1
|
Chitkara R, Bennett M, Bohnert J, Yamada N, Fuerch J, Halamek LP, Quinn J, Padua K, Gould J, Profit J, Xu X, Lee HC. In Situ Simulation and Clinical Outcomes in Infants Born Preterm. J Pediatr 2023; 263:113715. [PMID: 37659586 PMCID: PMC10841094 DOI: 10.1016/j.jpeds.2023.113715] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE To evaluate impact of a multihospital collaborative quality improvement project implementing in situ simulation training for neonatal resuscitation on clinical outcomes for infants born preterm. STUDY DESIGN Twelve neonatal intensive care units were divided into 4 cohorts; each completed a 15-month long program in a stepped wedge manner. Data from California Perinatal Quality Care Collaborative were used to evaluate clinical outcomes. Infants with very low birth weight between 22 through 31 weeks gestation were included. Primary outcome was survival without chronic lung disease (CLD); secondary outcomes included intubation in the delivery room, delivery room continuous positive airway pressure, hypothermia (<36°C) upon neonatal intensive care unit admission, severe intraventricular hemorrhage, and mortality before hospital discharge. A mixed effects multivariable regression model was used to assess the intervention effect. RESULTS Between March 2017 and December 2020, a total of 2626 eligible very low birth weight births occurred at 12 collaborative participating sites. Rate of survival without CLD at participating sites was 74.1% in March to August 2017 and 76.0% in July to December 2020 (risk ratio 1.03; [0.94-1.12]); no significant improvement occurred during the study period for both participating and nonparticipating sites. The effect of in situ simulation on all secondary outcomes was stable. CONCLUSIONS Implementation of a multihospital collaborative providing in situ training for neonatal resuscitation did not result in significant improvement in survival without CLD. Ongoing in situ simulations may have an impact on unit practice and unmeasured outcomes.
Collapse
Affiliation(s)
- Ritu Chitkara
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA.
| | - Mihoko Bennett
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Janine Bohnert
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Nicole Yamada
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Janene Fuerch
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Louis P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Jenny Quinn
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Kimber Padua
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Jeffrey Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Henry C Lee
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA; Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA
| |
Collapse
|
2
|
Pang EM, Liu J, Lu T, Joshi NS, Gould J, Lee HC. Evaluating Epidemiologic Trends and Variations in NICU Admissions in California, 2008 to 2018. Hosp Pediatr 2023; 13:976-983. [PMID: 37867440 PMCID: PMC10593864 DOI: 10.1542/hpeds.2023-007190] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
OBJECTIVE Previous research suggests increasing numbers of and variation in NICU admissions. We explored whether these trends were reflected in California by examining NICU admissions and birth data in aggregate and among patient and hospital subpopulations more susceptible to variations in care. METHODS In this retrospective cohort study, we evaluated NICU utilization between 2008 and 2018 for all live births at hospitals that provide data to the California Perinatal Quality Care Collaborative. We compared hospital- and admission-level data across birth weight (BW), gestational age (GA), and illness acuity categories. Trends were analyzed by using linear regression models. RESULTS We identified 472 402 inborn NICU admissions and 3 960 441 live births across 144 hospitals. Yearly trends in NICU admissions remained stable among all births and higher acuity births (mean admission rates 11.9% and 4.1%, respectively). However, analysis of the higher acuity births revealed significant increases in NICU admission rates for neonates with higher BW and GA (BW ≥ 2500g: 1.8% in 2008, 2.1% in 2018; GA ≥ 37 weeks: 1.5% in 2010, 1.8% in 2018). Kaiser hospitals had a decreasing trend of NICU admissions compared to non-Kaiser hospitals (Kaiser: 13.9% in 2008, 10.1% in 2018; non-Kaiser: 11.3% in 2008, 12.3% in 2018). CONCLUSIONS Overall NICU admission rates in California were stable from 2008-2018. However, trends similar to national patterns emerged when stratified by infant GA, BW, and illness acuity as well as Kaiser or non-Kaiser hospitals, with increasing admission rates for infants born at higher BW and GA and within non-Kaiser hospitals.
Collapse
Affiliation(s)
- Emily M. Pang
- Stanford University School of Medicine, Stanford, California
| | - Jessica Liu
- Division of Neonatology, Department of Pediatrics
- California Perinatal Quality Care Collaborative (CPQCC)
| | - Tianyao Lu
- Division of Neonatology, Department of Pediatrics
- California Perinatal Quality Care Collaborative (CPQCC)
| | - Neha S. Joshi
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Jeffrey Gould
- Division of Neonatology, Department of Pediatrics
- California Perinatal Quality Care Collaborative (CPQCC)
| | - Henry C. Lee
- California Perinatal Quality Care Collaborative (CPQCC)
- Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, California
| |
Collapse
|
3
|
Padua K, Robinson R, Ness A, Judy A, Lee GM, Gould J. Moms in the NICU: developing a pilot to engage and empower women who have delivered a prematurely born infant. BMC Pregnancy Childbirth 2023; 23:432. [PMID: 37301839 DOI: 10.1186/s12884-023-05738-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Mothers spend long hours at their preterm infant's bedside in the Neonatal Intensive Care Unit (NICU), giving clinicians the opportunity to engage mothers in caring for their own health. OBJECTIVE To develop a NICU based intervention to reduce the risk of a future premature birth by engaging and empowering mothers to improve their own health and identify barriers to implementing their improvement. DESIGN Development based on a framework of narrative discourse refined by the Quality Improvement Plan Do Study Act Approach. SETTING Level II Stepdown Neonatal Intensive Care Unit. PARTICIPANTS 14 mothers of preterm infants, ages 24-39 years. METHODS A team of Maternal Fetal Medicine Physicians, obstetricians, neonatologists, neonatal nurses, and parents developed guidelines to elicit the mother's birth story, review the story with a clinical expert to fill in knowledge gaps, identify strategies to improve health to reduce the risk of future preterm birth, and facilitate mother developing an action plan with specific six week goals. A phone interview was designed to assess success and identify barriers to implementing their health plan. The protocol was modified as needed after each intervention to improve the interventions. RESULTS "Moms in the NICU" toolkit is effective to guide any clinical facilitator to engage, identify health improvement strategies, and co-develop an individualized health plan and its take home summary reached stability after the 5th mother. Mothers reported experiencing reassurance, understanding, and in some cases, relief. Participants were enthusiastic to inform future quality improvement activities by sharing the six week barriers faced implementing their health plan. CONCLUSION Engaging in the NICU provides an opportunity to improve mothers' understanding of potential factors that may be linked to preterm birth, and promote personally selected actions to improve their health and reduce the risk of a future preterm birth.
Collapse
Affiliation(s)
- Kimber Padua
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA, USA.
| | - Rebecca Robinson
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA, USA
| | - Amen Ness
- Division of Maternal Fetal Medicine, St. Elizabeth Medical Center, Boston, MA, USA
| | - Amy Judy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Grace M Lee
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA, USA
| | - Jeffrey Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA, USA
| |
Collapse
|
4
|
Chen X, Lu T, Gould J, Hintz SR, Lyell DJ, Xu X, Sie L, Rysavy M, Davis AS, Lee HC. Active Treatment of Infants Born at 22-25 Weeks of Gestation in California, 2011-2018. J Pediatr 2022; 249:67-74. [PMID: 35714966 PMCID: PMC9560960 DOI: 10.1016/j.jpeds.2022.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/19/2022] [Accepted: 06/09/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine the rate and trend of active treatment in a population-based cohort of infants born at 22-25 weeks of gestation and to examine factors associated with active treatment. STUDY DESIGN This observational study evaluated 8247 infants born at 22-25 weeks of gestation at hospitals in the California Perinatal Quality Care Collaborative between 2011 and 2018. Multivariable logistic regression was used to relate maternal demographic and prenatal factors, fetal characteristics, and hospital level of care to the primary outcome of active treatment. RESULTS Active treatment was provided to 6657 infants. The rate at 22 weeks was 19.4% and increased with each advancing week, and was significantly higher for infants born between days 4 and 6 at 22 or 23 weeks of gestation compared with those born between days 0 and 3 (26.2% and 78.3%, respectively, vs 14.1% and 65.9%, respectively; P < .001). The rate of active treatment at 23 weeks increased from 2011 to 2018 (from 64.9% to 83.4%; P < .0001) but did not change significantly at 22 weeks. Factors associated with increased odds of active treatment included maternal Hispanic ethnicity and Black race, preterm premature rupture of membranes, obstetrical bleeding, antenatal steroids, and cesarean delivery. Factors associated with decreased odds included lower gestational age and small for gestational age birth weight. CONCLUSIONS In California, active treatment rates at 23 weeks of gestation increased between 2011 and 2018, but rates at 22 weeks did not. At 22 and 23 weeks, rates increased during the latter part of the week. Several maternal and infant factors were associated with the likelihood of active treatment.
Collapse
Affiliation(s)
- Xuxin Chen
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
| | - Tianyao Lu
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Jeffrey Gould
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Susan R Hintz
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Deirdre J Lyell
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Lillian Sie
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Matthew Rysavy
- Division of Neonatology, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA; Division of Neonatology, Department of Pediatrics, University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX
| | - Alexis S Davis
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Henry C Lee
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
5
|
Gould J, Lampe J, Clark L, Moodie K, Paradis N. P139 Targeted chest compression locations result in variable hemodynamics in swine. Resuscitation 2022. [DOI: 10.1016/s0300-9572(22)00549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
6
|
Payton KSE, Wirtschafter D, Bennett MV, Benitz WE, Lee HC, Kristensen-Cabrera A, C Nisbet C, Gould J, Parker C, Sharek PJ. Vignettes Identify Variation in Antibiotic Use for Suspected Early Onset Sepsis. Hosp Pediatr 2021; 11:770-774. [PMID: 34083354 DOI: 10.1542/hpeds.2020-000448] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES There is widespread unwarranted antibiotic use and large individual provider variation in antibiotic use in NICUs. Vignette-based research methodology offers a unique method of studying variation in individual provider decisions. The objective with this study was to use a vignette-based survey to identify specific areas of provider antibiotic use variation in newborns being evaluated for early onset sepsis. METHODS This study was undertaken as part of a statewide multicenter neonatal antibiotic stewardship quality improvement project led by a perinatal quality improvement collaborative. A web-based vignette survey was administered to identify variation in decisions to start and discontinue antibiotics in cases of early onset sepsis. RESULTS The largest variation was noted in 3 of the 6 vignette cases. These cases highlighted variation in (1) decisions to start antibiotics in a case describing a well-appearing newborn with risk factors and an elevated C-reactive protein, (2) decisions to start antibiotics in the case of a newborn with risk factors plus mild respiratory signs at birth, and (3) decisions to stop antibiotics in the case of the newborn with a history of sepsis risk factors and mild clinical respiratory signs that resolved after 72 hours. CONCLUSIONS Clinical vignette assessment identified specific areas of variation in individual provider antibiotic use decisions in cases of suspected early onset sepsis. Vignettes are a valuable method of describing individual provider variation and highlighting antibiotic stewardship improvement opportunities in NICUs.
Collapse
Affiliation(s)
- Kurlen S E Payton
- Division of Neonatology, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California; .,California Perinatal Quality Care, Collaborative, Stanford, California
| | - David Wirtschafter
- Perinatal Quality Improvement Panel Research Committee, Stanford, California
| | - Mihoko V Bennett
- California Perinatal Quality Care, Collaborative, Stanford, California.,Divisions of Neonatology and
| | | | - Henry C Lee
- California Perinatal Quality Care, Collaborative, Stanford, California.,Divisions of Neonatology and
| | | | - Courtney C Nisbet
- California Perinatal Quality Care, Collaborative, Stanford, California
| | - Jeffrey Gould
- California Perinatal Quality Care, Collaborative, Stanford, California.,Divisions of Neonatology and
| | - Colin Parker
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles California; and
| | - Paul J Sharek
- California Perinatal Quality Care, Collaborative, Stanford, California.,Hospitalist Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford California.,Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
7
|
Elliott MK, Strocchi M, Sidhu BS, Mehta V, Porter B, Gould J, Niederer S, Rinaldi CA. Acute hemodynamic response of epicardial and endocardial cardiac resynchronization therapy, His bundle pacing and left bundle branch pacing. Europace 2021. [DOI: 10.1093/europace/euab116.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic
Background / Introduction
Endocardial pacing and conduction system pacing are emerging as alternative methods to deliver cardiac resynchronization therapy (CRT) and have been shown to achieve superior acute hemodynamic response (AHR) compared to conventional epicardial pacing. However, a direct comparison of all the methods of delivering CRT has not yet been performed.
Purpose
To directly compare the AHR of conventional CRT (BiV Epi), endocardial pacing (BiV Endo), His bundle pacing (HBP) and left bundle branch pacing (LBBP) during a temporary CRT study.
Methods
4 patients underwent a temporary CRT and hemodynamic study. Temporary pacing was achieved using quadripolar catheters in the right atrium and coronary sinus, and roving decapolar catheters in the right ventricle (RV) and left ventricle (LV) via retrograde aortic access. Hemodynamic assessment was performed with a PressureWire X (Abbott, CA, USA) in the LV cavity. AHR was calculated as the percentage improvement in LV dP/dtmax from baseline AAI or RV pacing (if underlying complete heart block).
Results
The patients had a mean age of 67.5 ±5.8 years and all had non-ischemic cardiomyopathy with severe LV impairment (mean ejection fraction 22.5 ±7.4%). 3 patients had left bundle branch block and 1 patient had complete heart block with an RV paced rhythm (mean QRS duration 157 ±24 ms). All methods of delivering CRT achieved a mean AHR of >10%, which is considered clinically significant and is predictive of LV remodelling at 6 months. Mean AHR during BiV Epi pacing was 12.6 ±5.0%. There was a trend towards higher AHR for BiV Endo pacing (23.6 ±7.6%), HBP (17.4 ± 9.5%) and LBBP (16.1 ±7.8%) as shown in figure 1, however there was no significant difference between groups on one-way analysis of variance (p = 0.348).
Conclusions
All methods of delivering CRT achieved an AHR >10%. The AHR during BiV Endo pacing, HBP and LBBP was higher than for BiV Epi pacing, but this did not reach statistical significance. Further investigation with larger studies is required to determine which method of delivering CRT achieves the best hemodynamic response.
Figure 1. Box plot of acute hemodynamic response (AHR) for conventional cardiac resynchronization therapy (BiV Epi), endocardial pacing (BiV Endo), His bundle pacing (HBP) and left bundle branch pacing (LBBP). Data displayed as median (solid line), mean (+), 1st and 3rd quartiles (box) and minimum and maximum values (whiskers). Abstract Figure 1
Collapse
Affiliation(s)
- MK Elliott
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - M Strocchi
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - BS Sidhu
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - V Mehta
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - B Porter
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - J Gould
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - S Niederer
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - CA Rinaldi
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
8
|
Mehta VS, Elliott MK, Sidhu BS, O"brien H, Gould J, Razavi R, Niederer S, Rinaldi CA. Assessing survival and re-hospitalisation following transvenous lead extraction in cardiac resynchronisation therapy devices depending on reimplantation timing: a propensity score matched analysis. Europace 2021. [DOI: 10.1093/europace/euab116.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Among patients undergoing transvenous lead extraction (TLE), differences in complication rate and 1-year mortality has been explored in patients with cardiac resynchronisation therapy (CRT) devices. Longer term outcomes and the influence of timing of reimplantation of device, with respect to rehospitalisation and longer-term mortality is poorly understood.
Purpose
The purpose of this study was to evaluate whether early reimplantation following TLE in patients with CRT devices influenced survival and rehospitalisation.
Methods
Clinical data from consecutive patients undergoing TLE in the reference centre between the years 2000 to 2019 were prospectively collected. Patients surviving to discharge who were re-implanted with the same device were included. The cohort was split depending on whether or not they had a CRT device at time of explant. The association between TLE in CRT patients and all-cause mortality and re-hospitalisation was assessed by Kaplan Meier estimates in a 1:1 propensity-score matched cohort, with a calliper of 0.10. Early reimplantation was defined as reimplantation within 7 days of TLE, and late reimplantation as reimplantation after greater than 7 days of TLE.
Results
Of 1005 patients included in the analysis, 285 (25%) had a CRT device. After matching, 192 CRT patients were compared with 192 non-CRT patients. Propensity scores were calculated using 39 baseline characteristics, including age, gender, co-morbidities, TLE indication, left ventricular ejection fraction, baseline creatinine and technical extraction data. Mean follow up was 53.5 ± 38.3 months, mean age at explant was 67.7 ± 12.1 years, 83.3% were male and 54.4% had an infective indication for TLE. In the matched cohort, there was no significant difference between the CRT and non-CRT group with respect to long-term mortality (hazard ratio [HR] = 1.01, 95% confidence interval [CI] [0.74-1.39], p = 0.093) or rehospitalisation (HR = 1.2 [0.87-1.66], p = 0.265). A similar proportion of patients were reimplanted within 7 days in the CRT and non-CRT groups (59.4% vs 61.5%, p = 0.754). In the matched non-CRT group, late reimplantation was associated with similar mortality to early reimplantation (HR = 1.33 [0.86-2.05], p = 0.208) and rehospitalisation (HR = 0.88 [0.53-1.45], p = 0.603). In the matched CRT group, late reimplantation was associated with higher mortality (HR = 1.64 [1.04-2.57], p = 0.032) and rehospitalisation (HR = 1.57 [1.00-2.46], p = 0.049] (see figure).
Conclusion
In this closely matched population, TLE in CRT patients resulted in similar long-term outcomes compared with non-CRT patients. Early reimplantation post CRT explant was associated with reduced long-term mortality and rehospitalisation. This suggests a longer duration without biventricular pacing post TLE may induce negative reverse-remodelling and should be avoided in a CRT population. Abstract Figure. Kaplan-Meier survival curves
Collapse
Affiliation(s)
- VS Mehta
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - MK Elliott
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - BS Sidhu
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - H O"brien
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Gould
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - R Razavi
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Niederer
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - CA Rinaldi
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
9
|
Mehta VS, Elliott MK, Sidhu BS, Gould J, Vergani V, Kadiwar S, Niederer S, Razavi R, Rinaldi CA. Long-term survival following transvenous lead extraction: importance of indication and comorbidities. Europace 2021. [DOI: 10.1093/europace/euab116.489] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction:
The significant rise in cardiac implantable electronic devices (CIED) has been paralleled by an increase in the number of procedures required for the removal of such devices and their associated leads. High procedural success rates with low rates of major in hospital complications is well recognised. Longer term mortality following transvenous lead extraction (TLE) is less well characterised. Long term outcomes are important as they should inform the decision making and consent process, especially in non-infected cases where there may not be a class I indication for lead removal.
Purpose
The purpose of this study was to evaluate the factors influencing survival in patients undergoing TLE depending on extraction indication.
Methods
Clinical data from consecutive patients undergoing TLE in the reference centre between the years 2000 to 2019 were prospectively collected. Only patients surviving to discharge were included. The total cohort was divided into groups depending on whether there was an infective or non-infective indication for TLE. We evaluated the association of demographic, clinical, device related and procedure-related factors on mortality.
Results
A total of 1151 patients were included in the analysis. 632 (54.9%) and 519 patients (45.1%) were for infective and non-infective indications respectively. Analysis of long-term outcomes on the total cohort (mean 66-month follow-up) revealed a mortality of 34.1% (392 deaths). A higher proportion of patients died in the infection vs the non-infection group (38.6% vs 28.5%, p < 0.001). Local infection (hazard ratio [HR] = 1.4, 95% confidence interval [CI] [1.12-1.75]) was associated with similar long-term mortality risk as systemic infection (HR = 1.3, CI[0.99-1.72]). Multivariate analysis demonstrated increased risk of mortality with higher age (HR = 1.05, CI[1.04-1.07]), eGFR < 60ml/min/1.73m2 (HR = 1.55, CI[11.22-1.97]), higher cumulative co-morbidity burden (HR = 1.15, CI [1.06-1.23], and reduced risk per percentage increase in LVEF (HR = 0.98, CI[0.96-1.00]). Kaplan-Meier survival analysis demonstrated statistically worse prognosis in patients with a higher number of leads extracted and increasing co-morbidities.
Conclusion
Long-term mortality for patients undergoing TLE remains high. Consensus guidelines recommend evaluating risk for major complications when determining whether to proceed with TLE. This study suggests assessing longer-term outcomes when considering TLE, particularly for non-infective indications. Abstract Figure.
Collapse
Affiliation(s)
- VS Mehta
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - MK Elliott
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - BS Sidhu
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Gould
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - V Vergani
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Kadiwar
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Niederer
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - R Razavi
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - CA Rinaldi
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
10
|
Kusuda S, Bennett M, Gould J. Outcomes of Infants with Very Low Birth Weight Associated with Birthplace Difference: A Retrospective Cohort Study of Births in Japan and California. J Pediatr 2021; 229:182-190.e6. [PMID: 33058856 DOI: 10.1016/j.jpeds.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/08/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine whether outcomes among infants with very low birth weight (VLBW) vary according to the birthplace (Japan or California) controlling for maternal ethnicity. STUDY DESIGN Severe intraventricular hemorrhage (IVH) and mortality were ascertained for infants with VLBW born at 24-29 weeks of gestation during 2008-2017 and retrospectively analyzed by the country of birth for mothers and infants (Japan or California). RESULTS Rates of severe IVH, mortality, or combined IVH/mortality were lower in the 24 095 infants born in Japan (5.1%, 5.0%, 8.8% respectively) compared with infants born in California either to 157 mothers with Japanese ethnicity (12.5%, 9.7%, 17.8%) or to a comparison group of 6173 non-Hispanic white mothers (8.4%, 8.8%, 14.6%). ORs for adverse outcomes were increased for infants born in California to mothers with Japanese ethnicity compared with infants born in Japan for severe IVH (OR, 3.31; 95% CI, 1.93-5.68), mortality (3.73; 95% CI, 2.03-6.86), and the combined outcome (3.26; 95% CI, 2.02-5.27). The odds of these outcomes also were increased for infants born in California to non-Hispanic white mothers compared with infants born in Japan. Outcomes of infants born in California did not differ by Japanese or non-Hispanic white maternal ethnicity. CONCLUSIONS Low rates of severe IVH and mortality for infants with VLBW born in Japan were not seen in infants born in California to mothers with Japanese ethnicity. Differences in systems of regional perinatal care, social environment, and the quality of perinatal care may partially account for these differences in outcomes.
Collapse
Affiliation(s)
- Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Tokyo, Japan.
| | - Mihoko Bennett
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics Stanford University School of Medicine, CA
| | - Jeffrey Gould
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics Stanford University School of Medicine, CA
| |
Collapse
|
11
|
Mendonca Costa C, Neic A, Gillette K, Porter B, Gould J, Sidhu B, Chen Z, Elliott M, Mehta V, Plank G, Rinaldi CA, Bishop MJ, Niederer SA. P532Endocardial pacing is less arrhythmogenic than conventional epicardial pacing when pacing in proximity to scar in patients with ischemic heart failure. Europace 2020. [DOI: 10.1093/europace/euaa162.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
WT 203148/Z/16/Z; MR/N011007/1; RE/08/003; PG/15/91/31812; PG/16/81/32441
Background
Endocardial pacing has been shown to improve response to cardiac
resynchronization therapy (CRT) in comparison to conventional epicardial pacing and the
physiological activation, endocardium to epicardium, is proposed to make it less arrhythmogenic.
However, the relative arrhythmic risk of endocardial and epicardial pacing has not been
systematically investigated. Pacing in proximity to scar increases susceptibility to arrhythmogenesis
during epicardial pacing. Whether this is also the case during endocardial pacing is currently
unknown.
Purpose
We investigate 1) whether endocardial pacing is less arrhythmogenic than epicardial
pacing, 2) whether pacing location relative to scar plays a role in arrhythmogenesis during
endocardial pacing, and 3) whether these findings could be explained by the direction of the
transmural action potential duration (APD) gradient.
Methods
We used computational models of ischemic heart failure and patient-specific (n = 24) left ventricular anatomy and scar morphology to simulate repolarization during endocardial and
epicardial pacing. Pacing locations were selected 0.2-3.5cm from a scar. We ran simulations with a
20ms transmural APD gradient, as found in heart failure, from the epicardium to endocardium
(physiological) and with this gradient inverted. We computed the volume of high
(>3ms/mm) repolarization gradients (HRG) within 1cm around a scar, as a surrogate for arrhythmia
risk, and analysed these with ANOVA and Tukey-Kramer post-hoc tests.
Results
Simulations with a physiological APD gradient predict that endocardial pacing creates a
smaller (34%) volume of HRG around (1cm) a scar compared to epicardial pacing when
pacing 0.2cm from scar (Figure 1-A). The volume of HRG decreases (P < 0.05) with distance
from scar for epicardial pacing but not endocardial pacing (Figure 1-A). Inverting the
transmural APD gradient, inverts the trend observed with a physiological gradient. In this case, the
volume of HRG is unaffected by pacing location during epicardial pacing, whereas it decreases (19%)
with the distance from scar for endocardial pacing. This is illustrated
in the regions highlighted in yellow in Figure 1 for endocardial pacing at 0.2 and 3.5cm from a scar
with a physiological (B) and an inverted (C) gradient.
Conclusions
Endocardial pacing is less arrhythmogenic (purpose 1) than conventional epicardial
pacing when pacing in proximity to scar and is also less susceptible to pacing location relative to scar
(purpose 2). The direction of the transmural APD gradient offers a mechanistic explanation for
reduced susceptibility to arrhythmogenesis during endocardial pacing compared to epicardial pacing
(purpose 3). Endocardial pacing is an attractive alternative to conventional epicardial pacing in
patients with scar, as it allows pacing in proximity to scar while avoiding increasing arrhythmogenic
risk in patients with ischemic heart failure.
Abstract Figure.
Collapse
Affiliation(s)
- C Mendonca Costa
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Neic
- Medical University of Graz, Graz, Austria
| | - K Gillette
- Medical University of Graz, Graz, Austria
| | - B Porter
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Gould
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - B Sidhu
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Chen
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Elliott
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - V Mehta
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - G Plank
- Medical University of Graz, Graz, Austria
| | - C A Rinaldi
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M J Bishop
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S A Niederer
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
12
|
Jecmen D, King R, Gould J, Mitchell J, Ralston K, Burns AI, Bullock A, Grandner MA, Alkozei A, Killgore WD. 0038 The Effects of Morning Blue Light Therapy on Insomnia Severity and PTSD Symptoms in a Clinical Sample. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.037] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Individuals with Post Traumatic Stress Disorder (PTSD) often present with insomnia, which may exacerbate other symptoms of the disorder. Morning Blue Light Therapy (BLT) can regulate circadian rhythms and may even improve sleep and mood in individuals with major depressive disorder. However, it is unclear whether morning BLT could also be an effective treatment for the insomnia associated with PTSD. We investigated whether 6 weeks of daily morning BLT would improve insomnia severity and symptom presentation in individuals with PTSD in comparison to a placebo condition of amber light (ALT). We hypothesized that changes in insomnia severity would correlate with improvement in PSTD symptom severity.
Methods
Forty-one participants with a clinical diagnosis of PTSD were randomized to receive 6 weeks of either daily morning BLT (n=22) or ALT (n=19). Insomnia and PTSD symptom severity were evaluated at pre- and post-treatment using the Insomnia Severity Index (ISI) and the Clinician-Administered PTSD Scale (CAPS) for DSM-5, respectively.
Results
Both groups showed a significant decrease in their PTSD symptom severity (p<0.001) and insomnia severity (p<0.001) over the 6-week treatment period. However, improvement in insomnia severity significantly predicted improvements in PTSD symptom severity for the BLT group only (BLT: r =0.542, p=0.009; ALT: r=-0.095, p=0.699). The difference between the two correlation coefficients was significant (Z=-2.07, p=0.039).
Conclusion
The results suggest that morning BLT may be effective in improving PTSD symptoms by regulating the circadian rhythm and improving sleep. While ALT also led to improved PTSD symptom severity, it appears that those changes cannot be explained by improved sleep and may have other underlying mechanisms (e.g., placebo effect). Morning BLT may be a promising adjunctive method to bolster current treatment approaches for PTSD. Because of its ease of administration, it could be easily added to ongoing treatment as usual. This approach warrants further research.
Support
US Army Medical Research and Materiel Command: W81XWH-14-1-0570
Collapse
Affiliation(s)
- D Jecmen
- University of Arizona, Tucson, AZ
| | - R King
- University of Arizona, Tucson, AZ
| | - J Gould
- University of Arizona, Tucson, AZ
| | | | | | | | | | | | | | | |
Collapse
|
13
|
King R, Jecmen D, Mitchell J, Ralston K, Gould J, Burns A, Bullock A, Grandner MA, Alkozei A, Killgore WD. 0081 Habitual Sleep Duration is Negatively Correlated with Emotional Reactivity within the Rostral Anterior Cingulate Cortex in Individuals with PTSD. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.079] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Sleep difficulties, such as insomnia, are highly prevalent in individuals with Post-Traumatic Stress Disorder (PTSD). However, sleep deprivation can also increase emotional reactivity to positive (as well as negative) stimuli. While the effects of sleep loss on emotional perception healthy individuals has been documented, it remains unclear how lack of sleep in individuals with PTSD may affect their emotional reactivity to positive stimuli. We hypothesized that lower habitual sleep duration would be associated with greater functional brain activation changes in response to subliminally presented happy faces in brain areas of the reward network, such as the rostral anterior cingulate cortex (rACC).
Methods
Thirty-nine individuals with DSM-5 confirmed PTSD were administered the Pittsburgh Sleep Quality Index (PSQI) as a measure of their average nightly sleep duration over the past month. Participants then underwent fMRI imagining while viewing subliminal presentations of faces displaying happiness, using a backward masked facial affect paradigm to minimize conscious awareness of the expressed emotion. Brain activation to masked happy expressions was regressed against sleep duration in SPM12.
Results
There was a negative correlation between habitual sleep duration and activation within the rACC in response to the masked happy faces (x=14,y=40,z=0; k=102, pFWE-corr= 0.008).
Conclusion
Individuals with PTSD who average less sleep at night showed greater emotional reactivity, as indexed by greater functional brain activation changes within an area of the reward network, than individuals who obtained more sleep per night. Future research involving actual sleep duration manipulation will be necessary to determine whether this finding reflects the well-known antidepressant effect of sleep deprivation or a form of greater emotional expression error monitoring among traumatized patients when lacking sleep. Regardless, these findings suggest that insufficient sleep could affect unconsciously perceived emotion in faces and potentially affect social and emotional responses among individuals with PTSD.
Support
US Army Medical Research and Materiel Command: W81XWH-14-1-0570
Collapse
Affiliation(s)
- R King
- University of Arizona, Tucson, AZ
| | - D Jecmen
- University of Arizona, Tucson, AZ
| | | | | | - J Gould
- University of Arizona, Tucson, AZ
| | - A Burns
- University of Arizona, Tucson, AZ
| | | | | | | | | |
Collapse
|
14
|
Clark L, Senderling B, Gould J, Kaufman C, Stergiou N. Kinematic differences between professional and lay rescuers with and without the use of real-time cpr feedback. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
15
|
Gould J, Hershelman L, McDannold R, Mullins M, Walka P, Deslauriers I, Bull D, Bobrow B. The effect of chest compression quality on SpO2 measured at the finger and the ear. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.211] [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: 11/17/2022]
|
16
|
Lampe J, Gould J, Lindqwister A, Moodie K, Paradis N. Hemodynamic responses to guideline compliant chest compressions during pseudo-pulseless electrical activity in swine. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.092] [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]
|
17
|
Lee AWC, Nguyen UC, Razeghi O, Gould J, Sidhu BS, Sieniewicz B, Behar J, Mafi-Rad M, Plank G, Prinzen FW, Rinaldi CA, Vernooy K, Niederer S. A rule-based method for predicting the electrical activation of the heart with cardiac resynchronization therapy from non-invasive clinical data. Med Image Anal 2019; 57:197-213. [PMID: 31326854 PMCID: PMC6746621 DOI: 10.1016/j.media.2019.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 04/12/2018] [Revised: 06/20/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022]
Abstract
Background Cardiac Resynchronization Therapy (CRT) is one of the few effective treatments for heart failure patients with ventricular dyssynchrony. The pacing location of the left ventricle is indicated as a determinant of CRT outcome. Objective Patient specific computational models allow the activation pattern following CRT implant to be predicted and this may be used to optimize CRT lead placement. Methods In this study, the effects of heterogeneous cardiac substrate (scar, fast endocardial conduction, slow septal conduction, functional block) on accurately predicting the electrical activation of the LV epicardium were tested to determine the minimal detail required to create a rule based model of cardiac electrophysiology. Non-invasive clinical data (CT or CMR images and 12 lead ECG) from eighteen patients from two centers were used to investigate the models. Results Validation with invasive electro-anatomical mapping data identified that computer models with fast endocardial conduction were able to predict the electrical activation with a mean distance errors of 9.2 ± 0.5 mm (CMR data) or (CT data) 7.5 ± 0.7 mm. Conclusion This study identified a simple rule-based fast endocardial conduction model, built using non-invasive clinical data that can be used to rapidly and robustly predict the electrical activation of the heart. Pre-procedural prediction of the latest electrically activating region to identify the optimal LV pacing site could potentially be a useful clinical planning tool for CRT procedures.
Collapse
Affiliation(s)
- A W C Lee
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - U C Nguyen
- Department of Physiology, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Department of Cardiology, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - O Razeghi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - J Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - B S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - B Sieniewicz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - J Behar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Bart's Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - M Mafi-Rad
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - G Plank
- Department of Biophysics, Medical University of Graz, Graz, Austria
| | - F W Prinzen
- Department of Physiology, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - C A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - K Vernooy
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - S Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| |
Collapse
|
18
|
Jackson T, Claridge S, Behar J, Sieniewicz B, Gould J, Porter B, Sidhu B, Yao C, Lee A, Niederer S, Rinaldi CA. Differential effect with septal and apical RV pacing on ventricular activation in patients with left bundle branch block assessed by non-invasive electrical imaging and in silico modelling. J Interv Card Electrophysiol 2019; 57:115-123. [PMID: 31201592 PMCID: PMC7036078 DOI: 10.1007/s10840-019-00567-2] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/19/2019] [Indexed: 11/24/2022]
Abstract
Purpose It is uncertain whether right ventricular (RV) lead position in cardiac resynchronization therapy impacts response. There has been little detailed analysis of the activation patterns in RV septal pacing (RVSP), especially in the CRT population. We compare left bundle branch block (LBBB) activation patterns with RV pacing (RVP) within the same patients with further comparison between RV apical pacing (RVAP) and RVSP. Methods Body surface mapping was undertaken in 14 LBBB patients after CRT implantation. Nine patients had RVAP, 5 patients had RVSP. Activation parameters included left ventricular total activation time (LVtat), biventricular total activation time (VVtat), interventricular electrical synchronicity (VVsync), and dispersion of left ventricular activation times (LVdisp). The direction of activation wave front was also compared in each patient (wave front angle (WFA)). In silico computer modelling was applied to assess the effect of RVAP and RVSP in order to validate the clinical results. Results Patients were aged 64.6 ± 12.2 years, 12 were male, 8 were ischemic. Baseline QRS durations were 157 ± 18 ms. There was no difference in VVtat between RVP and LBBB but a longer LVtat in RVP (102.8 ± 19.6 vs. 87.4 ± 21.1 ms, p = 0.046). VVsync was significantly greater in LBBB (45.1 ± 20.2 vs. 35.9 ± 17.1 ms, p = 0.01) but LVdisp was greater in RVP (33.4 ± 5.9 vs. 27.6 ± 6.9 ms, p = 0.025). WFA did rotate clockwise with RVP vs. LBBB (82.5 ± 25.2 vs. 62.1 ± 31.7 op = 0.026). None of the measurements were different to LBBB with RVSP; however, the differences were preserved with RVAP for VVsync, LVdisp, and WFA. In silico modelling corroborated these results. Conclusions RVAP activation differs from LBBB where RVSP appears similar. Trial registration (ClinicalTrials.gov identifier: NCT01831518) Electronic supplementary material The online version of this article (10.1007/s10840-019-00567-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- T Jackson
- Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK.
- Department of Cardiology, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, SP2 8BJ, UK.
| | - S Claridge
- Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK
| | - J Behar
- Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK
| | - B Sieniewicz
- Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK
| | - J Gould
- Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK
| | - B Porter
- Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK
| | - B Sidhu
- Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK
| | - C Yao
- Medtronic/CardioInsight, Cleveland, OH, USA
| | - A Lee
- Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK
| | - S Niederer
- Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK
| | - C A Rinaldi
- Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK
- Guy's and St Thomas' NHS Trust, King's College London, London, SE1 9RT, UK
| |
Collapse
|
19
|
Niederer SA, Gould J, Sieniewicz B, Prinzen F, Rinaldi CA. Is the rapidly paced pig the optimal model for endocardial cardiac resynchronization therapy? Europace 2018; 20:1227-1228. [PMID: 29040521 DOI: 10.1093/europace/eux280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S A Niederer
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
| | - J Gould
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - B Sieniewicz
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - F Prinzen
- Maastricht University Medical Center, Cardiovascular Research Institute (CARIM), Maastricht, the Netherlands
| | - C A Rinaldi
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
20
|
Gould A, Akinwande O, Foltz G, Gould J, Molloy C, Sarah C, Darcy M, Ramaswamy R. 4:03 PM Abstract No. 299 Factors influencing selection of an interventional radiology training program. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
21
|
Sieniewicz B, Behar J, Gould J, Claridge S, Porter B, Betts TR, Webster D, James S, Turley A, Rinaldi CA. P329Optimal site selection during biventircualar endocardial pacing improves acute haemodynamic response and chronic remodeling: A multi-centre UK study. Europace 2018. [DOI: 10.1093/europace/euy015.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- B Sieniewicz
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Behar
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Gould
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - S Claridge
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - B Porter
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - T R Betts
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - D Webster
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - S James
- James Cook University Hospital, Middlesborough, United Kingdom
| | - A Turley
- James Cook University Hospital, Middlesborough, United Kingdom
| | - C A Rinaldi
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| |
Collapse
|
22
|
Gould J, Behar J, Rajani R, Sieniewicz B, Porter B, Claridge S, Sidhu B, Razeghi O, Niederer S, Toth D, Mountney P, Haberland U, Carr-White G, Razavi R, Rinaldi CA. P333Dual energy cardiac computed tomography to guide cardiac resynchronisation therapy: a feasibility study using coronary venous anatomy, scar and strain to guide optimal left ventricular lead placement. Europace 2018. [DOI: 10.1093/europace/euy015.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Gould
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - J Behar
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - R Rajani
- Guy's & St Thomas' NHS Foundation Trust, Cardiology Department, London, United Kingdom
| | - B Sieniewicz
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - B Porter
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - S Claridge
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - B Sidhu
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - O Razeghi
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - S Niederer
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - D Toth
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - P Mountney
- Medical Imaging Technologies, Siemens Healthineers, Princeton, United States of America
| | - U Haberland
- Medical Imaging Technologies, Siemens Healthineers, Princeton, United States of America
| | - G Carr-White
- Guy's & St Thomas' NHS Foundation Trust, Cardiology Department, London, United Kingdom
| | - R Razavi
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - C A Rinaldi
- Guy's & St Thomas' NHS Foundation Trust, Cardiology Department, London, United Kingdom
| |
Collapse
|
23
|
Sieniewicz B, Behar J, Gould J, Porter B, Betts TR, Webster D, James S, Turley A, Rinaldi CA. P1134Safety and efficacy of optimal site selection during biventircualar endocardial pacing: A multi-centre UK study. Europace 2018. [DOI: 10.1093/europace/euy015.620] [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)
- B Sieniewicz
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Behar
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Gould
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - B Porter
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - T R Betts
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - D Webster
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - S James
- James Cook University Hospital, Middlesborough, United Kingdom
| | - A Turley
- James Cook University Hospital, Middlesborough, United Kingdom
| | - C A Rinaldi
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| |
Collapse
|
24
|
Gould J, Porter B, Claridge S, Chen Z, Sieniewicz B, Sidhu B, Antoniadis AP, Carr-White G, Razavi R, Chiribiri A, Rinaldi CA. 994Quantitative assessment of myocardial scar heterogeneity using texture analysis to predict implantable cardioverter defibrillator therapies using cardiac magnetic resonance imaging. Europace 2018. [DOI: 10.1093/europace/euy015.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Gould
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - B Porter
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - S Claridge
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - Z Chen
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - B Sieniewicz
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - B Sidhu
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - A P Antoniadis
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - G Carr-White
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - R Razavi
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - A Chiribiri
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - C A Rinaldi
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| |
Collapse
|
25
|
Gould J, Claridge S, Williams S, Porter B, Sieniewicz B, Sidhu B, Antoniadis A, Rinaldi CA. 45A 16 year single centre experience of transvenous lead and system extraction in patients with and without coronary sinus leads. Europace 2018. [DOI: 10.1093/europace/euy015.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Gould
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - S Claridge
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - S Williams
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - B Porter
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - B Sieniewicz
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - B Sidhu
- King's College London, Division of Imaging Sciences & Biomedical Engineering, London, United Kingdom
| | - A Antoniadis
- Guy's & St Thomas' NHS Foundation Trust, Cardiology Department, London, United Kingdom
| | - C A Rinaldi
- Guy's & St Thomas' NHS Foundation Trust, Cardiology Department, London, United Kingdom
| |
Collapse
|
26
|
Porter B, Bishop M, Gould J, Sieniewicz B, Sidhu B, Rinaldi CA, Taggart P, Gill JS. P793Ventricular action potential duration variability is enhanced in heart failure patients with spontaneous ventricular tachycardia or fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.397] [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)
- B Porter
- King's College London, Cardiovascular, London, United Kingdom
| | - M Bishop
- King's College London, Cardiovascular, London, United Kingdom
| | - J Gould
- King's College London, Cardiovascular, London, United Kingdom
| | - B Sieniewicz
- King's College London, Cardiovascular, London, United Kingdom
| | - B Sidhu
- King's College London, Cardiovascular, London, United Kingdom
| | - C A Rinaldi
- St Thomas' Hospital, Cardiovascular , London, United Kingdom
| | - P Taggart
- University College London, Cardiovascular, London, United Kingdom
| | - J S Gill
- St Thomas' Hospital, Cardiovascular , London, United Kingdom
| |
Collapse
|
27
|
Deam S, Dolan G, Gould J. Prothrombin 20210A Polymorphism and Third Generation Oral Contraceptives – A Case Report of Coeliac Axis Thrombosis and Splenic Infarction. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615043] [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: 10/17/2022]
|
28
|
Behar JM, James S, Betts TR, Sieniewicz B, Turley A, Webster D, Claridge S, Gould J, Rinaldi CA. 20A multi-centre UK clinical experience with wireless intracardiac left ventricular endocardial stimulation for delivery of cardiac resynchronisation therapy (WiSE CRT). Europace 2017. [DOI: 10.1093/europace/eux283.029] [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: 11/14/2022] Open
|
29
|
Carlisle L, Gould J, Sieniewicz B, Claridge S, Jackson T, Carr-White G, Rinaldi CA, Behar JM. 94Routine pre assessment variables fail to predict response to CRT. Europace 2017. [DOI: 10.1093/europace/eux283.089] [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: 11/15/2022] Open
|
30
|
Claridge S, Sebag F, Behar J, Porter B, Jackson T, Sieniewicz B, Gould J, Webb J, Chen Z, O'Neill M, Gill J, Leclercq C, Rinaldi C. 96Cost effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators at the time of generator change. Europace 2017. [DOI: 10.1093/europace/eux283.091] [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: 11/12/2022] Open
|
31
|
Behar JM, James S, Betts TR, Sieniewicz B, Turley A, Webster D, Claridge S, Gould J, Rinaldi CA. 234A multi centre UK experience with optimal site implantation of a wireless intracardiac LV endocardial electrode (WiCS-LV) for delivery of cardiac resynchronisation therapy. Europace 2017. [DOI: 10.1093/ehjci/eux139.001] [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: 11/14/2022] Open
|
32
|
Fukushima H, Bobrow B, Silver A, Iwami T, Gould J, Edgell K, Mullins M, McDannold R. Bystander CPR performance and AED retrieval during out-of-hospital cardiac arrest. Resuscitation 2016. [DOI: 10.1016/j.resuscitation.2016.07.065] [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]
|
33
|
Abstract
Partial embolization of the spleen has been well established for the treatment of hypersplenism. A weakness of the technique is the lack of an objective method to quantitate the flow reduction during the procedure. The video dilution technique (VDT) has earlier been used to measure blood flow in regional arteries using video cassette replay. By adapting the VDT concept of relative flow to digital subtraction angiography, it is possible to calculate the flow reduction instantly following each injection of embolic material. We present a case of partial splenic embolization where the flow in the splenic artery was reduced to a predetermined level of 50 per cent of baseline flow. The clinical results were excellent. By observing the clinical results of partial embolization, terminated at different levels of flow reduction, it will be possible to optimize the results and prevent overembolization.
Collapse
Affiliation(s)
- D. P. Link
- Departments of Diagnostic Radiology and Urology, University of California Davis Medical Center, Sacramento, California 95817, USA
| | - J. A. Seibert
- Departments of Diagnostic Radiology and Urology, University of California Davis Medical Center, Sacramento, California 95817, USA
| | - J. Gould
- Departments of Diagnostic Radiology and Urology, University of California Davis Medical Center, Sacramento, California 95817, USA
| | - B. M. T. Lantz
- Departments of Diagnostic Radiology and Urology, University of California Davis Medical Center, Sacramento, California 95817, USA
| |
Collapse
|
34
|
Kilpatrick SJ, Abreo A, Gould J, Greene N, Main EK. Confirmed severe maternal morbidity is associated with high rate of preterm delivery. Am J Obstet Gynecol 2016; 215:233.e1-7. [PMID: 26899903 DOI: 10.1016/j.ajog.2016.02.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [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: 12/16/2015] [Revised: 01/22/2016] [Accepted: 02/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Because severe maternal morbidity (SMM) is increasing in the United States, affecting up to 50,000 women per year, there was a recent call to review all mothers with SMM to better understand their morbidity and improve outcomes. Administrative screening methods for SMM have recently been shown to have low positive predictive value for true SMM after chart review. To ultimately reduce maternal morbidity and mortality we must better understand risk factors, and preventability issues about true SMM such that interventions could be designed to improve care. OBJECTIVE Our objective was to determine risk factors associated with true SMM identified from California delivery admissions, including the relationship between SMM and preterm delivery. STUDY DESIGN In this retrospective cohort study, SMM cases were screened for using International Classification of Diseases, Ninth Revision codes for severe illness and procedures, prolonged postpartum length of stay, intensive care unit admission, and transfusion from all deliveries in 16 hospitals from July 2012 through June 2013. Charts of screen-positive cases were reviewed and true SMM diagnosed based on expert panel agreement. Underlying disease diagnosis was determined. Women with true-positive SMM were compared to SMM-negative women for the following variables: maternal age, ethnicity, gestational age at delivery, prior cesarean delivery, and multiple gestation. RESULTS In all, 491 women had true SMM and 66,977 women did not have SMM for a 0.7% rate of true SMM. Compared to SMM-negative women, SMM cases were significantly more likely to be age >35 years (33.6 vs 23.8%; P < .0001), be African American (14.1 vs 7.9%; P < .0001), have had a multiple gestation (9.7 vs 2.1%; P < .0001), and, for the multiparous women, have had a prior cesarean delivery (58 vs 30.2%; P < .0001). Preterm delivery was significantly more common in SMM women compared to SMM-negative women (41 vs 8%; P < .0001), including delivery <32 weeks (18 vs 2%; P < .0001). The most common underlying disease was obstetric hemorrhage (42%) followed by hypertensive disorders (20%) and placental hemorrhage (14%). Only 1.6% of women with SMM had cardiovascular disease as the underlying disease category. CONCLUSION An extremely high proportion of women with severe morbidity (42.5%) delivered preterm with 17.8% delivering <32 weeks, which underscores the importance of access to appropriate-level care for mothers with SMM and their newborns. Further, the extremely high rate of preterm delivery (75%) in women with placental hemorrhage in combination with their 63% prior cesarean delivery rate highlights another risk of prior cesarean delivery: subsequent preterm delivery. These data provide a reminder that a cesarean delivery could be a contributing factor to not only hemorrhage-related SMM, but also to increased subsequent preterm delivery, more reason to continue national efforts to safely reduce initial cesarean deliveries.
Collapse
Affiliation(s)
- Sarah J Kilpatrick
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Anisha Abreo
- California Maternal Quality Care Collaborative, Stanford University, Palo Alto, CA
| | - Jeffrey Gould
- California Maternal Quality Care Collaborative, Stanford University, Palo Alto, CA; March of Dimes Prematurity Research Center at Stanford University, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Naomi Greene
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Elliot K Main
- California Maternal Quality Care Collaborative, Stanford University, Palo Alto, CA
| |
Collapse
|
35
|
Paine TD, Millar JG, Hanks LM, Gould J, Wang Q, Daane K, Dahlsten DL, Mcpherson EG. Cost-Benefit Analysis for Biological Control Programs That Targeted Insect Pests of Eucalypts in Urban Landscapes of California. J Econ Entomol 2015; 108:2497-2504. [PMID: 26470370 DOI: 10.1093/jee/tov224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 05/22/2015] [Accepted: 07/07/2015] [Indexed: 06/05/2023]
Abstract
As well as being planted for wind breaks, landscape trees, and fuel wood, eucalypts are also widely used as urban street trees in California. They now are besieged by exotic insect herbivores of four different feeding guilds. The objective of the current analysis was to determine the return on investment from biological control programs that have targeted these pests. Independent estimates of the total number of eucalypt street trees in California ranged from a high of 476,527 trees (based on tree inventories from 135 California cities) to a low of 190,666 trees (based on 49 tree inventories). Based on a survey of 3,512 trees, the estimated mean value of an individual eucalypt was US$5,978. Thus, the total value of eucalypt street trees in California ranged from more than US$1.0 billion to more than US$2.8 billion. Biological control programs that targeted pests of eucalypts in California have cost US$2,663,097 in extramural grants and University of California salaries. Consequently, the return derived from protecting the value of this resource through the biological control efforts, per dollar expended, ranged from US$1,070 for the high estimated number of trees to US$428 for the lower estimate. The analyses demonstrate both the tremendous value of urban street trees, and the benefits that stem from successful biological control programs aimed at preserving these trees. Economic analyses such as this, which demonstrate the substantial rates of return from successful biological control of invasive pests, may play a key role in developing both grass-roots and governmental support for future urban biological control efforts.
Collapse
Affiliation(s)
- T D Paine
- Department of Entomology, University of California, Riverside, CA.
| | - J G Millar
- Department of Entomology, University of California, Riverside, CA
| | - L M Hanks
- Department of Entomology, University of California, Riverside, CA. Present address: Department of Entomology, University of Illinois at Urbana-Champaign, Urbana, IL
| | - J Gould
- Department of Entomology, University of California, Riverside, CA. Present address: United States Department of Agriculture APHIS, Otis, MA
| | - Q Wang
- Department of Entomology, University of California, Riverside, CA. Institute of Agriculture and Environment, Massey University, Palmerston North, New Zealand
| | - K Daane
- Department of Environmental Science, Policy and Management, University of California, Berkeley, CA
| | - D L Dahlsten
- Department of Environmental Science, Policy and Management, University of California, Berkeley, CA. Deceased
| | - E G Mcpherson
- Pacific Southwest Research Station, United States Department of Agriculture Forest Service, Davis, CA
| |
Collapse
|
36
|
Mani D, Almuklass A, Amiridis I, Gould J, Matkowski B, Enoka R. Effect Of Neuromuscular Electrical Stimulation On Contralateral Motor Unit Activity In Biceps Brachii. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000478508.29207.ec] [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: 11/21/2022]
|
37
|
Jelliffe-Pawlowski L, Ryckman K, Bedell B, Baer R, O'Brodovich H, Gould J, Currier R, Shaw G, Murray J, Stevenson D. 586: Prediction of early spontaneous preterm birth using placental, lipid, and immune related markers. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.792] [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: 10/24/2022]
|
38
|
Shachar BZ, Mayo J, Lee H, Shaw G, Gould J. 132: Maternal height and risk for spontaneous preterm birth across BMI categories. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Robles D, Blumenfeld Y, Lee H, Gould J, Main E, Profit J, Melsop K, Druzin M. 464: Opportunities for maternal transport of pregnancies at risk for delivery of VLBW infants – results from the california maternal quality care collaborative. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.510] [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]
|
40
|
Patel CJ, Yang T, Hu Z, Wen Q, Sung J, El-Sayed YY, Cohen H, Gould J, Stevenson DK, Shaw GM, Ling XB, Butte AJ. Investigation of maternal environmental exposures in association with self-reported preterm birth. Reprod Toxicol 2014; 45:1-7. [PMID: 24373932 PMCID: PMC4316205 DOI: 10.1016/j.reprotox.2013.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 12/11/2013] [Accepted: 12/18/2013] [Indexed: 01/31/2023]
Abstract
Identification of maternal environmental factors influencing preterm birth risks is important to understand the reasons for the increase in prematurity since 1990. Here, we utilized a health survey, the US National Health and Nutrition Examination Survey (NHANES) to search for personal environmental factors associated with preterm birth. 201 urine and blood markers of environmental factors, such as allergens, pollutants, and nutrients were assayed in mothers (range of N: 49-724) who answered questions about any children born preterm (delivery <37 weeks). We screened each of the 201 factors for association with any child born preterm adjusting by age, race/ethnicity, education, and household income. We attempted to verify the top finding, urinary bisphenol A, in an independent study of pregnant women attending Lucile Packard Children's Hospital. We conclude that the association between maternal urinary levels of bisphenol A and preterm birth should be evaluated in a larger epidemiological investigation.
Collapse
Affiliation(s)
- Chirag J Patel
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Ting Yang
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Zhongkai Hu
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Qiaojun Wen
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Joyce Sung
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasser Y El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Harvey Cohen
- Division of Hematology-Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - David K Stevenson
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary M Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Xuefeng Bruce Ling
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Atul J Butte
- Division of Systems Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA; Lucile Packard Children's Hospital, Palo Alto, CA, USA.
| |
Collapse
|
41
|
Lang TA, Gould J, von Seidlein L, Lusingu JP, Mshamu S, Ismael S, Liheluka E, Kamuya D, Mwachiro D, Olotu A, Njuguna P, Bejon P, Marsh V, Molyneux C. Approaching the community about screening children for a multicentre malaria vaccine trial. Int Health 2013; 4:47-54. [PMID: 24030880 DOI: 10.1016/j.inhe.2011.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Community sensitisation, as a component of community engagement, plays an important role in strengthening the ethics of community-based trials in developing countries and is fundamental to trial success. However, few researchers have shared their community sensitisation strategies and experiences. We report on our perspective as researchers on the sensitisation activities undertaken for a phase II malaria vaccine trial in Kilifi District (Kenya) and Korogwe District (Tanzania), with the aim of informing and guiding the operational planning of future trials. We report wide variability in recruitment rates within both sites; a variability that occurred against a backdrop of similarity in overall approaches to sensitisation across the two sites but significant differences in community exposure to biomedical research. We present a range of potential factors contributing to these differences in recruitment rates, which we believe are worth considering in future community sensitisation plans. We conclude by arguing for carefully designed social science research around the implementation and impact of community sensitisation activities.
Collapse
Affiliation(s)
- T A Lang
- KEMRI-Wellcome Trust Research Centre, P.O. Box 230, Kilifi, Kenya
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Gould J. Unilateral anhidrosis: a rare presentation of atrial myxoma? Case Reports 2012; 2012:bcr-2012-007891. [DOI: 10.1136/bcr-2012-007891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
43
|
Bao T, Tarpinian K, Medeiros M, Gould J, Jeter S, Cai L, Tait N, Shetty J, Lewis J, Gitten L, Betts K, Hoffman A, Feigenberg S, Chumsri S, Armstronge DK, Bardia A, Tan M, Stebbing J, Folkerd E, Dowsett M, Singh H, Tkaczuk K, Stearns V. P4-12-13: A Multi-Center Randomized Controlled Double Blind Trial Assessing the Effect of Acupuncture in Reducing Musculoskeletal Symptoms in Breast Cancer Patients Taking Aromatase Inhibitors: First Interim Analysis. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-12-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Aromatase inhibitors (AIs) are recommended as first-line adjuvant hormonal therapy in postmenopausal women with hormone-receptor-positive breast cancer, as monotherapy or sequential therapy after tamoxifen. AI-associated musculoskeletal symptoms (AIMSS) occur in approximately 50% of women receiving AIs and in some may result in discontinuation of treatment. Symptom management is essential to ensure that breast cancer patients receive the full recommended duration of AI therapy. We conducted a randomized, placebo-controlled trial to evaluate the effect of acupuncture on AIMSS and report the first interim analysis.
Method: Postmenopausal women with early stage breast cancer, experiencing AIMSS, who had not had acupuncture in the year prior to the study, were eligible. Patients were randomized to 8 weekly acupuncture or sham acupuncture. Health assessment questionnaire disability index (HAQ-DI ranging 0–3.0) and pain visual analog scale (VAS ranging 0–100) were used to assess clinical musculoskeletal disorder severity at weeks 0, 4, 8, and 12 or 24. Change in HAQ-DI (ΔHAQ-DI) and VAS scores (ΔVAS) from baseline were compared between patients receiving acupuncture versus sham acupuncture using exact Wilcoxon rank sum test. Serum samples were collected for measurements of estrogens and beta endorphin concentrations and cytokine profile before and after the intervention to evaluate the etiology of AIMSS and the mechanism of acupuncture in treating AIMSS.
Results: Between May 2008 and June 2011, 48 patients were enrolled, 2 patients were not evaluable due to noncompliance to treatment and lost to follow up, 10 were still receiving treatment and therefore not evaluable. Thirty-six were evaluable, and were equally distributed between the real and sham acupuncture groups. Baseline characteristics were balanced between the two groups with regard to age, race, and body mass index (BMI) with the exception that baseline mean HAQ-DI was higher in the acupuncture group (0.9 vs 0.55, p=0.04). White/Black/Asian: 26/7/3, Median (range): age: 61 (45-82); BMI (kg/m2): 31.1 (22.9−59.6). At week 8, both groups showed a wide range of ΔHAQ-DI (ΔHAQ-DI =HAQ-DIweek8-HAQ-DIbaseline): from −1.38 to 0.5 in the acupuncture group versus from −1 to 0.12 in sham acupuncture group. There was no statistically significant difference in mean ΔHAQ-DI between the real and sham acupuncture groups (−0.33 vs −0.33, p=0.87). Eleven patients in each group (61%) reported decreased HAQ-DI scores, which correlated with improved function. There was no difference in mean ΔVAS between the real and sham acupuncture groups (−9.27 vs −13.82, p=0.67). No significant side effects were reported. Changes in other time points and in serum biomarkers will be presented at the meeting.
Conclusions: The majority of breast cancer patients experiencing AIMSS who participated in our study reported a reduced HAQ-DI score both from acupuncture and sham acupuncture. We did not observe significant differences between responses to real versus sham acupuncture after 8 weekly treatments. The study remains open to accrual to reach 50 evaluable patients.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-12-13.
Collapse
Affiliation(s)
- T Bao
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - K Tarpinian
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - M Medeiros
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - J Gould
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - S Jeter
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - L Cai
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - N Tait
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - J Shetty
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - J Lewis
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - L Gitten
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - K Betts
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - A Hoffman
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - S Feigenberg
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - S Chumsri
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - DK Armstronge
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - A Bardia
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - M Tan
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - J Stebbing
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - E Folkerd
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - M Dowsett
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - H Singh
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - K Tkaczuk
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - V Stearns
- 1University of Maryland Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hammersmith Hospitals NHS Trust Charing Cross Hospital, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
44
|
Hufschmid J, Beveridge I, Coulson G, Gould J. Bone fluoride concentrations of eastern grey kangaroos (Macropus giganteus) resident near an aluminium smelter in south-eastern Australia. Ecotoxicology 2011; 20:1378-1387. [PMID: 21553258 DOI: 10.1007/s10646-011-0695-0] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Accepted: 04/28/2011] [Indexed: 05/30/2023]
Abstract
Lesions of skeletal and dental fluorosis have been described recently in eastern grey kangaroos (Macropus giganteus). The present study further examined the epidemiology of skeletal fluorosis in this species. Bone fluoride concentrations were obtained from a range of skeletal sites of animals from a high (Portland Aluminium) and a low (Cape Bridgewater) fluoride environment in Victoria, Australia. Age, but not sex, affected the mean bone fluoride concentration of kangaroos. For a given age, bone fluoride concentrations were significantly higher in kangaroos from Portland than Cape Bridgewater. Concentrations varied between skeletal sites examined, with samples containing cancellous bone having higher fluoride concentrations than those containing only cortical bone.
Collapse
Affiliation(s)
- J Hufschmid
- Faculty of Veterinary Science, The University of Melbourne, 250 Princes Highway, Werribee, VIC, 3030, Australia.
| | | | | | | |
Collapse
|
45
|
Abstract
There is a high non-attendance and dropout attrition from weight management interventions for adults with obesity. Patient dissatisfaction with consultations involving decisions about interventions may be a factor. A systematic review was undertaken of qualitative studies reporting perceptions, experiences, contexts and influences for adults facing, or reflecting on, weight management. The aim was to synthesize a generic model of influences on decision-making about weight management for adult patients. Electronic database and hand searches identified 29 qualitative studies involving 1387 participants (mean age 45.3 years; mean BMI 37.1 kg m(-2) ; 79.9% women). Seven overarching themes were inductively derived from extracted data spanning: cultural identity; social structures such as gender; responses to obesity stigma; previous weight loss experiences; personal motivators and barriers; social support; and practical resources. A model is presented in the paper. Improving decisions about weight management requires attention to how diffuse cultural and psycho-social factors, such as obesity stigma, influence patient choices. Reflection on experiences of previous attempts at weight loss is also essential, as are practical resource factors - particularly for less affluent groups. Considering these factors along with more established theories of individual psychological motivations and barriers may help to improve initial participation and retention within interventions.
Collapse
Affiliation(s)
- I Brown
- The Clover Practice Sheffield and Centre for Health and Social Research, Sheffield Hallam University, Sheffield UK;Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield UK
| | | |
Collapse
|
46
|
Saria S, Rajani AK, Gould J, Koller D, Penn AA. Integration of early physiological responses predicts later illness severity in preterm infants. Sci Transl Med 2010; 2:48ra65. [PMID: 20826840 DOI: 10.1126/scitranslmed.3001304] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Physiological data are routinely recorded in intensive care, but their use for rapid assessment of illness severity or long-term morbidity prediction has been limited. We developed a physiological assessment score for preterm newborns, akin to an electronic Apgar score, based on standard signals recorded noninvasively on admission to a neonatal intensive care unit. We were able to accurately and reliably estimate the probability of an individual preterm infant's risk of severe morbidity on the basis of noninvasive measurements. This prediction algorithm was developed with electronically captured physiological time series data from the first 3 hours of life in preterm infants (< or =34 weeks gestation, birth weight < or =2000 g). Extraction and integration of the data with state-of-the-art machine learning methods produced a probability score for illness severity, the PhysiScore. PhysiScore was validated on 138 infants with the leave-one-out method to prospectively identify infants at risk of short- and long-term morbidity. PhysiScore provided higher accuracy prediction of overall morbidity (86% sensitive at 96% specificity) than other neonatal scoring systems, including the standard Apgar score. PhysiScore was particularly accurate at identifying infants with high morbidity related to specific complications (infection: 90% at 100%; cardiopulmonary: 96% at 100%). Physiological parameters, particularly short-term variability in respiratory and heart rates, contributed more to morbidity prediction than invasive laboratory studies. Our flexible methodology of individual risk prediction based on automated, rapid, noninvasive measurements can be easily applied to a range of prediction tasks to improve patient care and resource allocation.
Collapse
Affiliation(s)
- Suchi Saria
- Department of Computer Science, Stanford University, Stanford, CA 94305, USA
| | | | | | | | | |
Collapse
|
47
|
Gould J, Ellsmere J, Fanelli R, Hutter M, Jones S, Pratt J, Schauer P, Schirmer B, Schwaitzberg S, Jones DB. Panel report: best practices for the surgical treatment of obesity. Surg Endosc 2010; 25:1730-40. [PMID: 21136099 DOI: 10.1007/s00464-010-1487-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 09/15/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bariatric surgery is a rapidly growing field. Advances in surgical technologies and techniques have raised concerns about patient safety. Bariatric surgeons and programs are under increased scrutiny from regulatory agencies, insurers, and public health officials to provide high quality and safe care for bariatric patients at all phases of care. METHODS During the 2009 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), a panel of experts convened to provide updated information on patient safety and best practices in bariatric surgery. The following article is a summary of this panel presentation. RESULTS AND CONCLUSIONS Weight loss surgery is a field that is evolving and adapting to multiple external pressures. Safety concerns along with increasing public scrutiny have led to a systematic approach to defining best practices, creating standards of care, and identifying mechanisms to ensure that patients consistently receive the best and most effective care possible. In many ways, bariatric surgery and multidisciplinary bariatric surgery programs may serve as a model for other programs and surgical specialties in the near future.
Collapse
Affiliation(s)
- J Gould
- University of Wisconsin School of Medicine, 600 Highland Avenue, H4/726 Clinical Science Center, Madison, WI 53792, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
James DF, Brown JR, Werner L, Wierda WG, Rai KR, Gould J, Castro JE, Rassenti L, Neuberg DS, Kipps TJ. Lenalidomide and rituximab for the initial treatment of chronic lymphocytic leukemia: Report of an ongoing study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6583] [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: 11/20/2022] Open
|
49
|
Winnall WR, Gould J, Muir JA, Hertzog P, Hedger MP. 179. PURIFICATION AND CHARACTERISATION OF MOUSE TESTICULAR MACROPHAGES: GENE EXPRESSION RESPONSE TO LIPOPOLYSACCHARIDE ACTIVATION INDICATES AN IMMUNOSUPPRESSIVE PHENOTYPE. Reprod Fertil Dev 2010. [DOI: 10.1071/srb10abs179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Studies on rat testicular macrophages (TMs) have indicated that these cells play an important role in testis function by supporting the immunosuppressive environment that protects developing germ cells and by responding to pathogens. By comparison, mouse TMs are essentially uncharacterised due to difficulties in isolating sufficient cells for study. We have established a technique for isolating 95% pure TMs from adult mice by differential adherence. Mouse TMs were cultured for 3h with saline, 10 or 100 ng/mL lipopolysaccharide (LPS) and compared with resident peritoneal macrophages (PMs) and bone marrow-derived macrophages (BMMs). Expression of inflammatory regulators was determined using real-time Q-PCR and AgilentTM microarray analysis. Microarray analysis indicated that each macrophage type displayed very distinct gene expression profiles. There were 526 genes uniquely expressed in TMs at basal levels compared with the other macrophages and 268 genes uniquely expressed by TMs after LPS treatment. Q-PCR determined that LPS induced expression of the anti-inflammatory cytokine interleukin (IL)-10 in each of the macrophage types, with BMMs the strongest responders. LPS stimulated IL-10 mRNA approximately 100-fold in TMs, but only 20-fold in PMs. The anti-inflammatory transforming growth factor-β1 was not significantly induced at this time-point in any macrophage type. In terms of pro-inflammatory mediators, the TM response to LPS was always lower compared to the BMMs. Compared to PMs, the responses of TMs were similar for the hallmark pro-inflammatory cytokine tumour necrosis factor- a, but 40% less for IL-1β. TMs were also deficient in production of IL-6 and cyclooxygenase-2 and IL-12. TMs were therefore relatively strong responders to LPS in terms of IL-10, but weak responders in terms of pro-inflammatory mediators, indicating an immunosuppressive phenotype. The isolation and gene measurement methods established in this study will allow us to use knockout and transgenic mouse models to determine the role for TMs in testicular inflammation/fibrosis models.
Collapse
|
50
|
Blumenfeld Y, Lee H, Gould J, Langen E, Jafari A, El-Sayed Y. 439: Do ruptured membranes remote from term affect neonatal mortality? Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.605] [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]
|