs, and additive effects must be considered. TDM is recommended to reduce the risk of adverse effects due to supratherapeutic serum levels, also in a naturalistic clinical setting.
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Affiliation(s)
- S Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Füchsleinstrasse 15, 97080, Würzburg, Germany.
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Le May M, Osborne C, Maloney J, Pageau P, Poulin C, Blondeau M, Nelson M, Tee N, Turek M, Hooper J, Neilipovitz D, Sherrard H. 290 Steps in Developing A Regionalized Multidisciplinary Code ROSC Program For Comatose Survivors Of Out-of-hospital Cardiac Arrest. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.273] [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] Open
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Maloney J, Nolte H, Nekam K, Creticos P, Berman G, Kaur A, Hebert J. Dose-related Effects of Ragweed Allergy Immunotherapy Tablet on Nasal and Ocular Symptoms of Allergic Rhinoconjunctivitis During the Peak Ragweed Pollen Seasons in Europe and North America. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.840] [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: 11/17/2022]
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Skoner D, Nolte H, Creticos P, Blaiss M, Maloney J, Nelson H. Timothy Grass Allergy Immunotherapy Tablets Reduce Nasal and Ocular Symptoms Associated With Allergic Rhinoconjunctivitis During Grass Pollen Season in North American Children and Adults: 2 Randomized, Placebo-Controlled Trials. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.483] [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: 11/27/2022]
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Le May M, So D, Glover C, Maloney J, Froeschl M, Marquis J, O'Brien E, Dick A, Blondeau M, Poirier P, Wells G, Chen L, Trickett J, Dionne R, Labinaz M. 392 Mortality benefit associated with direct transfer from the field for primary PCI in ST-elevation myocardial infarction. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.331] [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: 10/16/2022] Open
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Lin J, Bruni F, Fu Z, Maloney J, Bardina L, Gimenez G, Boner A, Sampson H. IgE and IgG4 Epitope Mapping by Peptide Microarray Immunoassay for the Identification of Patients with Symptomatic Peanut Allergy. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.712] [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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Maloney J, Skoner D, Nolte H, Gawchik S, Blaiss M. Efficacy of Timothy Grass Allergy Immunotherapy Tablet During Peak Grass Pollen Season in North American Children and Adolescents. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.200] [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: 11/25/2022]
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Bernstein D, Atiee G, Maloney J, Nolte H, Nayak A. Safety of a Short Ragweed Allergy Immunotherapy Tablet in Adults With Ragweed-Induced Allergic Rhinoconjunctivitis and Asthma. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.202] [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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Osaki S, Maloney J, Cornwell R, Meyer K, Edwards N, De Oliveira N. 335: Impact of the UNOS Lung Allocation Scoring System on Lung Transplantation for Interstitial Lung Disease. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.348] [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] Open
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Blaiss M, Maloney J, Nolte H, Gawchik S, Skoner D. Efficacy and Safety of Grass Allergy Immunotherapy Tablet (AIT) in a North American Pediatric Population. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2010.01.015] [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: 10/19/2022]
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Resnick E, Pieretti M, Maloney J, Noone S, Muñoz-Furlong A, Sicherer S. Development of a Disease-Specific Instrument to Measure Quality of Life in Adolescents with Food Allergy. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koltun W, Maloney J, Marr J, Kunz M. P728 Ethinylestradiol 20 mcg/drospirenone 3 mg oral contraceptive administered in 24/4 regimen in the treatment of moderate acne vulgaris: a pooled analysis of two randomized, double-blind, placebo-controlled studies. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62219-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Emminger W, Durham S, Riis B, Maloney J, Nolte H. The Efficacy Of Single-grass-allergen-immunotherapy-tablet Treatment In Mono- And Multi-sensitized Allergic Rhinitis Patients: Findings From A Post Hoc Analysis. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.257] [Citation(s) in RCA: 10] [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: 11/16/2022]
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Eberle P, Bufe A, Maloney J, Nolte H. Effect Of Single-grass-allergen Immunotherapy-tablet Treatment On The Time To First Symptom And Time To First Use Of Rescue Medication In Children With Allergic Rhinitis. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.256] [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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Krishnamachary MK, Swain-Eng RJ, Barnet J, Maloney J, Stewart JA, Asthana S. Wisconsin Comorbidity Assessment Scale (WCAS): A novel, comprehensive, performance-based assessment scale of geriatric syndromes and medical comorbidities in older cancer patients. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19619] [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
19619 Background: Elderly patients with cancer have potential for multiple geriatric syndromes that influence treatment and outcomes. No single clinical assessment tool has targeted all the major geriatric syndromes and their interaction on cancer management and outcomes. We developed WCAS to evaluate cognitive and physical function, risk of falls and gait disorders, polypharmacy, and medical comorbidities. Methods: Eighteen newly diagnosed patients with breast cancer (age 55–82), were enrolled prior to cancer treatment. Cognitive function was evaluated with a comprehensive battery of neuropsychological tests targeting the domains of memory, executive function, attention, language, and praxis. Physical function skills were assessed with novel performance-based tasks (e.g., bed-making) and computerized assessments of balance, gait and risk of falls. Cancer treatment included surgery in all patients with variable use of adjuvant radiation and medical therapy. WCAS was administered at baseline and at month 6. Results: Ten subjects have completed both baseline and month 6 visits. Surgical treatment occurred at a mean of ten days after baseline assessment (SD 6.7). The mean (SD) of the age, years of education and baseline Mini Mental Status Exam (MMSE) was 66 years (7.3), 15.2 years (3.7) and 29.3 (1.1). From baseline to month six assessment performance on the WAIS Digit Symbol test, a measure of working memory and processing speed, declined (mean change −11.7, p<0.01). Likewise, the performance on the WAIS letter number sequence test (mean change −1.3, p=0.09) and the MMSE (mean change −1.1, p=0.12) declined. Interestingly, four subjects with pre-existing hypothyroidism on replacement treatment showed a greater decline (p<0.01) in memory than those without this common condition. Conclusions: Findings indicate that breast cancer diagnosis and therapy can be associated with significant decline in aspects of cognition in older adults with cancer. These changes can last at least 6 months and are more pronounced in those with hypothyroidism. Larger, longer term prospective studies utilizing WCAS are necessary to confirm our preliminary findings. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - J. Barnet
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
| | - J. Maloney
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
| | - J. A. Stewart
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
| | - S. Asthana
- University of Wisconsin, VAMC Madison, GRECC, Madison, WI
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Osmond M, Stiell I, Nesbitt L, Clement C, Campbell S, Munkley D, Luinstra-Toohey L, Maloney J, Wells G, Study Group. Multicenter Controlled Clinical Trial to Evaluate the Impact of Advanced Life Support on Children with Out-of-hospital Respiratory Distress. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1174] [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: 11/10/2022]
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Osmond M, Stiell I, Nesbitt L, Clement C, Campbell S, Munkley D, Luinstra-Toohey L, Maloney J, Wells G, Study Group. What is the Impact of Advanced Life Support on the Management and Outcomes of Out-of-hospital Seizures in Children? Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.959] [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: 11/10/2022]
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Lustig RH, Greenway F, Velasquez-Mieyer P, Heimburger D, Schumacher D, Smith D, Smith W, Soler N, Warsi G, Berg W, Maloney J, Benedetto J, Zhu W, Hohneker J. A multicenter, randomized, double-blind, placebo-controlled, dose-finding trial of a long-acting formulation of octreotide in promoting weight loss in obese adults with insulin hypersecretion. Int J Obes (Lond) 2006; 30:331-41. [PMID: 16158082 PMCID: PMC1540404 DOI: 10.1038/sj.ijo.0803074] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To compare changes in weight in obese patients who received long-acting octreotide (octreotide LAR) at one of three dose levels (20, 40, or 60 mg) or placebo over 6 months and to identify the lowest dose of octreotide LAR that safely achieved optimal weight loss. DESIGN Randomized, double-blind, placebo-controlled trial of octreotide LAR at three dose levels. PATIENTS A total of 172 adults (28 men and 144 women) with at least moderate obesity (body mass index (BMI) range 30-65 kg/m2) and evidence of insulin hypersecretion were enrolled. Patients were predominantly either Caucasian (50.0%) or African American (45.3%). The mean age (38 +/- 11 year), weight (110.7 +/- 23 kg), and BMI (39.8 +/- 6.5 kg/m2) were similar across the four treatment groups. MEASUREMENTS Efficacy measures included weight, BMI, fasting serum glucose; triglycerides; percentage of total body fat and abdominal fat as measured by dual-energy X-ray absorptiometry; skin fold thickness; waist-to-hip circumference; leptin; percentage of carbohydrates, fat, and protein ingested; nutritional evaluation (including dietary analysis--3-day food record); quality of life (QoL; using the Impact of Weight on Quality of Life-Lite); Beck Depression Inventory; and Carbohydrate Craving Questionnaire. Safety measures included medical history, vital signs, physical examinations, hematology, blood chemistries, thyroid function tests, hemoglobin A1c, gallbladder ultrasound, electrocardiograms, and adverse events. RESULTS After 6 months of treatment, patients receiving 40 or 60 mg of octreotide LAR experienced statistically significant weight loss compared to baseline, with mean differences from placebo in percent weight change of -1.98 and -1.87%, respectively. This finding was accompanied by statistically significant mean decreases in BMI compared to baseline, that is, a mean decrease of 0.73 and 0.79 kg/m2 for the 40 and 60 mg treatment arms, respectively. The observed weight loss was progressive during the 6-month treatment in the two higher dose groups. The lowest dose to reach statistical significance in weight loss after 6 months' treatment was 40 mg. Post hoc analysis revealed a 3.5-3.8% weight loss at month 6 in the two higher dose groups among Caucasian patients having insulin secretion greater than the median of the cohort, defined as CIR(gp) (corrected insulin response at the glucose peak) > or = 1.43. There were no statistically significant changes in QoL scores, body fat, leptin concentration, Beck Depression Inventory, or macronutrient intake. Mean changes of blood glucose AUC(0-180 min) during an oral glucose tolerance test in patients taking octreotide LAR were 39-40 mg/dl h higher than those on placebo. A total of 7-21% of the patients taking octreotide LAR reached a 5% or greater decrease in body weight from Baseline, compared to 11% for the placebo group. This was not statistically significant. The most common adverse events included diarrhea, headache, cholelithiasis, nausea, and abdominal pain. CONCLUSION Octreotide LAR given at 40 or 60 mg resulted in statistically significant weight loss. A post hoc analysis stratifying patients by race and CIR(gp) indicated that Caucasian patients with the greater degree of insulin hypersecretion appeared to derive the most benefit from treatment. The observed safety profile was consistent with the known effects of octreotide from previous studies.
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Affiliation(s)
- R H Lustig
- Division of Pediatric Endocrinology, University of California San Francisco School of Medicine, San Francisco, CA 94143-0434, USA.
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Arcaroli J, Silva E, He Q, Svetkauskaite D, Coldren C, Maloney J, Park J, Abraham E. Crit Care 2005; 9:P1. [DOI: 10.1186/cc3545] [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: 11/10/2022] Open
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Abstract
STUDY OBJECTIVES To investigate the hypothesis that an increase in circulating vascular endothelial growth factor (VEGF) occurs in mountaineers at high altitude, particularly in association with acute mountain sickness (AMS) and/or low hemoglobin oxygen saturation. DESIGN : Collection of medical histories, AMS scores, plasma samples, and arterial oxygen saturation (SaO(2)) measurements from mountaineers at 1,500 feet (sea level) and at 14,200 feet. SETTING Mount McKinley ("Denali"), AK. PARTICIPANTS Sixty-six mountaineers. INTERVENTIONS None. MEASUREMENTS AND RESULTS Plasma VEGF at 14,200 feet was not increased in any group. In fact, plasma VEGF was significantly lower in subjects who did not develop AMS (53 +/- 7.9 pg/mL; mean +/- SEM; n = 47) compared to control subjects at sea level (98.4 +/- 14.3 pg/mL; n = 7; p = 0.005). Plasma VEGF at 14, 200 feet for subjects with AMS (62 +/- 12 pg/mL; n = 15) did not differ significantly from subjects at 14,200 feet without AMS, or from control subjects at sea level. Of a small number of subjects with paired specimens at sea level and at base camp (n = 5), subjects who exhibited a decrease in plasma VEGF at 14,200 feet were those who did not develop AMS. Neither SaO(2), prior AMS, AMS symptom scores, or acetazolamide use were correlated with plasma VEGF. CONCLUSIONS Subjects at high altitude who do not develop AMS have lower plasma VEGF levels compared to control subjects at sea level. Plasma VEGF at high altitude is not elevated in association with AMS or hypoxia. Sustained plasma VEGF at altitude may reflect a phenotype more susceptible to AMS.
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Affiliation(s)
- J Maloney
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Abstract
OBJECTIVE To assess the performance of paramedics, in a newly-initiated prehospital program, during invasive airway management. METHODS An audit of paramedic call reports for a 12-month period from January to December 1997 was performed. Call reports that documented invasive airway management were retrieved and relevant data were extracted using a preformulated data-entry form. RESULTS Paramedics attempted tracheal intubation in 453 patients and were successful in 408 (90.1%); 331 of the patients were in cardiopulmonary arrest with vital signs absent (VSA), 101 had medical emergencies, and 21 had trauma-related problems. In the VSA cohort, the tracheas of 96% of the patients were intubated successfully; 80.1% on the first attempt, 10.6% on the second, 4.5% on the third, and 0.9% after more than three attempts. In the medical cohort, the tracheas of 74.3% of the patients were intubated; 60.4% on the first attempt, 11.9% on the second, and 2.9% on the third. In the trauma cohort, 71.4% of the intubations were successful; 66.6% on the first attempt, 26.6% on the second, and 6.6% on the third. There was a difference (p < 0.001) in the incidence of successful intubations comparing the VSA cohort with the medical/trauma cohorts. There was also a difference (p < 0.001) between the success rate for nasal intubations (43 of 68, 63% of patients successfully intubated) and that for oral intubation (365 of 385, 94% of patients). CONCLUSION This study demonstrated a difference in the paramedics' success rates for tracheal intubation in VSA patients compared with those with preserved airway reflexes and a lower success rate for nasal vs oral tracheal intubation. These differences may be due to inadequate training, technical difficulties experienced in the field, or lack of sufficient exposure to medical/trauma scenarios to gain management experience. Future training to address these issues, both in the initial training phase and in the continuing education program, may be beneficial in improving performance.
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Affiliation(s)
- B Rocca
- Department of Anesthesiology, Ottawa Hospital, Ontario, Canada
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Stiell IG, Wells GA, Field BJ, Spaite DW, De Maio VJ, Ward R, Munkley DP, Lyver MB, Luinstra LG, Campeau T, Maloney J, Dagnone E. Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support. JAMA 1999; 281:1175-81. [PMID: 10199426 DOI: 10.1001/jama.281.13.1175] [Citation(s) in RCA: 254] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Survival rates for out-of-hospital cardiac arrest are low; published survival rates in Ontario are only 2.5%. This study represents phase II of the Ontario Prehospital Advanced Life Support (OPALS) study, which is designed to systematically evaluate the effectiveness and efficiency of various prehospital interventions for patients with cardiac arrest, trauma, and critical illnesses. OBJECTIVE To assess the impact on out-of-hospital cardiac arrest survival of the implementation of a rapid defibrillation program in a large multicenter emergency medical services (EMS) system with existing basic life support and defibrillation (BLS-D) level of care. DESIGN Controlled clinical trial comparing survival for 36 months before (phase I) and 12 months after (phase II) system optimization. SETTING Nineteen urban and suburban Ontario communities (populations ranging from 16 000 to 750 000 [total, 2.7 million]). PATIENTS All patients who had out-of-hospital cardiac arrest in the study communities for whom resuscitation was attempted by emergency responders. INTERVENTIONS Study communities optimized their EMS systems to achieve the target response interval from when a call was received until a vehicle stopped with a defibrillator of 8 minutes or less for 90% of cardiac arrest cases. Working both locally and provincially, communities implemented multiple measures, including defibrillation by firefighters, base paging, tiered response agreements with fire departments, continuous quality improvement for response intervals, and province-wide revision and implementation of standard dispatch policies. All response times were obtained from a central dispatch system. MAIN OUTCOME MEASURE Survival to hospital discharge. RESULTS The 4690 cardiac arrest patients studied in phase I and the 1641 in phase II were similar for all clinical and demographic characteristics, including age, sex, witnessed status, rhythm, and receipt of bystander cardiopulmonary resuscitation. The proportion of cases meeting the 8-minute response criterion improved (76.7% vs 92.5%; P<.001) as did most median response intervals. Overall survival to hospital discharge for all rhythm groups combined improved from 3.9% to 5.2 % (P = .03). The 33% relative increase in survival represents an additional 21 lives saved each year in the study communities (approximately 1 life per 120000 residents). The charges were estimated to be US $46900 per life saved for establishing the rapid defibrillation program and US $2400 per life saved annually for maintaining the program. CONCLUSION An inexpensive, multifaceted system optimization approach to rapid defibrillation can lead to significant improvements in survival after cardiac arrest in a large BLS-D EMS system.
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Affiliation(s)
- I G Stiell
- Division of Emergency Medicine, University of Ottawa, Ontario, Canada
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Abstract
The best studied of the endothelial cell specific growth factors, VEGF, is present in alveolar and bronchial epithelial cells, in vascular smooth muscle cells, and in macrophages. The gene encoding VEGF is abundantly present in lung tissue and is induced by short-term and long-term hypoxia, as well as by prostacyclin, prostaglandin E2, and cyclic AMP. In the case of prostaglandin-stimulated gene upregulation protein kinase A (PKA) is involved. Suramin, an inhibitor of growth factor receptor binding inhibits the development of chronic hypoxic pulmonary hypertension in rats. Further evidence is necessary to link VEGF with pulmonary hypertensive vascular remodeling. This requires the development of antibodies directed against VEGF or against VEGF receptors and gene transfection or antisense strategies.
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Affiliation(s)
- N F Voelkel
- Pulmonary Hypertension Center, University of Colorado Health Sciences Center, Denver 80262, USA
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Stiell I, Hébert P, Wells G, Laupacis A, Vandemheen K, Weitzman B, Maloney J, Mahon J, Kirby A, Higginson L, Gibson J, Eisenhauer M, Dreyer J. O-53 The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in hospital cardiac arrest. Resuscitation 1996. [DOI: 10.1016/0300-9572(96)83842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVES This study assessed the mechanism(s) of the decrease in upright blood pressure in patients with supine hypertension by using the tilt test and a hemodynamic approach. BACKGROUND Orthostatic hypotension in patients with supine hypertension creates a pathophysiologic and therapeutic dilemma. METHODS We studied 28 consecutive patients with history of orthostatic intolerance amounting to recurrent syncope in 13 of them (15 men, 13 women; mean [SD] age 65 +/- 11 years). They all had supine hypertension (systolic blood pressure > 160 mm Hg) and orthostatic hypotension (found to be a decrease in systolic blood pressure > 30 mm Hg during tilt test). Cardiac output, cardiopulmonary volume and systemic resistance were assessed by radionuclide first-pass technique (technetium-99m red blood cell tagging). Total blood volume was determined by radioiodinated serum albumin, and the ratio of cardiopulmonary to total blood volume was used as an index of venous capacitance. RESULTS Twenty-one patients had accentuated venous pooling defined as a tilt-induced decrease in cardiopulmonary volume/total blood volume ratio > 15% from baseline or a supine ratio < 14% (normal 16% to 18%), or both. Seven of the 28 patients had autonomic insufficiency; 6 of the 7 also had venous pooling; 1 patient had autonomic insufficiency only. Neither clinical history nor changes during tilt differentiated the subgroups. Plasma catecholamine levels increased during head-up tilt in all subgroups, and differences in their increase were not significant between patients with venous pooling and those with autonomic insufficiency. However, radionuclide hemodynamic variables revealed that patients with venous pooling compensated for the decrease in stroke volume by increasing peripheral resistance, whereas patients with autonomic dysfunction did not. CONCLUSIONS Orthostatic hypotension in patients with supine hypertension may have multiple etiologies. Hemodynamic assessment with determination of cardiopulmonary volume and systemic vascular resistance differentiated between venous pooling and autonomic insufficiency in these patients; head-up tilt and plasma catecholamine levels did not. These findings may have important therapeutic implications.
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Affiliation(s)
- J Schutzman
- Department of Cardiovascular Biology, Cleveland Clinic Foundation, Ohio 44195-5069
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Hill LM, Guzick D, DiNofrio D, Maloney J, Merolillo C, Nedzesky P. Ratios between the abdominal circumference, head circumference, or femur length and the transverse cerebellar diameter of the growth-retarded and macrosomic fetus. Am J Perinatol 1994; 11:144-8. [PMID: 8198657 DOI: 10.1055/s-2007-994575] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The purpose of our investigation was twofold: to provide normative data for the ratios between head circumference and cerebellum, abdominal circumference and cerebellum, and femur length and cerebellum; and to evaluate the predictive accuracy of an abnormal ratio in the detection of growth retardation and macrosomia. Data on 675 women with normal gestations between 14 and 42 weeks were used to estimate reference curves for the three ratios to be evaluated. We then compared the ratios of 34 fetuses with intrauterine growth retardation and 28 macrosomic fetuses to the control group. Of the three ratios that we investigated, abdominal circumference to transverse cerebellar diameter was the most efficacious. However, the sensitivity of this ratio for the detection of intrauterine growth retardation and macrosomia was only 52.9% and 46.6%, respectively. A ratio between head circumference, abdominal circumference, or femur length and the transverse cerebellar diameter cannot reliably distinguish between normally growing fetuses and those that are growth retarded or macrosomic.
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Affiliation(s)
- L M Hill
- Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, PA 15213
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41
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Dash H, Kononov A, Maloney J, Browne E. A simple arteriotomy method for microsurgical end-to-side anastomoses: technical aspects of use in training and laboratory applications. J Reconstr Microsurg 1993; 9:381-4. [PMID: 8301637 DOI: 10.1055/s-2007-1006746] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An experiment was carried out to show the patency rates of microsurgical carotid artery bypasses with femoral artery grafts, using a single-cut arteriotomy in rats. A bypass was done on 127 Sprague-Dawley rats. Of these, 125 were patent after 20 min, and all of these were patent after the animals were sacrificed at 3 days, for a 98 percent patency rate. The method of performing the arteriotomies, as well as the bypass itself, is described. The benefits of using the end-to-side anastomosis are explained. The authors conclude that the single-cut arteriotomy is convenient and easy to perform. The end-to-side anastomosis is a worthwhile technique and should encourage the proficiency of every student of microsurgery.
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Affiliation(s)
- H Dash
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Ohio 44195
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Hill LM, Guzick D, Peterson C, DiNofrio D, Maloney J, Nedzeksy P. Fetal heart circumference as a predictor of menstrual age in fetuses affected by disturbances in growth. Am J Obstet Gynecol 1993; 169:347-51. [PMID: 8362946 DOI: 10.1016/0002-9378(93)90086-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The purpose of this study was twofold: (1) to evaluate the relationship between fetal heart circumference and gestational age and (2) to determine the effect, if any, of disturbances in fetal growth on heart circumference. STUDY DESIGN Heart circumference was measured in 262 women with normal gestations (control group) and in two study groups consisting of 52 large-for-gestational age 32 small-for-gestational age fetuses. Standardized, gestational age-adjusted values in the two study groups were compared with normative data provided by the control group. RESULTS There was a close correlation (R2 = 0.94) between heart circumference and gestational age in normally growing fetuses. Disturbances of fetal growth (i.e., macrosomia and growth retardation) were found to have an inconsistent effect on heart circumference. CONCLUSION Heart circumference cannot be used as an independent parameter for gestational age evaluation in fetuses with disturbances of growth.
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Affiliation(s)
- L M Hill
- Department of Ultrasound, Magee-Womens Hospital, Pittsburgh, PA 15213
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Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Reardon M, Stewart JP, Maloney J. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA 1993; 269:1127-32. [PMID: 8433468 DOI: 10.1001/jama.269.9.1127] [Citation(s) in RCA: 382] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To validate and refine previously derived clinical decision rules that aid the efficient use of radiography in acute ankle injuries. DESIGN Survey prospectively administered in two stages: validation and refinement of the original rules (first stage) and validation of the refined rules (second stage). SETTING Emergency departments of two university hospitals. PATIENTS Convenience sample of adults with acute ankle injuries: 1032 of 1130 eligible patients in the first stage and 453 of 530 eligible patients in the second stage. MAIN OUTCOME MEASURES Attending emergency physicians assessed each patient for standardized clinical variables and classified the need for radiography according to the original (first stage) and the refined (second stage) decision rules. The decision rules were assessed for their ability to correctly identify the criterion standard of fractures on ankle and foot radiographic series. The original decision rules were refined by univariate and recursive partitioning analyses. MAIN RESULTS In the first stage, the original decision rules were found to have sensitivities of 1.0 (95% confidence interval [CI], 0.97 to 1.0) for detecting 121 maleolar zone fractures, and 0.98 (95% CI, 0.88 to 1.0) for detecting 49 midfoot zone fractures. For interpretation of the rules in 116 patients, kappa values were 0.56 for the ankle series rule and 0.69 for the foot series rule. Recursive partitioning of 20 predictor variables yielded refined decision rules for ankle and foot radiographic series. In the second stage, the refined rules proved to have sensitivities of 1.0 (95% CI, 0.93 to 1.0) for 50 malleolar zone fractures, and 1.0 (95% CI, 0.83 to 1.0) for 19 midfoot zone fractures. The potential reduction in radiography is estimated to be 34% for the ankle series and 30% for the foot series. The probability of fracture, if the corresponding decision rule were "negative," is estimated to be 0% (95% CI, 0% to 0.8%) in the ankle series, and 0% (95% CI, 0% to 0.4%) in the foot series. CONCLUSION Refinement and validation have shown the Ottawa ankle rules to be 100% sensitive for fractures, to be reliable, and to have the potential to allow physicians to safely reduce the number of radiographs ordered in patients with ankle injuries by one third. Field trials will assess the feasibility of implementing these rules into clinical practice.
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Affiliation(s)
- I G Stiell
- Division of Emergency Medicine, University of Ottawa, Ontario, Faculty of Medicine, Canada
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Fouad FM, Sitthisook S, Vanerio G, Maloney J, Okabe M, Jaeger F, Schluchter M, Maloney JD. Sensitivity and specificity of the tilt table test in young patients with unexplained syncope. Pacing Clin Electrophysiol 1993; 16:394-400. [PMID: 7681189 DOI: 10.1111/j.1540-8159.1993.tb01600.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
UNLABELLED The usefulness of the head-up tilt testing (HUT) has been previously addressed in diagnosing vasovagal neuroregulatory syncope in the teenage population. However, data concerning sensitivity and specificity is deficient due to the lack of control groups. We compared the response to HUT in young patients referred because of syncope or near syncope (n = 44, mean age 16 +/- 3 years SD) to healthy young volunteers with a normal physical examination and no previous history of syncope (n = 18, mean age 16 +/- 2 years) and to determine the sensitivity and specificity of HUT. The graded tilt protocol was performed at 15 degrees, 30 degrees, and 45 degrees (each for 2 min), and then 60 degrees for 20 minutes. Cuff blood pressure was measured every minute and lead II ECG was continuously monitored. RESULTS 25 of the 44 patients (57%) developed a vasovagal response or became symptomatic after 13.8 +/- 5.7 minutes of HUT. Three of the 18 volunteers (17%) had a vasovagal response and became symptomatic after 9 +/- 3 minutes of HUT. There was no statistical difference among the four groups (with and without tilt induced vasovagal response) in terms of age and baseline hemodynamic data. The sensitivity of 20 minutes HUT was 57% and its specificity was 83%. The presyncopal hemodynamic response in patients with history of syncope that was characterized by a significant decrease in systolic blood pressure and lack of increase of diastolic blood pressure as compared with baseline and with other groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F M Fouad
- Department of Heart and Hypertension, Cleveland Clinic Foundation, Ohio
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Brison RJ, Davidson JR, Dreyer JF, Jones G, Maloney J, Munkley DP, O'Connor HM, Rowe BH. Cardiac arrest in Ontario: circumstances, community response, role of prehospital defibrillation and predictors of survival. CMAJ 1992; 147:191-9. [PMID: 1623465 PMCID: PMC1336161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To describe the patient characteristics, circumstances and community response in cases of out-of-hospital cardiac arrest; to evaluate the effect on survival of the introduction of prehospital defibrillation; and to identify factors that predict survival. DESIGN Population-based before-and-after clinical trial. SETTING Five Ontario communities: London, Sudbury, the Greater Niagara region, Kingston and Ottawa. PATIENTS A consecutive sample of 1510 primary cardiac arrest patients who were transported to hospital by ambulance over 2 years. INTERVENTION The use of defibrillators by ambulance attendants. MAIN OUTCOME MEASURES Patient characteristics (sex and age), circumstances of arrest (place, whether arrest was witnessed and cardiac rhythm), citizen response (whether cardiopulmonary resuscitation [CPR] was started by a bystander, time to access to emergency medical services and time to initiation of CPR), emergency medical services response (ambulance response time, time to initiation of CPR and time to rhythm analysis with defibrillator) and survival rates. MAIN RESULTS A total of 92.1% of the patients were 50 years of age or older, and 68.3% were men. Overall, 79.6% of the arrests occurred in the home. The average ambulance response time for witnessed cases was 7.8 minutes. The overall survival rate was 2.5%. The survival rates before and after defibrillators were introduced were similar, and the general functional outcome of the survivors did not differ significantly between the two phases. Factors predicting survival included patient's age, ambulance response time and whether CPR was started before the ambulance arrived. CONCLUSIONS The survival rate was lower than expected. The availability of prehospital defibrillation did not affect survival. To improve survival rates after cardiac arrest ambulance response times must be reduced and the frequency of bystander-initiated CPR increased. Once these changes are in place a beneficial effect from advanced manoeuvres such as prehospital defibrillation may be seen.
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Affiliation(s)
- R J Brison
- Division of Emergency Medicine, Queen's University, Kingston, ON
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Abstract
The hemodynamic consequences of atrioventricular (AV) synchrony during ventricular tachycardia were evaluated during cardiac electrophysiologic testing. The relationship between stroke volume and the AV interval was investigated on a beat-by-beat basis in six patients during induced monomorphic ventricular tachycardia. Stroke volume was calculated either (1) in the right ventricle using impedance catheter method (four patients) or (2) in the left ventricle using Doppler measurement of aortic blood velocity (two patients). The impedance catheter method underestimated stroke volume by a factor of 4.2 +/- 2.4 compared with the thermodilution cardiac output method. However, there was a highly linear relationship between both methods for computing stroke volume (r greater than 0.9). Five patients had complete AV dissociation during ventricular tachycardia, and different AV intervals spanned the entire tachycardia cycle lengths. Largest stroke volumes were associated with optimal AV intervals within 120 and 230 msec, resulting in a 97 +/- 59% increase in stroke volume over ventricular tachycardia cycles not associated with atrial activity. Customized atrial pacing during ventricular tachycardia may provide a valuable means for artificially establishing the hemodynamically optimal AV interval and eliminating the ventricular tachycardia cycles not preceded by atrial activity.
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Affiliation(s)
- J Maloney
- Department of Cardiology, Cleveland Clinic Foundation, OH 44195
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McCowan R, Maloney J, Wilkoff B, Simmons T, Khoury D, McAlister H, Morant V, Castle L. Automatic implantable cardioverter-defibrillator implantation without thoracotomy using an endocardial and submuscular patch system. J Am Coll Cardiol 1991; 17:415-21. [PMID: 1991899 DOI: 10.1016/s0735-1097(10)80108-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The automatic cardioverter-defibrillator lead system is implanted by a thoracotomy procedure that may result in atelectasis, pleural effusion, cardiac tamponade and lengthy convalescence. A new defibrillator lead system that allows selection of different defibrillating current pathways is implanted without a thoracotomy. Ten patients requiring a cardioverter-defibrillator for recurrent sustained ventricular tachycardia (five patients) or aborted sudden cardiac death (five patients) were evaluated for implantation of this lead system. A lead configuration with a bidirectional defibrillating current pathway was implanted in nine patients. The defibrillation threshold with this lead configuration was 15 J in five patients, 20 J in three and 30 to 35 J in one patient. In the remaining patient the lead system had a 40 J defibrillation threshold and was not implanted. No perioperative complications occurred. Induced ventricular fibrillation was successfully terminated at the predischarge and intermediate follow-up (8 to 12 weeks) electrophysiologic studies. During the follow-up period, there were three deaths (one sudden, two due to heart failure) and two lead system failures (oversensing with inappropriate shocks in one patient and patch lead fracture in another). Implantation of the cardioverter-defibrillator lead system by a nonthoracotomy approach is feasible, has no significant perioperative complications and is well tolerated by patients. Effective defibrillation was demonstrated immediately as well as at intermediate follow-up study. The occurrence of patch lead fracture and oversensing requires improvement in the present (nonthoracotomy) lead system technology.
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Affiliation(s)
- R McCowan
- Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195-5058
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Maloney J, Masterson M, Khoury D, Trohman R, Wilkoff B, Simmons T, Morant V, Castle L. Clinical performance of the implantable cardioverter defibrillator: electrocardiographic documentation of 101 spontaneous discharges. Pacing Clin Electrophysiol 1991; 14:280-5. [PMID: 1706838 DOI: 10.1111/j.1540-8159.1991.tb05107.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Records of 105 patients, who received an automatic implantable cardioverter defibrillator (AICD), were studied to investigate the causes of spontaneous AICD discharges and to correlate the symptoms with the arrhythmias triggering AICD discharges. During a follow-up period of 13 +/- 8 months, 46/105 (44%) patients had 566 spontaneous AICD discharges. A total of 101 discharges were documented with Holter monitoring in 23 patients. In this study group, there were 8 (8%) AICD discharges for 5 episodes of ventricular fibrillation, and 68 (67%) discharges for 63 episodes of sustained ventricular tachycardia. Patients lost consciousness in all episodes of ventricular fibrillation, but were symptomatic prior to only 36 (53%) discharges in ventricular tachycardia. Nonsustained ventricular tachycardia persisting for a period of 7.5 +/- 2 seconds resulted in 20 AICD discharges; patients were symptomatic prior to 13 (65%) discharges. Supraventricular tachycardias triggered three discharges. One patient had two spurious discharges during sinus rhythm. In conclusion, most of the spontaneous AICD discharges were appropriate for the detected rhythms, but only clinically appropriate for the management of arrhythmias in 75% of the cases. A significant portion of the patients with sustained or nonsustained ventricular tachycardias triggering AICD discharges were asymptomatic prior to discharge, which requires further assessment of the physiology of the arrhythmia as a component of the detection algorithm.
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Affiliation(s)
- J Maloney
- Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195
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Vanerio G, Maloney J, Rashidi R, McCowan R, Castle L, Morant V, Wilkoff B, Simmons T. The effects of percutaneous catheter ablation on preexisting permanent pacemakers. Pacing Clin Electrophysiol 1990; 13:1637-45. [PMID: 1704517 DOI: 10.1111/j.1540-8159.1990.tb06866.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE Determine the effect of percutaneous catheter ablation (CA) on permanent pacemakers. MEASUREMENTS AND RESULTS Twenty-three patients who underwent CA at The Cleveland Clinic Foundation from September 1983 to January 1990, and had a previously implanted pacemaker were studied. Electrocardiographic data during the CA procedure and clinic data including pacemaker evaluations were analyzed. Fifty-two percent (12/23) of the pacemakers malfunctioned: five developed transient ventricular loss of capture; two undersensing; one oversensing; three could not be interrogated or programmed, and one did not respond to the magnet test. Four patients developed syncopal episodes and two severe dizziness after the procedure. All had their pacemakers replaced. In total, seven were explanted. Destructive analysis by the individual manufacturer identified pacemaker circuitry failure in five. Unipolar pacemakers and anodal ablation procedures had more frequent and severe malfunctions, but the difference was not statistically significant. CONCLUSIONS Pacemaker malfunction is frequent during CA. It may be prevented by programming the pacemaker, when possible, to the nonfunctioning mode (000 mode). Temporarily disconnecting the pacemaker during ablation requires further evaluation as an alternative approach. Close follow-up can detect pacemaker malfunction and prevent complications.
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Affiliation(s)
- G Vanerio
- Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195
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Abstract
Implantable cardioverter defibrillators (ICDs) have been documented as an effective modality in reducing arrhythmic mortality. A serious complication associated with implantation of the device is infection. Few studies have addressed this issue. Two hundred seven patients with refractory ventricular arrhythmias underwent 207 ICD implantations, and 56 subcutaneous generator changes at our institution. Eight patients developed wound infections, four following ICD implantation (4 out of 207 or 1.9%), and four following a generator change (4 out of 56 or 7.1%). Wound cultures most commonly revealed Staphylococcus aureus and Staphylococcus epidermidis. Infections treated with antibiotics alone, or with only generator removal, frequently recurred (four out of five attempts). There were no recurrences following total patch/lead and generator system removal. In five patients, the same generator unit was successfully reimplanted following ethylene oxide sterilization without infection recurrence. We conclude that treatment of device-associated infection generally requires total generator and patch/lead system removal, and that generator units can be successfully reimplanted yielding substantial cost savings.
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Affiliation(s)
- D Wunderly
- Department of Cardiology, Cleveland Clinic Foundation, Ohio
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