1
|
Amrenova A, Baudin C, Ostroumova E, Stephens J, Anderson R, Laurier D. Intergenerational effects of ionizing radiation: review of recent studies from human data (2018-2021). Int J Radiat Biol 2024:1-11. [PMID: 38319708 DOI: 10.1080/09553002.2024.2309917] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE The purpose of this paper was to conduct a review of the studies published between 2018 and 2022 to investigate radiation-related effects in the offspring of human individuals exposed to ionizing radiation. METHODS The search identified 807 publications, from which 9 studies were selected for detailed analysis to examine for effects in children whose parents were exposed to various types and doses of radiation. RESULTS The review does not yield substantial evidence supporting intergenerational effects of radiation exposure in humans. However, caution is required when interpreting the results due to limitations in the majority of the published articles. CONCLUSION This review, covering the period 2018-2022, serves as an extension of the previous systematic review conducted by Stephens et al. (2024), which encompassed the years 1988-2018. Together, these two papers offer a comprehensive overview of the available evidence regarding the intergenerational effects of parental pre-conceptional exposure to ionizing radiation. Overall, the findings do not provide strong evidence supporting a significant association between adverse (or other) outcomes in unexposed children and parental preconception radiation exposure.
Collapse
Affiliation(s)
- A Amrenova
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay aux Roses, France
| | - C Baudin
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay aux Roses, France
| | - E Ostroumova
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - J Stephens
- Centre for Health Effects of Radiological and Chemical Agents, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - R Anderson
- Centre for Health Effects of Radiological and Chemical Agents, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - D Laurier
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay aux Roses, France
| |
Collapse
|
2
|
Gregory A, Wright D, Spencer H, Mankowski JJ, Dickens JC, Stephens J, Neuber AA. An apparatus for probing multipactor in X-band waveguide components. Rev Sci Instrum 2023; 94:2888169. [PMID: 37140338 DOI: 10.1063/5.0139620] [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] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023]
Abstract
Rectangular waveguides are susceptible to avalanche-style breakdown via the multipactor phenomenon. The growth in secondary electron density produced via multipactor can damage and destroy RF components. A pulse-adjustable, hard-switched modulator powering an X-band magnetron was utilized to drive a modular experimental setup that enables testing different surface geometries and coatings. Power measurements, taken via diodes, and phase measurements, facilitated via a double-balanced mixer, were integrated into the overall apparatus enabling multipactor detection with high sensitivity and nanosecond temporal resolution. The utilized 150 kW peak microwave source with 2.5 μs pulse width and 100 Hz repetition frequency allows for threshold testing without the need for initial electron seeding. This paper includes the initial results of surface conditioning of the test multipactor gap via electron bombardment.
Collapse
Affiliation(s)
- A Gregory
- Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
| | - D Wright
- Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
| | - H Spencer
- Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
| | - J J Mankowski
- Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
| | - J C Dickens
- Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
| | - J Stephens
- Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
| | - A A Neuber
- Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
| |
Collapse
|
3
|
Bondje S, Bateman L, Stephens J. 432 Improving the Use of Acute ENT Clinic in a DGH During the COVID19 Pandemic. Br J Surg 2022. [PMCID: PMC9452109 DOI: 10.1093/bjs/znac269.338] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aim The SHO led acute ENT clinic is used to assess and treat a variety of ENT pathology. Following the COVID19 pandemic, the department has seen an increase in referrals for conditions that do not meet departmental guidelines. To meet demand, our clinics were always overbooked and over running as juniors sought help from seniors for more complex referrals. Method A quality improvement project was initially set to be performed over a few months; however, due to COVID, data was collected over a year from December 2019 to 2020. We looked specifically at number of patients referred, reason for referral, number of follow-up appointments, senior review required and how COVID affected the running of the clinics. Results Compared with the clinic's standard operating procedure, 77.2% of clinics were overbooked and 69.8% of patients had unsuitable referrals. This prompted changes such as increasing clinic capacity by introducing full day clinics and increasing senior support by moving to the outpatient department, then clinics were only overbooked 1% of the time. Other areas for improvement highlighted such as advice given to patients as well as referral to main ENT clinic. Conclusion It was clear that the capacity of the acute clinic did not meet demand, and this was needed to ensure patient safety and adhere to ENT UK guidance. We implemented a more stringent referral system to increase patient safety by ensuring patients with appropriate pathology are seen in this clinic or referred to other relevant clinics where they can be seen earlier by seniors.
Collapse
Affiliation(s)
- S Bondje
- Western Isles Hospital, Stornoway, United Kingdom
| | - L Bateman
- East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
| | - J Stephens
- East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
| |
Collapse
|
4
|
Bondje S, Tanna R, Stephens J. 1508 Acute ENT Clinic Audit. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
The acute ENT clinic is run by the ENT SHO’s and is used to assess and treat patients with a variety of everyday ENT pathology. As a department, we are seeing increasing numbers of patients who have been referred via the community for conditions that do not meet the departmental guidelines as well as noting our clinic is consistently overbooked and overrunning.
Method
A retrospective audit was performed analysing all clinic data between December 2019 and January 2020, specifically looking at patient demographics and reason for referral. The total number of patients per clinic was analysed and compared against ENT UK guidelines for safe clinic numbers, which state that an SHO led acute clinic should have 6 patients maximum.
Results
Over a two-month period, we looked at data from 35 clinics. As per our standard operating practice, children should be seen first in the clinic and this occurred in only 8 clinics (22.9%). Secondly, 8 clinics had appropriately booked a maximum of 6 patients, whilst in 27 clinics (77.2%) there were more than 7 patients booked. Finally, 69.8% of patients had unsuitable referrals as per the guideline.
Conclusions
It is clear from our data that the capacity of the acute clinic does not meet its current demand, and this is something that needs to be addressed to ensure patient safety and to adhere to ENT UK guidance. The implementation of a more stringent referral system will increase patient safety by ensuring patients with appropriate pathology are seen in this clinic.
Collapse
Affiliation(s)
- S Bondje
- East & North Hertfordshire NHS Trust, Stevenage, United Kingdom
| | - R Tanna
- East & North Hertfordshire NHS Trust, Stevenage, United Kingdom
| | - J Stephens
- East & North Hertfordshire NHS Trust, Stevenage, United Kingdom
| |
Collapse
|
5
|
Pillai S, Davies G, Lawrence M, Whitley J, Stephens J, Williams PR, Morris K, Evans PA. The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic? Clin Hemorheol Microcirc 2021; 77:183-194. [PMID: 32925001 DOI: 10.3233/ch-200957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a medical emergency with a high mortality rate and is associated with severe metabolic acidosis and dehydration. DKA patients have an increased risk of arterial and venous thromboembolism, however little is known about this metabolic derangement in the first 24 hours of admission and to assess its effect on coagulation. We therefore utilised a novel functional marker of clot microstructure (fractal dimension - df) to assess these changes within the first 24 hours. METHODS Prospective single centre observational study to demonstrate whether the tendency of blood clot formation differs in DKA patients. RESULTS 15 DKA patients and 15 healthy matched controls were recruited. Mean df in the healthy control group was 1.74±0.03. An elevated df of 1.78±0.07 was observed in patients with DKA on admission. The mean pH on admission was 7.14±0.13 and the lactate was 3.6±2.0. df changed significantly in response to standard treatment and was significantly reduced to 1.68±0.09 (2-6& h) and to 1.66±0.08 at 24& h (p < 0.01 One-way ANOVA). df also correlated significantly with lactate and pH (Pearson correlation coefficient 0.479 and -0.675 respectively, p < 0.05). CONCLUSIONS DKA patients at presentation have a densely organising less permeable thrombogenic clot microstructure as evidenced by high df. These structural changes are due to a combination of dehydration and a profound metabolic acidosis, which was reversed with treatment. These changes were not mirrored in standard clinical markers of thromboge-nicity.
Collapse
Affiliation(s)
- Suresh Pillai
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Gareth Davies
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK
| | - Matthew Lawrence
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Janet Whitley
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Jeffrey Stephens
- Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | | | | | - Phillip Adrian Evans
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| |
Collapse
|
6
|
Bazan J, Stephens J, Agnese D, Skoracki R, Reiland J, Arneson K, Gupta G, Gallagher K, McElroy S, Park K, Grignol V, Lee C, Sisk G, Schulz S, Chetta M, Jhawar S, Grecula J, Martin D, Carson W, Farrar W, Carlson M, Gupta N, White J. PO-0933: Prospective Evaulation Of Iort Boost In Women Undergoing Lumpectomy With Oncoplastic Reconstruction. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00950-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Campbell D, Chacko S, Abdollah H, Eniquez A, Redfearn D, Wang C, Hazell M, Boose L, Murphy K, Stephens J, Bakker D, Joseph P, McQullian C, Baranchuk A. DEALING WITH TEMPORARY PERMANENT PACEMAKERS: OUR JOURNEY TO IMPROVE QUALITY ASSURANCE. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
8
|
Shah S, O’Connor M, Lewis C, Stephens J, Vaughan D, Chaggar R. Face-to-face videolaryngoscopy-assisted tracheal intubation: does the hand matter? Br J Anaesth 2020. [DOI: 10.1016/j.bja.2020.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
9
|
Soni S, Shah S, Chaggar R, Saini R, James E, Elliot J, Stephens J, McCormack T, Hartle A. Surgical cancellation rates due to peri‐operative hypertension: implementation of multidisciplinary guidelines across primary and secondary care. Anaesthesia 2020; 75:1314-1320. [DOI: 10.1111/anae.15084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 11/29/2022]
Affiliation(s)
- S. Soni
- Division of Anaesthetics Pain Medicine and Intensive Care Imperial College London UK
- Imperial School of Anaesthesia London UK
| | - S. Shah
- Imperial School of Anaesthesia London UK
| | - R. Chaggar
- Northwick Park Hospital Harrow London UK
| | - R. Saini
- Great Ormond Street Hospital London UK
| | - E. James
- Imperial College Healthcare NHS Trust London UK
| | - J. Elliot
- Imperial College Healthcare NHS Trust London UK
| | | | - T. McCormack
- Primary Care Cardiovascular Medicine Hull York Medical School UK
| | - A. Hartle
- Imperial College Healthcare NHS Trust London UK
| |
Collapse
|
10
|
Meldau JE, Borowsky P, Blanchett J, Stephens J, Muh S, Moutzouros V, Makhni EC. Impact of Patient Demographic Factors on Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, Pain Interference, and Depression Computer Adaptive Testing Scores in Patients Undergoing Shoulder and Elbow Surgery. Orthop J Sports Med 2019; 7:2325967119884543. [PMID: 31803791 PMCID: PMC6876178 DOI: 10.1177/2325967119884543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: There has been a growing emphasis in orthopaedics on providing patient-centered care. The US National Institutes of Health launched the Patient-Reported Outcomes Measurement Information System (PROMIS) initiative that incorporates patient-reported outcome measures across a number of medical domains. The relationship between PROMIS domains and the impact of patient demographic factors in those undergoing upper extremity surgery remains unclear. Purpose/Hypothesis: The goal of this study was to investigate the correlation between physical function, pain interference, and depression in patients undergoing shoulder and elbow surgery as measured by PROMIS computer adaptive testing (CAT) forms and to determine the impact of patient demographic factors. We hypothesized that there would be a significant negative correlation between physical function and both pain interference and depression in this patient population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All patients who underwent elective shoulder or elbow surgery by 3 shoulder, elbow, and/or sports medicine fellowship–trained orthopaedic surgeons were included in the study. Preoperative PROMIS–Upper Extremity (PROMIS-UE), PROMIS–Pain Interference (PROMIS-PI), and PROMIS-Depression (PROMIS-D) CAT scores were analyzed. Pearson correlations were calculated between PROMIS domains as well as between PROMIS outcomes with patient demographic factors. Results: Preoperative PROMIS CAT scores for all 3 domains were collected and analyzed from 172 unique patients (516 individual CAT forms) with shoulder and elbow injuries. A negative correlation of moderate strength was found between the PROMIS-UE and PROMIS-PI (R = –0.61; P < .001), and a negligible correlation was found between the PROMIS-UE and PROMIS-D (R = –0.28; P < .001). When stratified by patient demographic factors, the correlation between the PROMIS-UE and PROMIS-PI was stronger in female patients compared with male patients (R = –0.77 vs –0.46, respectively; P < .001 for both), stronger in black patients compared with white patients (R = –0.72 vs –0.56, respectively; P < .001 for both), and highest in current tobacco users (R = –0.80; P < .001). Conclusion: Before shoulder and elbow surgery, patients demonstrated impairments in physical function and pain interference as measured by CAT forms, with a moderate negative correlation between baseline upper extremity physical function and pain interference scores. In certain subpopulations, such as female patients, black patients, and current tobacco users, the correlations between these tested domains were stronger than in other groups.
Collapse
Affiliation(s)
- Jason E Meldau
- Henry Ford West Bloomfield Hospital, Henry Ford Health System, West Bloomfield, Michigan, USA
| | - Peter Borowsky
- Henry Ford West Bloomfield Hospital, Henry Ford Health System, West Bloomfield, Michigan, USA
| | - Jacob Blanchett
- Henry Ford West Bloomfield Hospital, Henry Ford Health System, West Bloomfield, Michigan, USA
| | | | - Stephanie Muh
- Henry Ford West Bloomfield Hospital, Henry Ford Health System, West Bloomfield, Michigan, USA
| | - Vasilios Moutzouros
- Henry Ford West Bloomfield Hospital, Henry Ford Health System, West Bloomfield, Michigan, USA
| | - Eric C Makhni
- Henry Ford West Bloomfield Hospital, Henry Ford Health System, West Bloomfield, Michigan, USA
| |
Collapse
|
11
|
Feldsine PT, Lienau AH, Roa NH, Green ST, Braut-Taormina J, Braymen C, Chavey C, Cohen A, Deans A, Delancey S, Elems C, Forgey R, Gonzalez E, Hall V, Huang MCJ, Humes L, Johnson F, Kerdaji K, King J, Kipker L, Lau D, Nogle J, Peters C, Pinkston J, Porter M, Potter L, Rogers S, Stephens J, Skorupa G, Taylor R, Tuncan E, Vought K, Vrana D. Enumeration of Total Coliforms and E. coli in Foods by the SimPlate® Coliform and E. coli Color Indicator Method and Conventional Culture Methods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/88.5.1318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
The relative effectiveness of the SimPlate® Coliform and E. coli Color Indicator (CEc-CI) method was compared to the AOAC 3-tube Most Probable Number (MPN) methods for enumerating and confirming coliforms and Escherichia coli in foods (966.23 and 966.24). In this study, test portions were prepared and analyzed according to the conditions stated in both the AOAC methods and SimPlate directions for use. Six food types were artificially contaminated with coliform bacteria and E. coli: frozen burritos, frozen broccoli, fluid pasteurized milk, whole almond nut meats, cheese, and powdered cake mix. Method comparisons were conducted. Overall, the SimPlate method demonstrated <0.3 log difference for total coliform and E. coli counts compared to the AOAC reference methods for the majority of food types and levels analyzed. In all cases, the repeatability and reproducibility of the SimPlate CEc-CI method were not different from those of the reference methods and in certain cases, were statistically better than those of the AOAC 3-tube MPN methods. These results indicate that the SimPlate CEc-CI method and the reference culture methods are comparable for enumeration of both total coliforms and E. coli in foods.
Collapse
Affiliation(s)
| | - Andrew H Lienau
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - Nerie H Roa
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - Shannon T Green
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Haider S, Li J, Aggarwal J, Chambers R, Manocha P, Stephens J. PCV10 EPIDEMIOLOGICAL STUDY DESIGN TO UNDERSTAND CARDIOVASCULAR RISK FACTORS AND TREATMENT IN GENERAL PRACTICE PATIENTS IN LATIN AMERICA. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
13
|
Wesolowski R, Brufsky A, Chambers M, Bhattacharya S, Lustberg M, VanDeusen J, Sardesai S, Williams N, Noonan A, Phelps M, Grever M, Stephens J, Carson W, Ramaswamy B. Phase Ib study of heat shock protein 90 inhibitor, onalespib in combination with paclitaxel in patients with advanced, triple negative breast cancer (NCT02474173). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
14
|
Rosen AC, Bhat J, Soman S, Laird AR, Stephens J, Eickhoff SB, Fox PM, Long BY, Dinishak D, Ortega M, Lane B, Wintermark M, Hitchner E, Zhou W. P4-220: EVALUATION OF RESERVE AND RESILIENCE IN THE OLDER SURGICAL PATIENT. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Allyson C. Rosen
- VA Medical Center-Palo Alto; Palo Alto CA USA
- Stanford University; School of Medicine; Stanford CA USA
| | | | | | - Angela R. Laird
- The Neuroinformatics and Brain Connectivity Laboratory, Department of Physics; Florida International University; Miami FL USA
| | | | | | - P. Mickle Fox
- University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | | | | | | | - Barton Lane
- Stanford University; School of Medicine; Stanford CA USA
| | - Max Wintermark
- Stanford University; School of Medicine; Stanford CA USA
| | | | - Wei Zhou
- University of Arizona; Tucson AZ USA
| |
Collapse
|
15
|
Makhni EC, Meldau JE, Blanchett J, Borowsky P, Stephens J, Muh S, Moutzouros V. Correlation of PROMIS Physical Function, Pain Interference, and Depression in Pediatric and Adolescent Patients in the Ambulatory Sports Medicine Clinic. Orthop J Sports Med 2019; 7:2325967119851100. [PMID: 31263725 PMCID: PMC6593930 DOI: 10.1177/2325967119851100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Recently, interest has increased in incorporating the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes into clinical and research applications in sports medicine. The PROMIS forms have not been studied in pediatric and adolescent sports medicine patients. Purpose/Hypothesis: The goal of this study was to determine the correlation between PROMIS Computer Adaptive Test (CAT) forms measuring physical function, pain interference, and depression in pediatric and adolescent patients seen in the ambulatory sports medicine clinic. We hypothesized that there would be a negative correlation between physical function and pain interference as well as depression, as has been demonstrated in adult patient populations. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All patients aged 8 to 17 years seen by 3 shoulder and sports medicine providers were included in this study. Patients completed a series of PROMIS CAT forms at clinic visits, including the PROMIS-PF and PROMIS-UE (Physical Function and Upper Extremity; depending on the nature of the complaint), PROMIS-PI (Pain Interference), and PROMIS-Depression subscales. Pearson correlation coefficients were calculated between the PROMIS forms as well as with other patient demographic data. Results: A total of 236 patient visits (152 patients) were included in the study, comprising 712 total PROMIS CAT forms. A negative correlation was found between PROMIS-PF and both PROMIS-Depression (R = –0.34) and PROMIS-PI (R = –0.76). These correlations with PROMIS-Depression and PROMIS-PI were –0.21 and –0.75, respectively, when considering the PROMIS-UE CAT. Patient demographic information had minimal impact on PROMIS scores as well as on correlations between scores. Conclusion: Correlations between physical function, pain interference, and depression were found to be similar in pediatric patients as they are in adult patients, as measured by PROMIS CAT forms.
Collapse
|
16
|
Berryhill M, Arciniega H, Jones K, Stephens J, Gozenman F. Who, what, where and how much: tDCS and training effects on working memory. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
17
|
Bazan JG, Stephens J, Agnese D, Skoracki R, Arneson K, Reiland J, Gupta G, Gallagher K, McElroy S, Gupta N, White JR. Abstract OT2-04-04: Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-stage breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-04-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In women amenable to breast conserving therapy, lumpectomy followed by adjuvant whole breast irradiation (WBI) remains the standard of care. Randomized trials demonstrate that addition of a lumpectomy cavity boost significantly reduces the risk of ipsilateral breast tumor recurrences but also increases the risk of breast fibrosis. Contemporary randomized trials define the lumpectomy cavity boost volume as a 1.7 cm isometric expansion on the lumpectomy cavity as delineated on CT. However, identifying the lumpectomy cavity can be challenging, especially in women that receive adjuvant chemotherapy and in cases in which surgical clips are not present. Recently, the use of oncoplastic techniques in breast conserving surgery has increased. These techniques are used to prevent the poor cosmetic results that can occur when a large volume of breast tissue is resected. Women that undergo oncoplastic reconstruction represent especially difficult cases for lumpectomy cavity delineation. Retrospective series have evaluated the use of intraoperative electron radiotherapy (IOERT) as a boost prior to WBI in women receiving lumpectomy without oncoplastic reconstruction. In the largest series of IOERT boost prior to WBI the local control rate of this approach was >99%. Prospective data regarding IOERT boost in women undergoing oncoplastic reconstruction are limited. The advantages of this approach include direct visualization/irradiation of the tumor bed, sparing the skin of irradiation, and reducing the treatment time by ˜1 week. We hypothesize that IOERT boost followed by WBI will result in acceptably low rates of grade 3 fibrosis in women undergoing lumpectomy with oncoplastic reconstruction.
Trial Design: This is a single-arm, prospective study to evaluate the safety, toxicity and efficacy of IOERT boost at the time of breast conserving surgery in women with early-stage breast cancer undergoing oncoplastic reconstruction. Eligible women will receive 1 dose of 8 Gy to the surgical bed after lumpectomy but prior to oncoplastic reconstruction. Women will then receive adjuvant WBI of 40 Gy in 15 fractions or 50 Gy in 25 fractions.
Eligibility: Key criteria include age≥18 yo, clinically node-negative stage I/II, any breast cancer subtype.
Specific Aims: To determine the rate of grade 3 breast fibrosis at 1 year. Additional aims include surgical complication rates, cosmesis, and local regional cancer control.
Statistical Methods: Safety will be evaluated by the rate of surgical complications necessitating hospital readmission or return to the operating room within 30 days of surgery+IOERT. If ≥4 events in the first 10 patients, ≥7 events in the first 20 patients, or ≥9 events in the first 30 patients are seen, the study will be halted. We hypothesize that the grade 3 fibrosis rate in our study will be ≤5%. Assuming an actual rate of 4%, an unacceptable rate of 9%, and a drop-out rate of 10%, the expected sample size is 176.
Sites: Ohio State University, Avera Medical Group, University of North Carolina-Chapel Hill
Patient Accrual: Current accrual is 5/176.
Contact Information: Jose Bazan (jose.bazan2@osumc.edu)
Funding Source: Intraop Medical
Citation Format: Bazan JG, Stephens J, Agnese D, Skoracki R, Arneson K, Reiland J, Gupta G, Gallagher K, McElroy S, Gupta N, White JR. Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-04-04.
Collapse
Affiliation(s)
- JG Bazan
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - J Stephens
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - D Agnese
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - R Skoracki
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - K Arneson
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - J Reiland
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - G Gupta
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - K Gallagher
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - S McElroy
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - N Gupta
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - JR White
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| |
Collapse
|
18
|
Sardesai S, Liu J, Palettas M, Stephens J, Stover D, Williams N, Reinbolt R, VanDeusen J, Wesolowski R, Lustberg M, Ramaswamy B. Abstract P4-16-03: Cardiovascular outcomes and long term survival with discontinuation of adjuvant trastuzumab. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-16-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Trastuzumab (T) induced cardiomyopathy remains a significant limitation to adjuvant HER2 directed therapy. Recent studies have aimed to reduce cardiotoxicity through combination with non-anthracycline (non-A) chemotherapy or shorter treatment duration. However there is limited data regarding cardiac outcomes and long-term survival with early discontinuation of adjuvant T.
Methods: An IRB-approved single-institution retrospective analysis was performed for 401 consecutive patients with non-metastatic HER2+ breast cancer treated at the Ohio State University Comprehensive Cancer Center from 2005-2015. Medical records were reviewed for clinicopathologic features, systemic treatment and survival information. Disease Free Survival (DFS) was defined as time from diagnosis to first recurrence (loco-regional or distant recurrence) including second primary breast cancer or death. Overall survival (OS) was defined as time from diagnosis to death or last known follow up. OS and DFS estimates were generated using Kaplan Meier methods and compared using Log-rank tests. Cox proportional hazard models were used to calculate univariate and multivariate hazard ratios for OS and DFS.
Results: A total of 371/401 (92.5%) patients received adjuvant T (n= 401, mean age: 59.4 years; stage 1: 120, 30%; stage II: 194, 48%; stage III: 87, 22%; ER+: 235, 58%); among whom 106/371 (28.6%) patients held adjuvant T for any reason. Median duration of therapy in patients with any interruption with T was 11.3 (0.5-16.9) months and 23/371 (6.9%) received less than 6 months of adjuvant T. Cardiomyopathy (measured as LVEF decline on 2D echocardiogram or MUGA >= 15 points) was the most common reason for withholding T (66/106, 62.3%). The majority of these patients received a cardiology referral (77/ 106, 72.6%) with a 13 day mean time to evaluation in outpatient clinic. Patients receiving non-A chemotherapy and beta blockers or ACE inhibitors during treatment were significantly less likely to experience cardiomyopathy (A vs non-A: 49/190, 25.8% vs. 16/136, 11.8% p=0.002); (Med vs no Med: 7/148, 4.73% vs 59/184, 32.1%; p<0.001). Log-rank tests indicate a significant worsening in OS and DFS for patients who discontinued T (p=0.021, 0.001 respectively). Multivariate analyses confirmed significant worsening in DFS after adjusting for age, stage, ER , node status, and cardiomyopathy (Adjusted HR: 4.0[2.02 – 7.92], p< 0.001)
Table 1- Discontinuation of adjuvant trastuzumab Number of patients (%)Initial treatment371Completed therapy with no interruption265 (71.4)Interruption of therapy for minimum of 2 weeks64 (17.2)Permanently discontinued42 (11.3)
Conclusion: Discontinuation of adjuvant trastuzumab, most often from cardiomyopathy, is an independent prognostic marker for worse DFS in non-metastatic HER2 positive breast cancer. Non-anthracycline chemotherapy and use of cardio-protective medication is associated with significantly reduced incidence of cardiotoxicity in this population. Future prospective studies should consider optimizing cardiovascular function to avoid interruption in adjuvant HER 2 directed therapy.
Citation Format: Sardesai S, Liu J, Palettas M, Stephens J, Stover D, Williams N, Reinbolt R, VanDeusen J, Wesolowski R, Lustberg M, Ramaswamy B. Cardiovascular outcomes and long term survival with discontinuation of adjuvant trastuzumab [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-03.
Collapse
Affiliation(s)
- S Sardesai
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - J Liu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - M Palettas
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - J Stephens
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - D Stover
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - N Williams
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - R Reinbolt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - J VanDeusen
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - R Wesolowski
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - M Lustberg
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - B Ramaswamy
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| |
Collapse
|
19
|
Buck K, Southerland L, Schwaderer A, Exline M, Hebert C, Lampert B, Stephens J, Caterino J. 140EMF Older Adult Emergency Department Patients With Dyspnea: Epidemiology and Improved Diagnostic Strategies. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.145] [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: 11/15/2022]
|
20
|
Amaducci A, Anderson R, Frey A, Sheen A, Colon M, Roth P, Stephens J, Weaver K, Burmeister D, Greenberg M, Cannon R. 361 Sex-Specific Outcomes in a Substance Use Intervention Program. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.366] [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: 10/28/2022]
|
21
|
Rosen AC, Soman S, Bhat J, Laird AR, Stephens J, Eickhoff SB, Fox PM, Long B, Dinishak D, Ortega M, Lane B, Wintermark M, Hitchner E, Zhou W. Convergence Analysis of Micro-Lesions (CAML): An approach to mapping of diffuse lesions from carotid revascularization. Neuroimage Clin 2018; 18:553-559. [PMID: 29868451 PMCID: PMC5984594 DOI: 10.1016/j.nicl.2018.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/19/2017] [Accepted: 01/18/2018] [Indexed: 11/25/2022]
Abstract
Carotid revascularization (endarterectomy, stenting) prevents stroke; however, procedure-related embolization is common and results in small brain lesions easily identified by diffusion weighted magnetic resonance imaging (DWI). A crucial barrier to understanding the clinical significance of these lesions has been the lack of a statistical approach to identify vulnerable brain areas. The problem is that the lesions are small, numerous, and non-overlapping. Here we address this problem with a new method, the Convergence Analysis of Micro-Lesions (CAML) technique, an extension of the Anatomic Likelihood Analysis (ALE). The method combines manual lesion tracing, constraints based on known lesion patterns, and convergence analysis to represent regions vulnerable to lesions as probabilistic brain atlases. Two studies were conducted over the course of 12 years in an active, vascular surgery clinic. An analysis in an initial group of 126 patients at 1.5 T MRI was cross-validated in a second group of 80 patients at 3T MRI. In CAML, lesions were manually defined and center points identified. Brains were aligned according to side of surgery since this factor powerfully determines lesion distribution. A convergence based analysis, was performed on each of these groups. Results indicated the most consistent region of vulnerability was in motor and premotor cortex regions. Smaller regions common to both groups included the dorsolateral prefrontal cortex and medial parietal regions. Vulnerability of motor cortex is consistent with previous work showing changes in hand dexterity associated with these procedures. The consistency of CAML also demonstrates the feasibility of this new approach to characterize small, diffuse, non-overlapping lesions in patients with multifocal pathologies. Convergence Analysis of Micro-Lesions technique finds patterns in diffuse lesions. Lesions from carotid revascularization affect consistent brain targets. Motor cortex is the most vulnerable brain region to these lesions.
Collapse
Affiliation(s)
- Allyson C Rosen
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Department of Psychiatry, Stanford University, Stanford, CA 94305, United States.
| | - Salil Soman
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA 00215, United States
| | - Jyoti Bhat
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Palo Alto Veterans Institute for Research, Palo Alto, CA 94304, United States
| | - Angela R Laird
- Department of Physics, School of Integrated Science and Humanity, Florida International University, Miami, FL 33199, United States
| | - Jeffrey Stephens
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States
| | - Simon B Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - P Mickle Fox
- Research Imaging Institute, The University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Becky Long
- Department of Surgery, Stanford University, Stanford, CA 94305, United States; Department of Surgery, Texas Tech University Health Science Center El Paso, TX 79905, United States
| | - David Dinishak
- Palo Alto University, Redwood City, CA 94063, United States
| | - Mario Ortega
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Barton Lane
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Department of Radiology, Stanford University, Stanford, CA 94305, United States
| | - Max Wintermark
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Department of Radiology, Stanford University, Stanford, CA 94305, United States
| | - Elizabeth Hitchner
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Department of Vascular Surgery, Stanford University, Stanford, CA 94305, United States
| | - Wei Zhou
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Department of Vascular Surgery, Stanford University, Stanford, CA 94305, United States; Department of Surgery, Tucson, AZ 85724-5066, United States
| |
Collapse
|
22
|
Bazan JG, Stephens J, Terando A, Skoracki R, McElroy S, Sexton J, Gupta N, White J. Abstract OT2-03-01: Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-Stage breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-03-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: In women amenable to breast conserving therapy, lumpectomy followed by adjuvant whole breast irradiation (WBI) remains the standard of care. Randomized trials have demonstrated that the addition of a lumpectomy cavity boost significantly reduces the risk of ipsilateral breast tumor recurrences but also increases the risk of breast fibrosis. Contemporary randomized trials define the lumpectomy cavity boost volume as a 1.7 cm isometric expansion on the lumpectomy cavity as delineated on CT. However, identifying the lumpectomy cavity can be challenging, especially in women that receive adjuvant chemotherapy and in cases in which surgical clips are not present. Recently, the use of oncoplastic techniques in breast conserving surgery has increased. These techniques are used to prevent the poor cosmetic results that can occur when a large volume of breast tissue is resected. Women that undergo oncoplastic reconstruction represent especially difficult cases for lumpectomy cavity delineation. Retrospective series have evaluated the use of intraoperative electron radiotherapy (IOERT) as a boost prior to WBI in women receiving lumpectomy without oncoplastic reconstruction. In the largest series of IOERT boost prior to WBI the local control rate of this approach was >99%. Prospective data regarding IOERT boost in women undergoing oncoplastic reconstruction are limited. Advantages of this approach include direct visualization/irradiation of the tumor bed, sparing the skin of irradiation, and reducing the treatment time by ˜1 week. We hypothesize that IOERT boost followed by WBI will result in acceptably low rates of grade 3 fibrosis in women undergoing lumpectomy with oncoplastic reconstruction.
Trial Design: This is a single-arm, prospective study to evaluate the safety, toxicity and efficacy of IOERT boost at the time of breast conserving surgery in women with early-stage breast cancer undergoing oncoplastic reconstruction. Eligible women will receive 1 dose of 8 Gy to the surgical bed after lumpectomy but prior to oncoplastic reconstruction. Women will then receive adjuvant WBI of 40 Gy in 15 fractions or 50 Gy in 25 fractions.
Eligibility: Key inclusion criteria include age≥18 yo, clinically node-negative stage I/II, any breast cancer subtype.
Specific Aims: Our primary aim is to determine the rate of grade 3 breast fibrosis at 1 year. Additional aims include surgical complication rates, cosmesis, and local regional cancer control.
Statistical Methods: Safety will be evaluated by the rate of surgical complications necessitating hospital readmission or return to the operating room within 30 days of surgery+IOERT. If ≥4 events in the first 10 patients, ≥7 events in the first 20 patients, or ≥9 events in the first 30 patients are seen, the study will be halted. We hypothesize that the grade 3 fibrosis rate in our study will be ≤5%. Assuming an actual rate of 4%, an unacceptable rate of 9%, and a drop-out rate of 10%, the expected sample size is 176.
Patient Accrual: Current accrual is 0 of 176.
Contact Information: Soyhum McElroy (soyhun.mcelroy@osumc.edu) or Jose Bazan (jose.bazan2@osumc.edu)
Funding Source: Intraop Medical
Citation Format: Bazan JG, Stephens J, Terando A, Skoracki R, McElroy S, Sexton J, Gupta N, White J. Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-Stage breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-03-01.
Collapse
Affiliation(s)
- JG Bazan
- The Ohio State University, Columbus, OH
| | | | - A Terando
- The Ohio State University, Columbus, OH
| | | | - S McElroy
- The Ohio State University, Columbus, OH
| | - J Sexton
- The Ohio State University, Columbus, OH
| | - N Gupta
- The Ohio State University, Columbus, OH
| | - J White
- The Ohio State University, Columbus, OH
| |
Collapse
|
23
|
Stephens J, Alonso PL, Byass P, Snow RW. Tropical Epidemiology: A System for Continuous Demographic Monitoring of a Study Population. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1635562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract:Epidemiologists in many developing countries, where official demographic services are unavailable, have to include some demographic functions in their work. The usual method of documenting a study population for epidemiological research in a developing country consists of three stages: mapping, enumeration and vital registration. This paper considers the last element of this process, detailing the development of a suitable data system and explaining how its implementation using microcomputers and a database management system can help in the creation of an on-line continuous vital registration system for a study population as an epidemiological tool. The issues covered are data collection, entry and analysis, and the advantages of such a system for use in epidemiological research in developing countries are also discussed.
Collapse
|
24
|
Alber KF, Dachsel M, Gilmore A, Lawrenson P, Matsa R, Smallwood N, Stephens J, Tabiowo E, Walden A. Focused Acute Medicine Ultrasound (FAMUS). Acute Med 2018; 17:164-167. [PMID: 30129952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Point of care ultrasound (POCUS) has seen steady growth in its use and applications in aiding clinicians in the management of acutely unwell patients. Focused Acute Medicine Ultrasound (FAMUS) is the standard created specifically for Acute Medicine physicians and is endorsed by the Society for Acute Medicine and recognised by the Acute Internal Medicine (AIM) training committee as a specialist skill. In this document we present a curriculum mapping exercise which utilises a 'knowledge, skills and behaviours' framework and incorporates the GMC's 'Good Medical Practice' (GMP) domains. We believe this will provide a standard for consideration of integrating focused ultrasound in AIM training programmes, with the aim of ultimately incorporating FAMUS as a core skill for all AIM trainees.
Collapse
Affiliation(s)
- K F Alber
- Ultrasound fellow, Royal Berkshire hospital, UK
| | - M Dachsel
- Consultant in Acute Internal Medicine, East Surrey hospital
| | - A Gilmore
- Consultant in Acute Internal Medicine, Wirral University hospital
| | - P Lawrenson
- Consultant in Acute Internal Medicine, Wirral University hospital
| | - R Matsa
- Consultant in Acute Internal and Intensive Care Medicine, Royal Stoke University hospital
| | - N Smallwood
- Consultant in Acute Internal Medicine, East Surrey hospital
| | - J Stephens
- Consultant in Acute Internal and Intensive Care Medicine, Royal Cornwall hospital
| | - E Tabiowo
- Consultant in Acute Internal Medicine, Royal Glamorgan hospital
| | - A Walden
- Consultant in Acute Internal and Intensive Care Medicine, Royal Berkshire hospital
| |
Collapse
|
25
|
Alber KF, Dachsel M, Gilmore A, Lawrenson P, Matsa R, Smallwood N, Stephens J, Tabiowo E, Walden A. Curriculum mapping for Focused Acute Medicine Ultrasound (FAMUS). Acute Med 2018; 17:168. [PMID: 30129953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Point of care ultrasound (POCUS) in the hands of the non-radiologist has seen a steady growth in popularity amongst emergency, intensive care and acute medical physicians. Increased accessibility to portable, purpose-built ultrasound machines has meant that clinicians often have access to a safe and non-invasive tool to enhance their management of the unwell.
Collapse
Affiliation(s)
- K F Alber
- Ultrasound fellow, Royal Berkshire hospital, UK
| | - M Dachsel
- Consultant in Acute Internal Medicine, East Surrey hospital
| | - A Gilmore
- Consultant in Acute Internal Medicine, Wirral University hospital
| | - P Lawrenson
- Consultant in Acute Internal Medicine, Wirral University hospital
| | - R Matsa
- Consultant in Acute Internal and Intensive Care Medicine, Royal Stoke University hospital
| | - N Smallwood
- Consultant in Acute Internal Medicine, East Surrey hospital
| | - J Stephens
- Consultant in Acute Internal and Intensive Care Medicine, Royal Cornwall hospital
| | - E Tabiowo
- Consultant in Acute Internal Medicine, Royal Glamorgan hospital
| | - A Walden
- Consultant in Acute Internal and Intensive Care Medicine, Royal Berkshire hospital
| |
Collapse
|
26
|
Abstract
BACKGROUND There has been a great expansion in patient-based outcome measures to face the ever-increasing demand to demonstrate surgical efficacy. However, surgeons have not adopted until now any systematic outcome instrument. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a validated sinonasal outcome score in sinonasal and septorhinoplasty surgery but does not measure aesthetic outcome. The aim of this paper is to validate a modification to the Sino-Nasal Outcomes Test-22 (SNOT-22) with a new question regarding the shape of the nose (SNOT-23). METHODOLOGY We conducted a prospective cohort study on 69 consecutive patients undergoing septorhinoplasty and a control group of healthy volunteers. Reproducibility, responsiveness to treatment, known group differences and validity of the SNOT-23 were analysed. Scores were compared to visual analogue scales, nasal obstruction symptoms evaluation (NOSE) score and nasal inspiratory peak flow. RESULTS SNOT-23 has good test-retest reliability and is a valid outcome measure for assessing response to surgery especially with regards to shape of the nose and nasal obstruction when compared to other patient reported measures. CONCLUSION SNOT-23 is a valid and reliable tool that can be easily used in routine clinical practice to assess the functional and aesthetic outcomes from septorhinoplasty surgery. The SNOT-23 could be adopted as a universal, easy to use tool in rhinology clinics for the assessment of response to septorhinoplasty and sinus surgery.
Collapse
Affiliation(s)
- A Takhar
- Department of Facial Plastics and Rhinology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - J Stephens
- Department of Facial Plastics and Rhinology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - P S Randhawa
- Department of Facial Plastics and Rhinology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - A L Poirrier
- Department of Facial Plastics and Rhinology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - P Andrews
- Department of Facial Plastics and Rhinology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| |
Collapse
|
27
|
Wakelam OC, Dimitriadis PA, Stephens J. The use of FloSeal haemostatic sealant in the management of epistaxis: a prospective clinical study and literature review. Ann R Coll Surg Engl 2017; 99:28-30. [PMID: 27490981 PMCID: PMC5392783 DOI: 10.1308/rcsbull.2017.28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2016] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION It is standard practice in the UK that if conservative measures or chemical cautery fail to control epistaxis, patients receive nasal packing which is often uncomfortable, requires admission and has well documented associated morbidity. Our study aims to evaluate the use of FloSeal haemostatic sealant in managing patients with epistaxis. MATERIALS AND METHODS Patients were identified from those referred with active epistaxis. A successful outcome was defined as complete haemostasis with FloSeal alone, with no further significant bleeding requiring admission or further interventions in the subsequent 7 days. Patients reported satisfaction using a ten-point visual analogue scale. Ear, nose and throat doctors recorded patient demographics, time to prepare FloSeal, length of stay, need for further treatment and adverse events on an electronic database. RESULTS 30 patients were enrolled in the study. The mean time to prepare FloSeal was 5 minutes. The success rate of FloSeal was 90%. The mean length of stay was 2.75 hours. The mean patient satisfaction with FloSeal was 8.4/10. No adverse events occurred. DISCUSSION FloSeal was found to be effective in controlling anterior epistaxis. There was a single case of posterior epistaxis which required operative management. The literature largely supports FloSeal in anterior epistaxis, but indicates sphenopalatine artery ligation as the definitive management of posterior epistaxis. CONCLUSIONS Our data support the use of FloSeal in patients with anterior epistaxis not controlled with conservative measures or chemical cautery. It was found to be easy to use, is well tolerated by patients and is efficient in financial terms.
Collapse
Affiliation(s)
- O C Wakelam
- ENT Department, Lister Hospital , Stevenage , UK
| | | | - J Stephens
- ENT Department, Lister Hospital , Stevenage , UK
| |
Collapse
|
28
|
Dejesus E, Elion R, Ramgopal M, Wade BH, Sloan L, Edelstein H, Pierone G, Slim J, Stephens J, Yan M, Tran-Muchowski C, Rhee M. Efficacy and Safety of Tenofovir Alafenamide versus Tenofovir Disoproxil Fumarate in HIV-infected, Virologically Suppressed Black and Non-Blacks Adults Through Week 48: Subgroup Analysis of a Randomized Switch Study. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1210] [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)
| | | | - Moti Ramgopal
- Midway Immunology and Research Center, Fort Pierce, FL
| | - Barbara H. Wade
- Center for the Prevention and Treatment of Infections, Pensacola, FL
| | - Louis Sloan
- North Texas Infectious Diseases Consultants PA, Dallas, TX
| | | | - Gerald Pierone
- AIDS Research and Treatment Center of the Treasure Coast, Vero Beach, FL
| | - Jihad Slim
- Saint. Michael's Medical Center, Newark, NJ
| | | | - Mingjin Yan
- Biostatistics, Gilead Sciences, Inc., Foster City, CA
| | | | | |
Collapse
|
29
|
Wilcock AA, van der Arend H, Darling K, Scholz J, Siddall R, Snigg C, Stephens J. An Exploratory Study of People's Perceptions and Experiences of Wellbeing. Br J Occup Ther 2016. [DOI: 10.1177/030802269806100206] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper describes an exploratory study aimed at understanding peoples perceptions and experiences of wellbeing. As health and wellbeing are considered by world and national health authorities to be closely related, occupational therapists along with other health workers need to know more about wellbeing, particularly from the perspective of ‘the people’. Using a questionnaire, seven cluster samples of 20 people, giving a total of 140 participants, were asked to define their concept of wellbeing, how it felt to them and how often they experienced the feeling. Data were also collected about nationality, marital status, employment, income, religion and levels of education because these have been identified as affecting wellbeing. In this study, wellbeing was described as happiness, peace, mind and body health and self-esteem, and was strongly associated with occupations as varied as work, relaxation and dressing up; relationships; and environments. No particular associations were found with any of the demographic data.
Collapse
|
30
|
Stephens J, Southern V. Building a bright future: ‘remote’ conversations for telesolutions in practice. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
31
|
Stephens J, Salorio C, Denckla M, Mostofsky S, Suskauer S. Subtle Motor Findings During Recovery from Pediatric Traumatic Brain Injury: A Preliminary Report. J Mot Behav 2016; 49:20-26. [PMID: 27635631 DOI: 10.1080/00222895.2016.1204267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pediatric traumatic brain injury (TBI) is a heterogeneous condition, varying in both severity and sequelae. The long-term motor deficits following severe TBI requiring inpatient rehabilitation are better established than those following milder forms of TBI. The authors examined motor performance 2 and 12 months postinjury in children without overt motor impairment using standard measures of upper limb function and the Physical and Neurological Examination for Subtle Signs (PANESS). The PANESS was sensitive to differences between children with TBI and uninjured children as well as to changes in children with TBI over time. These data suggest that subtle motor deficits are present after milder forms of TBI and, particularly those related to balance and gait, may persist even 12 months postinjury.
Collapse
Affiliation(s)
- J Stephens
- a Kennedy Krieger Institute , Baltimore , Maryland.,b Department of Physical Medicine and Rehabilitation , Johns Hopkins School of Medicine , Baltimore , Maryland
| | - C Salorio
- a Kennedy Krieger Institute , Baltimore , Maryland
| | - M Denckla
- a Kennedy Krieger Institute , Baltimore , Maryland.,c Department of Neurology , Johns Hopkins School of Medicine , Baltimore , Maryland.,d Department of Psychiatry , Johns Hopkins School of Medicine , Baltimore , Maryland
| | - S Mostofsky
- a Kennedy Krieger Institute , Baltimore , Maryland.,c Department of Neurology , Johns Hopkins School of Medicine , Baltimore , Maryland.,e Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore , Maryland
| | - S Suskauer
- a Kennedy Krieger Institute , Baltimore , Maryland.,b Department of Physical Medicine and Rehabilitation , Johns Hopkins School of Medicine , Baltimore , Maryland.,e Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore , Maryland
| |
Collapse
|
32
|
Wakelam OC, Dimitriadis PA, Stephens J. The use of FloSeal haemostatic sealant in the management of epistaxis: a prospective clinical study and literature review. Ann R Coll Surg Engl 2016. [PMID: 27490981 DOI: 10.1308/rcsann.2016.0224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION It is standard practice in the UK that if conservative measures or chemical cautery fail to control epistaxis, patients receive nasal packing which is often uncomfortable, requires admission and has well documented associated morbidity. Our study aims to evaluate the use of FloSeal haemostatic sealant in managing patients with epistaxis. MATERIALS AND METHODS Patients were identified from those referred with active epistaxis. A successful outcome was defined as complete haemostasis with FloSeal alone, with no further significant bleeding requiring admission or further interventions in the subsequent 7 days. Patients reported satisfaction using a ten-point visual analogue scale. Ear, nose and throat doctors recorded patient demographics, time to prepare FloSeal, length of stay, need for further treatment and adverse events on an electronic database. RESULTS 30 patients were enrolled in the study. The mean time to prepare FloSeal was 5 minutes. The success rate of FloSeal was 90%. The mean length of stay was 2.75 hours. The mean patient satisfaction with FloSeal was 8.4/10. No adverse events occurred. DISCUSSION FloSeal was found to be effective in controlling anterior epistaxis. There was a single case of posterior epistaxis which required operative management. The literature largely supports FloSeal in anterior epistaxis, but indicates sphenopalatine artery ligation as the definitive management of posterior epistaxis. CONCLUSIONS Our data support the use of FloSeal in patients with anterior epistaxis not controlled with conservative measures or chemical cautery. It was found to be easy to use, is well tolerated by patients and is efficient in financial terms.
Collapse
Affiliation(s)
- O C Wakelam
- ENT Department, Lister Hospital , Stevenage , UK
| | | | - J Stephens
- ENT Department, Lister Hospital , Stevenage , UK
| |
Collapse
|
33
|
Stephens J, Halson S, Vaile J, Slater G, Askew C. Effect of body composition on core temperature responses to post-exercise cold water immersion. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
34
|
Stephens J, Evans B, Holmes S. Functional vs anatomical buttresses of the skull base. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.243] [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: 10/22/2022]
|
35
|
Dryden M, Baguneid M, Eckmann C, Corman S, Stephens J, Solem C, Li J, Charbonneau C, Baillon-Plot N, Haider S. Pathophysiology and burden of infection in patients with diabetes mellitus and peripheral vascular disease: focus on skin and soft-tissue infections. Clin Microbiol Infect 2015. [PMID: 26198368 DOI: 10.1016/j.cmi.2015.03.024] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diabetes mellitus affects 284 million adults worldwide and is increasing in prevalence. Accelerated atherosclerosis in patients with diabetes mellitus contributes an increased risk of developing cardiovascular diseases including peripheral vascular disease (PVD). Immune dysfunction, diabetic neuropathy and poor circulation in patients with diabetes mellitus, especially those with PVD, place these patients at high risk for many types of typical and atypical infections. Complicated skin and soft-tissue infections (cSSTIs) are of particular concern because skin breakdown in patients with advanced diabetes mellitus and PVD provides a portal of entry for bacteria. Patients with diabetes mellitus are more likely to be hospitalized with cSSTIs and to experience related complications than patients without diabetes mellitus. Patients with PVD requiring lower extremity bypass are also at high risk of surgical site and graft infections. Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent causative pathogen in cSSTIs, and may be a significant contributor to surgical site infections, especially in patients who are colonized with MRSA on hospital admission. Patients with cSSTIs and diabetes mellitus or PVD experience lower clinical success rates than patients without these comorbidities, and may also have a longer length of hospital stay and higher risk of adverse drug events. Clinicians should be vigilant in recognizing the potential for infection with multi-drug-resistant organisms, especially MRSA, in these populations and initiating therapy with appropriate antibiotics.
Collapse
Affiliation(s)
- M Dryden
- Hampshire Hospitals NHS Foundation Trust, Coitbury House Friarsgate, Winchester, UK
| | - M Baguneid
- Department of Vascular Surgery, University Hospital of South Manchester NHS, Manchester, UK
| | - C Eckmann
- Klinikum Peine, Academic Hospital of Medical University Hannover, Peine, Germany
| | - S Corman
- Pharmerit International, Bethesda, MD, USA
| | - J Stephens
- Pharmerit International, Bethesda, MD, USA.
| | - C Solem
- Pharmerit International, Bethesda, MD, USA
| | - J Li
- Pfizer Inc., San Diego, CA, USA
| | | | | | | |
Collapse
|
36
|
Ektare V, Khachatryan A, Xue M, Dunne M, Johnson K, Stephens J. Assessing the economic value of avoiding hospital admissions by shifting the management of gram+ acute bacterial skin and skin-structure infections to an outpatient care setting. J Med Econ 2015; 18:1092-101. [PMID: 26368787 DOI: 10.3111/13696998.2015.1078339] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate, from a US payer perspective, the cost offsets of treating gram positive acute bacterial skin and skin-structure infections (ABSSSI) with varied hospital length of stay (LOS) followed by outpatient care, as well as the cost implications of avoiding hospital admission. METHODS Economic drivers of care were estimated using a literature-based economic model incorporating inpatient and outpatient components. The model incorporated equal efficacy, adverse events (AE), resource use, and costs from literature. Costs of once- and twice-daily outpatient infusions to achieve a 14-day treatment were analyzed. Sensitivity analyses were performed. Costs were adjusted to 2015 US$. RESULTS Total non-drug medical cost for treatment of ABSSSI entirely in the outpatient setting to avoid hospital admission was the lowest among all scenarios and ranged from $4039-$4924. Total non-drug cost for ABSSSI treated in the inpatient setting ranged from $9813 (3 days LOS) to $18,014 (7 days LOS). Inpatient vs outpatient cost breakdown was: 3 days inpatient ($6657)/11 days outpatient ($3156-$3877); 7 days inpatient ($15,017)/7 days outpatient ($2495-$2997). Sensitivity analyses revealed a key outpatient cost driver to be peripherally inserted central catheter (PICC) costs (average per patient cost of $873 for placement and $205 for complications). LIMITATIONS Drug and indirect costs were excluded and resource use was not differentiated by ABSSSI type. It was assumed that successful ABSSSI treatment takes up to 14 days per the product labels, and that once-daily and twice-daily antibiotics have equal efficacy. CONCLUSION Shifting ABSSSI care to outpatient settings may result in medical cost savings greater than 53%. Typical outpatient scenarios represent 14-37% of total medical cost, with PICC accounting for 28-43% of the outpatient burden. The value of new ABSSSI therapies will be driven by eliminating the need for PICC line, reducing length of stay and the ability to completely avoid a hospital stay.
Collapse
Affiliation(s)
- V Ektare
- a Pharmerit International , Bethesda , MD , USA
| | | | - M Xue
- a Pharmerit International , Bethesda , MD , USA
| | - M Dunne
- b Durata Therapeutics , Chicago , IL , USA
| | - K Johnson
- b Durata Therapeutics , Chicago , IL , USA
| | - J Stephens
- a Pharmerit International , Bethesda , MD , USA
| |
Collapse
|
37
|
Raju R, Kazmi N, Stephens J, Delisle K, Malhotra P, Callister M. 44: Haemoptysis with a normal chest X-ray – what are the yields of CT and bronchoscopy? Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
38
|
Takhar A, Stephens J, Randhawa P, Poirrier A, Andrews P. Validation of the sino-nasal outcome test-23 in septorhinoplasty surgery. Rhinology 2014. [DOI: 10.4193/rhin14.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
39
|
Syme D, Popovichev S, Conroy S, Lengar I, Snoj L, Sowden C, Giacomelli L, Hermon G, Allan P, Macheta P, Plummer D, Stephens J, Batistoni P, Prokopowicz R, Jednorog S, Abhangi M, Makwana R. Fusion yield measurements on JET and their calibration. Fusion Engineering and Design 2014. [DOI: 10.1016/j.fusengdes.2014.07.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Patel D, Niederman MS, Li JZ, Mcnamara R, Haider S, Stephens J. An Economic Model to Compare the Different Empiric and First/Second Line Treatment Regimens for Suspected Methicillin-Resistant Staphylococcus Aureus Nosocomial Pneumonia. Value Health 2014; 17:A674. [PMID: 27202481 DOI: 10.1016/j.jval.2014.08.2499] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- D Patel
- Pharmerit North America LLC, Bethesda, MD, USA
| | | | - J Z Li
- Pfizer, Inc., San Diego, CA, USA
| | | | | | - J Stephens
- Pharmerit International, Bethesda, MD, USA
| |
Collapse
|
41
|
Alexakis C, Davies G, Stephens J, Clark S, Rogers S, Poullis A. Perspectives and attitudes of young patients with inflammatory bowel disease: symptoms, burden of disease and communication with their healthcare professionals. Frontline Gastroenterol 2014; 5:197-202. [PMID: 28839770 PMCID: PMC5369726 DOI: 10.1136/flgastro-2013-100400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) affects a significant proportion of young patients in the UK. The role of the healthcare professional, and their relationship with the young patient is particularly important at this difficult stage of their life, when education, social integration and career planning, can be dramatically affected by this consuming condition. OBJECTIVES To address the attitudes, experiences and erspectives of young patients suffering from IBD, focusing particularly on the relationship between sufferer and healthcare provider. METHODS Crohn's and Colitis UK invited its young members to respond to a detailed internet based questionnaire addressing various aspects of patients' disease and their relationship with respective healthcare workers. RESULTS 1081 patients aged 29 years or less responded. Self reported burden of illness was high with only 12% respondents free from a disease flare in the previous 12 months with almost half being hospitalised in the same period. Quality of ommunication with healthcare providers was generally high, with three-quarters of patients feeling appropriately empowered in their healthcare decisions. The IBD nurse specialist was highlighted as a particularly valuable member of the team, scoring the highest of the professional groups in communication comfort scores, as well as being nominated by the patients as the preferred professional group to discuss their disease with. CONCLUSIONS The results emphasize the considerable impact of the disease that this group is encumbered with, and identifies areas in the patient-professional relationship that can be augmented to improve the overall healthcare of this complex and fragile subgroup of patients.
Collapse
Affiliation(s)
- C Alexakis
- Department of Gastroenterology, St George's Hospital, London, UK
| | - G Davies
- Crohn's and Colitis UK, Hertfordshire, UK
| | - J Stephens
- Crohn's and Colitis UK, Hertfordshire, UK
| | - S Clark
- Crohn's and Colitis UK, Hertfordshire, UK
| | - S Rogers
- Crohn's and Colitis UK, Hertfordshire, UK
| | - A Poullis
- Department of Gastroenterology, St George's Hospital, London, UK
| |
Collapse
|
42
|
Joehlin-Price A, Perrino C, Stephens J, Backes F, Goodfellow P, Cohn D, Suarez A. Body mass index (BMI) associations, including mismatch repair protein expression, in 1051 endometrial carcinomas. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
43
|
Stephens J, Dickens J, Neuber A. Semiempirical wide-range conductivity model with exploding wire verification. Phys Rev E Stat Nonlin Soft Matter Phys 2014; 89:053102. [PMID: 25353899 DOI: 10.1103/physreve.89.053102] [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] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Indexed: 06/04/2023]
Abstract
Based on well-established physical relationships, a semiempirical set of equations dictating the electrical conductivity of dense, strongly coupled, partially ionized copper is presented. With the empirical coefficients, the model is tuned to experimental conductivity data obtained from exploding wire experiments [A. W. DeSilva and J. D. Katsouros, Phys. Rev. E 57, 5945 (1998)]. The result is a wide-range conductivity model, with demonstrated accuracy from room temperature-density conditions to 0.01 g/cm(3) and 30 kK. Using magnetohydrodynamic simulation the ability to utilize the conductivity model for predictive simulations is demonstrated. A complete electrical conductivity dataset for copper has been made available to the public.
Collapse
Affiliation(s)
- J Stephens
- Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
| | - J Dickens
- Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
| | - A Neuber
- Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
| |
Collapse
|
44
|
Drgona L, Khachatryan A, Stephens J, Charbonneau C, Kantecki M, Haider S, Barnes R. Clinical and economic burden of invasive fungal diseases in Europe: focus on pre-emptive and empirical treatment of Aspergillus and Candida species. Eur J Clin Microbiol Infect Dis 2014; 33:7-21. [PMID: 24026863 PMCID: PMC3892112 DOI: 10.1007/s10096-013-1944-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/29/2013] [Indexed: 11/23/2022]
Abstract
Invasive fungal diseases (IFDs) have been widely studied in recent years, largely because of the increasing population at risk. Aspergillus and Candida species remain the most common causes of IFDs, but other fungi are emerging. The early and accurate diagnosis of IFD is critical to outcome and the optimisation of treatment. Rapid diagnostic methods and new antifungal therapies have advanced disease management in recent years. Strategies for the prevention and treatment of IFDs include prophylaxis, and empirical and pre-emptive therapy. Here, we review the available primary literature on the clinical and economic burden of IFDs in Europe from 2000 to early 2011, with a focus on the value and outcomes of different approaches.
Collapse
Affiliation(s)
- L. Drgona
- Department of Haematology/Oncology, National Cancer Institute and Comenius University, Bratislava, Slovakia
| | - A. Khachatryan
- Pharmerit International, 4350 East West Highway, Suite 430, Bethesda, MD 20814 USA
| | - J. Stephens
- Pharmerit International, 4350 East West Highway, Suite 430, Bethesda, MD 20814 USA
| | - C. Charbonneau
- Pfizer Global Outcomes Research, Pfizer Inc., New York, NY USA
| | - M. Kantecki
- Pfizer International Operations, Pfizer Inc., Paris, France
| | - S. Haider
- Pfizer Global Research and Development, Pfizer Inc., Groton, CT USA
| | - R. Barnes
- Cardiff University School of Medicine, Cardiff, UK
| |
Collapse
|
45
|
Cooper A, Stephens J, Ketheesan N, Govan B. Detection ofCoxiella burnetiiDNA in Wildlife and Ticks in Northern Queensland, Australia. Vector Borne Zoonotic Dis 2013. [DOI: 10.1089/vbz.2011.0853] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [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)
- A. Cooper
- Discipline of Microbiology and Immunology, School of Veterinary & Biomedical Sciences, James Cook University, Townsville, Queensland, Australia
| | - J. Stephens
- Discipline of Microbiology and Immunology, School of Veterinary & Biomedical Sciences, James Cook University, Townsville, Queensland, Australia
| | - N. Ketheesan
- Discipline of Microbiology and Immunology, School of Veterinary & Biomedical Sciences, James Cook University, Townsville, Queensland, Australia
| | - B. Govan
- Discipline of Microbiology and Immunology, School of Veterinary & Biomedical Sciences, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
46
|
V Teijlingen E, Simkhada P, Stephens J, Simkhada B, Rogers SW, Sharma S. Making the best use of all resources: developing a health promotion intervention in rural Nepal. ACTA ACUST UNITED AC 2012. [DOI: 10.3126/hren.v10i3.7141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
DOI: http://dx.doi.org/10.3126/hren.v10i3.7141 Health Renaissance; September-December 2012; Vol 10 (No.3);229-235
Collapse
|
47
|
Stephens J, Neuber A. Exploding-wire experiments and theory for metal conductivity evaluation in the sub-eV regime. Phys Rev E Stat Nonlin Soft Matter Phys 2012; 86:066409. [PMID: 23368061 DOI: 10.1103/physreve.86.066409] [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] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Indexed: 06/01/2023]
Abstract
Copper and silver wires are subjected to pulsed high current densities producing high density metal plasma in the sub-eV regime with atmospheric air as a background gas. Numerical simulation via application of the one-dimensional magnetohydrodynamic partial differential equations solved simultaneously with the constraining circuit equations is presented. The simulations require accurate knowledge of the material equation of state (EOS) and transport properties; the LANL sesame database is applied for the EOS in all cases. Two electrical conductivity models are applied. First, the Lee-More-Desjarlais (LMD) and its modification, the quantum LMD (QLMD) conductivity, which have been well proven at higher temperatures, are applied. Simulations with the LMD and QLMD data indicate that the conductivity data as well as the MHD methodology are accurate in the sub-eV regime of interest. A less computationally involved, empirical conductivity model is applied in the same regime to explore its temperature-density range of applicability compared to the more sophisticated model.
Collapse
Affiliation(s)
- J Stephens
- Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
| | | |
Collapse
|
48
|
Sharma S, Sicuri E, Belizan J, Teijlingen EV, Simkhada P, Stephens J. PS21 Evaluation of Maternity Care Intervention in Rural Nepal: Can a Health Promotion Exercise Improve Maternal Health and Service uptake in Rural Nepal? Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.120] [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]
|
49
|
Stephens J, Dhar V. Re: Meniere’s disease and driving. Clin Otolaryngol 2012; 37:332-3. [DOI: 10.1111/j.1749-4486.2012.02510.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
50
|
Wiegand PN, Nathwani D, Wilcox MH, Stephens J, Shelbaya A, Haider S. Clinical and economic burden of Clostridium difficile infection in Europe: a systematic review of healthcare-facility-acquired infection. J Hosp Infect 2012; 81:1-14. [PMID: 22498638 DOI: 10.1016/j.jhin.2012.02.004] [Citation(s) in RCA: 222] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
PubMed, EMBASE and conference abstracts were reviewed systematically to determine the clinical and economic burden associated with Clostridium difficile infection (CDI) acquired and treated in European healthcare facilities. Inclusion criteria were: published in the English language between 2000 and 2010, and study population of at least 20 patients with documented CDI acquired/treated in European healthcare facilities. Data collection was completed by three unblinded reviewers using the Cochrane Handbook and PRISMA statement. The primary outcomes were mortality, recurrence, length of hospital stay (LOS) and cost related to CDI. In total, 1138 primary articles and conference abstracts were identified, and this was narrowed to 39 and 30 studies, respectively. Data were available from 14 countries, with 47% of studies from UK institutions. CDI mortality at 30 days ranged from 2% (France) to 42% (UK). Mortality rates more than doubled from 1999 to 2004, and continued to rise until 2007 when reductions were noted in the UK. Recurrent CDI varied from 1% (France) to 36% (Ireland); however, recurrence definitions varied between studies. Median LOS ranged from eight days (Belgium) to 27 days (UK). The incremental cost of CDI was £4577 in Ireland and £8843 in Germany, after standardization to 2010 prices. Country-specific estimates, weighted by sample size, ranged from 2.8% to 29.8% for 30-day mortality and from 16 to 37 days for LOS. CDI burden in Europe was most commonly described using 30-day mortality, recurrence, LOS and cost data. The continued spread of CDI and resultant healthcare burden underscores the need for judicious use of antibiotics.
Collapse
Affiliation(s)
- P N Wiegand
- Pharmerit International, Bethesda, MD 20814, USA
| | | | | | | | | | | |
Collapse
|