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Stovall MC, Firkins J, Hansen L, Dieckmann NF, van Ryn M. Personality Traits and Traumatic Outcome Symptoms in Registered Nurses in the Aftermath of a Patient Safety Incident. J Patient Saf 2021; 17:e1652-e1659. [PMID: 32604193 DOI: 10.1097/pts.0000000000000740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the relationship between personality traits (perfectionism and neuroticism) and the traumatic outcomes of reexperiencing, avoidance, and alcohol abuse severity of registered nurses (RNs) who have been involved with a patient safety incident (PSI). We hypothesized that higher scores for perfectionism and neuroticism would predict higher reexperiencing and avoidance symptoms in RNs in the aftermath of a PSI. Also, RNs with higher perfectionism and neuroticism sum scores would be more likely to abuse alcohol. METHODS A descriptive, correlational study design was used to characterize the relationships of personality traits and potential traumatic outcomes of RNs in the aftermath of a PSI. The Almost Perfect Scale-Revised, Neuroticism Scale, Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, and Alcohol Use Disorders Identification Test-Consumption measures were administered to RNs licensed in Oregon and New York. RESULTS Perfectionist-discrepancy personality traits (P < 0.01) were the strongest predictors for reexperiencing symptoms and neuroticism (P < 0.05) was the strongest predictor for avoidance symptoms, when controlling for sociodemographics and experience. We found a negative linear relationship between perfectionism-order and alcohol abuse severity (β = -0.15, P < 0.01; confidence interval, -0.24 to 0.05). CONCLUSIONS This study demonstrated a statistically significant relationship between perfectionism-discrepancy and reexperiencing as well as between neuroticism and reexperiencing and avoidance, each explaining 4% of variance of their model. The results add to the nurse second victim literature by validating 2 posttraumatic stress disorder symptoms in RNs in the aftermath of a PSI. Registered nurses with perfectionism-order were less likely to abuse alcohol.
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Affiliation(s)
- Mady C Stovall
- From the Oregon Health & Science University, School of Nursing, Portland, Oregon
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Taha AA, Jadalla A, Bin Ali W, Firkins J, Norman S, Azar N. Structured simulations improves students' knowledge acquisition and perceptions of teaching effectiveness: A quasi-experimental study. J Clin Nurs 2021; 30:3163-3170. [PMID: 33896066 DOI: 10.1111/jocn.15815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/16/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
AIMS To determine the effect of adding structured simulation to a traditional classroom lecture format on students' knowledge acquisition and their evaluation of faculty teaching effectiveness, compared to traditional classroom lectures alone. BACKGROUND There is a critical lack of high-quality clinical placements/experiences in nursing education, particularly in clinical specialty populations, such as paediatrics. Simulation has been shown to help students practice in a safe environment. However, less is known about the outcomes of embedding simulation in didactic class sessions or classroom lectures. Additionally, data on the impact of simulation as a teaching pedagogy on faculty teaching effectiveness is limited. DESIGN Post-test, nonequivalent control group quasi-experimental study. METHODS Students in two prelicensure nursing programs participated in a 10-week term paediatric nursing course taught by the same faculty member on two different campuses. The students at one campus, designated as the control group (n = 43), received four hours of traditional, lecture-only, instructions. The group at a second campus, the intervention group (n = 44), received the same lectures with added structured simulations. Students' knowledge acquisition and their evaluation of faculty teaching effectiveness were measured in both groups using the same standardised assessment measures. The CONSORT checklist was followed. RESULTS Students' knowledge acquisition scores and their evaluation scores of faculty teaching effectiveness were significantly higher in the intervention (simulation) group compared to the control group. A significantly higher number of students in the simulation group scored above the national average Nursing Care of Children score as compared to students in the control group. CONCLUSIONS Integrating simulation with didactic instruction enhanced students' knowledge acquisition and improved their opinion of faculty teaching effectiveness. RELEVANCE TO CLINICAL PRACTICE Augmenting lecture with simulation may provide students with learning experiences that they may not have during clinical rotation due to a lack of paediatric clinical placement sites and differences between sites.
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Affiliation(s)
- Asma A Taha
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Ahlam Jadalla
- School of Nursing, California State University, Long Beach, CA, USA
| | - Wafaa Bin Ali
- College of Nursing-Jeddah, King Saud Bin Abdul Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Jenny Firkins
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Sharon Norman
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Najood Azar
- Doctoral Department, School of Nursing, Azusa Pacific University, Monrovia, CA, USA
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Uluc K, Siler DA, Lopez R, Varallyay C, Netto JP, Firkins J, Lacy C, Huddleston A, Ambady P, Neuwelt EA. Long-Term Outcomes of Intra-Arterial Chemotherapy for Progressive or Unresectable Pilocytic Astrocytomas: Case Studies. Neurosurgery 2021; 88:E336-E342. [PMID: 33548921 PMCID: PMC7956020 DOI: 10.1093/neuros/nyaa588] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/18/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Progressive and/or unresectable pilocytic astrocytomas (PAs) carry a poor prognosis compared to typical PA. Early radiotherapy (RT) may have severe long-term neurocognitive side effects in this patient population. Intra-arterial (IA) chemotherapy is a viable alternative or addition to intravenous (IV) chemotherapy, which may be beneficial in avoidance of early RT. OBJECTIVE To evaluate the safety and efficacy of IA chemotherapy in this subset of patients. METHODS This is a retrospective review of medical records of PA patients who are treated with IA chemotherapy at Oregon Health & Science University from 1997 until 2019. Response to treatment was categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Progression free survival (PFS) and overall survival (OS) are also reported. RESULTS Twelve patients were identified. All patients experienced progression prior to initiation of IA chemotherapy. The most common grade 3 or 4 toxicities related to chemotherapy were thrombocytopenia (66%), neutropenia (66%), leukopenia (50%), anemia (33%), and lymphopenia (16%). Responses achieved were CR in 1, PR in 3, SD in 7, and PD in 1. Median PFS and median OS were 16.5 and 83.5 mo, respectively. A total of 112 procedures (IA injections) were performed and 250 arteries were catheterized. There were 3 minor and no major complications attributable to procedures. CONCLUSION This study demonstrates that IA chemotherapy can be safely used in patients with unresectable or progressive PA.
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Affiliation(s)
- Kutluay Uluc
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Dominic A Siler
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Ricardo Lopez
- Ponce Health Sciences University, Ponce, Puerto Rico
| | - Csanad Varallyay
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Department of Radiology, Oregon Health & Science University, Portland, Oregon
| | - Joao Prola Netto
- Department of Radiology, Providence St Joseph, Portland, Oregon
- The Radiology Group, Providence St Vincent Medical Center, Portland, Oregon
| | - Jenny Firkins
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Cindy Lacy
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Amy Huddleston
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Prakash Ambady
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
- Portland Veterans Affairs Medical Center, Portland, Oregon
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Barajas RF, Hamilton BE, Schwartz D, McConnell HL, Pettersson DR, Horvath A, Szidonya L, Varallyay CG, Firkins J, Jaboin JJ, Kubicky CD, Raslan AM, Dogan A, Cetas JS, Ciporen J, Han SJ, Ambady P, Muldoon LL, Woltjer R, Rooney WD, Neuwelt EA. Combined iron oxide nanoparticle ferumoxytol and gadolinium contrast enhanced MRI define glioblastoma pseudoprogression. Neuro Oncol 2020; 21:517-526. [PMID: 30277536 DOI: 10.1093/neuonc/noy160] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Noninvasively differentiating therapy-induced pseudoprogression from recurrent disease in patients with glioblastoma is prospectively difficult due to the current lack of a biologically specific imaging metric. Ferumoxytol iron oxide nanoparticle MRI contrast characterizes innate immunity mediated neuroinflammation; therefore, we hypothesized that combined ferumoxytol and gadolinium enhanced MRI could serve as a biomarker of glioblastoma pseudoprogression. METHODS In this institutional review board-approved, retrospective study, we analyzed ferumoxytol and gadolinium contrast enhanced T1-weighted 3T MRI in 45 patients with glioblastoma over multiple clinical timepoints. Isocitrate dehydrogenase 1 (IDH-1) mutational status was characterized by exome sequencing. Sum of products diameter measurements were calculated according to Response Assessment in Neuro-Oncology criteria from both gadolinium and ferumoxytol enhanced sequences. Enhancement mismatch was calculated as the natural log of the ferumoxytol to gadolinium sum of products diameter ratio. Analysis of variance and Student's t-test assessed differences in mismatch ratios. P-value <0.05 indicated statistical significance. RESULTS With the development of pseudoprogression we observed a significantly elevated mismatch ratio compared with disease recurrence (P < 0.01) within IDH-1 wild type patients. Patients with IDH-1 mutation demonstrated significantly reduced mismatch ratio with the development of pseudoprogression compared with disease recurrence (P < 0.01). Receiver operator curve analysis demonstrated 100% sensitivity and specificity for the use of mismatch ratios as a diagnostic biomarker of pseudoprogression. CONCLUSION Our study suggests that ferumoxytol to gadolinium contrast mismatch ratios are an MRI biomarker for the diagnosis of pseudoprogression in patients with glioblastoma. This may be due to the unique characterization of therapy-induced neuroinflammation.
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Affiliation(s)
- Ramon F Barajas
- Department of Radiology, Portland, Oregon.,Advanced Imaging Research Center, Portland, Oregon
| | | | - Daniel Schwartz
- Advanced Imaging Research Center, Portland, Oregon.,Department of Neurology, Portland, Oregon
| | | | | | | | | | - Csanad G Varallyay
- Department of Radiology, Portland, Oregon.,Department of Neurology, Portland, Oregon
| | | | | | | | | | | | | | | | | | | | | | - Randy Woltjer
- Department of Pathology, Oregon Health and Science University, Portland, Oregon
| | | | - Edward A Neuwelt
- Department of Neurology, Portland, Oregon.,Neurological Surgery, Portland, Oregon.,Portland Veterans Affairs Medical Center, Portland, Oregon
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Firkins J, Hansen L, Driessnack M, Dieckmann N. Quality of life in "chronic" cancer survivors: a meta-analysis. J Cancer Surviv 2020; 14:504-517. [PMID: 32162194 DOI: 10.1007/s11764-020-00869-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Cancer survivors are now living longer giving rise to a new concept-chronic cancer as survivors continue to face long-term consequences of cancer and its treatment. For these survivors, QOL becomes a vital consideration in understanding their survivorship and the long-term impact of cancer and its treatment. The primary aim of this review is to describe QOL in cancer survivors two or more years from diagnosis. METHODS A meta-analysis was completed of relevant studies assessing QOL in long-term cancer survivorship using PubMed, CINHAL, and PsycINFO. A total of 64 articles met inclusion criteria and included in the analysis. Standardized effect sizes and errors were calculated using previously published standard QOL pass rates to compare QOL across measurement tools and calculate cumulative effect sizes (CES). Fixed-effect or random-effects models were used based on the presence of significant heterogeneity of ≤ 0.10. RESULTS Physical health (CES = - 0.894; CI, - 1.472, - 0.316), role-physical health (CES = - 2.039; CI, - 2.643, - 1.435), and mental health (CES = - 0.870; CI, - 1.447, - 0.292) had large, negative cumulative effect sizes signifying worse QOL compared with acceptable QOL rates. Tested moderators, cancer type, average age, country of origin, time since diagnosis, or decade of diagnosis, were not significant to explain heterogeneity between included studies. CONCLUSION QOL is significantly impacted 2 to 26 years after cancer diagnosis. More research is needed to determine possible moderators of QOL in long-term cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS QOL continues to be significantly impacted in long-term cancer survivorship. More research is needed to understand the impact of these findings on care needs for survivors with chronic cancer.
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Affiliation(s)
- Jenny Firkins
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA.
| | - Lissi Hansen
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Martha Driessnack
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Nathan Dieckmann
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA.,Division of Clinical Psychology, Oregon Health & Science University, 3314 SW US Veterans Hospital Road, Portland, OR, 97239, USA
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Ambady P, Szidonya L, Firkins J, James J, Johansson K, White T, Jezierski C, Doolittle ND, Neuwelt EA. Combination immunotherapy as a non-chemotherapy alternative for refractory or recurrent CNS lymphoma. Leuk Lymphoma 2018; 60:515-518. [PMID: 30033836 DOI: 10.1080/10428194.2018.1480771] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Prakash Ambady
- a Department of Neurology , Oregon Health & Science University , Portland , OR, USA
| | - Laszlo Szidonya
- a Department of Neurology , Oregon Health & Science University , Portland , OR, USA
| | - Jenny Firkins
- a Department of Neurology , Oregon Health & Science University , Portland , OR, USA
| | - Jessica James
- a Department of Neurology , Oregon Health & Science University , Portland , OR, USA
| | - Kirsten Johansson
- a Department of Neurology , Oregon Health & Science University , Portland , OR, USA
| | - Tricia White
- a Department of Neurology , Oregon Health & Science University , Portland , OR, USA
| | - Caroline Jezierski
- a Department of Neurology , Oregon Health & Science University , Portland , OR, USA
| | - Nancy D Doolittle
- a Department of Neurology , Oregon Health & Science University , Portland , OR, USA
| | - Edward A Neuwelt
- a Department of Neurology , Oregon Health & Science University , Portland , OR, USA.,b Department of Neurosurgery , Portland Veterans Affairs Medical Center, Portland, OR , USA
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8
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Ambady P, Hambelton C, Fu R(R, Firkins J, Neuwelt EA. Early palliative care interventions in patients with glioblastoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22203] [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: 11/20/2022] Open
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Horváth A, Varallyay CG, Schwartz D, Toth GB, Netto JP, Barajas R, Várallyay P, Szidonya L, Firkins J, Youngers E, Fu R, Ambady P, Bogner P, Neuwelt EA. Quantitative comparison of delayed ferumoxytol T 1 enhancement with immediate gadoteridol enhancement in high grade gliomas. Magn Reson Med 2017; 80:224-230. [PMID: 29205477 DOI: 10.1002/mrm.27028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/26/2017] [Accepted: 11/07/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Delayed ferumoxytol enhancement on T1 -weighted images appears visually similar to gadoteridol enhancement. The purpose of this study was to quantitatively compare ferumoxytol T1 enhancement to gadoteridol enhancement with an objective, semi-automated method. METHODS 206 sets of post-gadoteridol and 24 h post-ferumoxytol T1 -weighted scans from 58 high grade glioma patients were analyzed (9 pre-chemoradiation, 111 < 90 days post-chemoradiation, 21 > 90 days post-chemoradiation, 65 post-bevacizumab scans). Enhancement volumes and signal intensities normalized to normal appearing tissue proximal to enhancement were calculated with a semi-automated method. Enhancement cube root volumes (D) and signal intensities (SI) were compared between the 2 contrast agents, and relative difference of D and SI were compared in different treatment groups with multivariate analysis. Within patient differences in D and SI before and after treatment with bevacizumab or steroid were assessed in 26 patients in each treatment group. RESULTS When compared to gadoteridol, ferumoxytol D was 13.83% smaller and SI was 7.24% lower (P < 0.0001). The relative differences in D and SI between the 2 contrast agents were not significantly different between treatment groups (P > 0.05). Relative difference in D and SI did not change significantly in response to bevacizumab (P = 0.5234 and P = 0.2442, respectively) or to steroid (P = 0.3774, P = 0.0741) in the within patient comparison. CONCLUSION The correlation between the 2 contrast agents' enhancement size and signal intensity and their similar behavior in response to therapy suggest that ferumoxytol can be used for revealing enhancement in high grade glioma patients. Magn Reson Med 80:224-230, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Andrea Horváth
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.,Advanced Imaging Research Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Csanad G Varallyay
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.,Department of Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Daniel Schwartz
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.,Advanced Imaging Research Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Gerda B Toth
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Joao P Netto
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.,Department of Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Ramon Barajas
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, Oregon, USA.,Department of Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Péter Várallyay
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - László Szidonya
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Jenny Firkins
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Emily Youngers
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Rongwei Fu
- School of Public Health, Oregon Health and Science University, Portland, Oregon, USA
| | - Prakash Ambady
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Péter Bogner
- University of Pécs, Department of Radiology, Pécs, Hungary
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.,Department of Neurosurgery, Oregon Health and Science University, Portland, Oregon, USA.,Portland Veterans Affairs Medical Center, Portland, Oregon, USA
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Firkins J, Ambady P, Neuwelt E. HOUT-29. COMORBIDITIES IN SURVIVAL OF ADULTS WITH A GLIOBLASTOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.459] [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
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Ambady P, Doolittle N, Firkins J, Netto JP, Siler D, James J, Johansson K, Huddleston A, Fu R, Neuwelt E. NTOX-09. RECOMMENDED PHASE II DOSE OF INTRA-ARTERIAL MELPHALAN GIVEN WITH INTRA-ARTERIAL CARBOPLATIN, OSMOTIC BLOOD-BRAIN BARRIER DISRUPTION AND DELAYED OTOPROTECTIVE SODIUM THIOSULFATE FOR PATIENTS WITH RECURRENT OR PROGRESSIVE CNS EMBRYONAL OR GERM CELL TUMORS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.676] [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
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Varallyay CG, Toth GB, Fu R, Netto JP, Firkins J, Ambady P, Neuwelt EA. What Does the Boxed Warning Tell Us? Safe Practice of Using Ferumoxytol as an MRI Contrast Agent. AJNR Am J Neuroradiol 2017; 38:1297-1302. [PMID: 28495944 PMCID: PMC5509484 DOI: 10.3174/ajnr.a5188] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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] [Received: 12/22/2016] [Accepted: 02/17/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Despite the label change and the FDA's boxed warning added to the Feraheme (ferumoxytol) label in March 2015, radiologists have shown increasing interest in using ferumoxytol as an MR imaging contrast agent as a supplement or alternative to gadolinium. The goals of this study were to provide information regarding ferumoxytol safety as an imaging agent in a single center and to assess how the Feraheme label change may affect this potential, currently off-label indication. MATERIALS AND METHODS This retrospective study evaluated the overall frequency of ferumoxytol-related adverse events when used for CNS MR imaging. Patients with various CNS pathologies were enrolled in institutional review board-approved imaging studies. Ferumoxytol was administered as multiple rapid bolus injections. The risk of adverse events was correlated with demographic data/medical history. RESULTS The safety of 671 ferumoxytol-enhanced MR studies in 331 patients was analyzed. No anaphylactic, life-threatening, or fatal (grade 4 or 5) adverse events were recorded. The overall proportion of ferumoxytol-related grade 1-3 adverse events was 10.6% (8.6% occurring within 48 hours), including hypertension (2.38%), nausea (1.64%), diarrhea (1.04%), and headache (1.04%). History of 1 or 2 allergies was associated with an increased risk of adverse events (14.61% versus 7.51% [no history]; P = .007). CONCLUSIONS The frequency of mild ferumoxytol-related adverse events was comparable with literature results, and no serious adverse event was recorded. Although the recommendations in the boxed warning should be followed, serious adverse events appear to be rare, and with proper precautions, ferumoxytol may be a valuable MR imaging agent.
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Affiliation(s)
- C G Varallyay
- From the Departments of Radiology (C.G.V., J.P.N.)
- Neurology (C.G.V., G.B.T., J.P.N., J.F., P.A., E.A.N.)
| | - G B Toth
- Neurology (C.G.V., G.B.T., J.P.N., J.F., P.A., E.A.N.)
| | - R Fu
- Medical Informatics and Clinical Epidemiology (R.F.)
- School of Public Health (R.F.), Oregon Health & Science University, Portland, Oregon
| | - J P Netto
- Neurology (C.G.V., G.B.T., J.P.N., J.F., P.A., E.A.N.)
| | - J Firkins
- Neurology (C.G.V., G.B.T., J.P.N., J.F., P.A., E.A.N.)
| | - P Ambady
- Neurology (C.G.V., G.B.T., J.P.N., J.F., P.A., E.A.N.)
| | - E A Neuwelt
- Neurology (C.G.V., G.B.T., J.P.N., J.F., P.A., E.A.N.)
- Neurosurgery (E.A.N.)
- Portland Veterans Affairs Medical Center (E.A.N.), Portland, Oregon
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Ambady P, Fu R, Netto JP, Kersch C, Firkins J, Doolittle ND, Neuwelt EA. Patterns of relapse in primary central nervous system lymphoma: inferences regarding the role of the neuro-vascular unit and monoclonal antibodies in treating occult CNS disease. Fluids Barriers CNS 2017; 14:16. [PMID: 28577579 PMCID: PMC5457655 DOI: 10.1186/s12987-017-0064-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/22/2017] [Indexed: 12/22/2022] Open
Abstract
Background and purpose The radiologic features and patterns of primary central nervous system lymphoma (PCNSL) at initial presentation are well described. High response rates can be achieved with first-line high-dose methotrexate (HD-MTX) based regimens, yet many relapse within 2 years of diagnosis. We describe the pattern of relapse and review the potential mechanisms involved in relapse. Methods We identified 78 consecutive patients who attained complete radiographic response (CR) during or after first-line treatment for newly diagnosed PCNSL (CD20+, diffuse large B cell type). Patients were treated with HD-MTX based regimen in conjunction with blood–brain barrier disruption (HD-MTX/BBBD); 44 subsequently relapsed. Images and medical records of these 44 consecutive patients were retrospectively reviewed. The anatomical location of enhancing lesions at initial diagnosis and at the time of relapse were identified and compared. Results 37/44 patients fulfilled inclusion criteria and had new measureable enhancing lesions at relapse; the pattern and location of relapse of these 37 patients were identified. At relapse, the new enhancement was at a spatially distinct site in 30 of 37 patients. Local relapse was found only in seven patients. Discussion Unlike gliomas, the majority of PCNSL had radiographic relapse at spatially distinct anatomical locations within the brain behind a previously intact neurovascular unit (NVU), and in few cases outside, the central nervous system (CNS). This may suggest either (1) reactivation of occult reservoirs behind an intact NVU in the CNS (or ocular) or (2) seeding from bone marrow or other extra CNS sites. Conclusion Recognizing patterns of relapse is key for early detection and may provide insight into potential mechanisms of relapse as well as help develop strategies to extend duration of complete response.
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Affiliation(s)
- Prakash Ambady
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA.,Portland Veterans Affairs Medical Center, Portland, OR, USA
| | - Rongwei Fu
- School of Public Health, Oregon Health & Science University, Portland, OR, USA.,Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Joao Prola Netto
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA.,Department of Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Cymon Kersch
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA
| | - Jenny Firkins
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA
| | - Nancy D Doolittle
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA. .,Portland Veterans Affairs Medical Center, Portland, OR, USA. .,Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA.
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Doolittle ND, Fu R, Ambady P, Firkins J, Neuwelt EA. Maintenance immunotherapy for primary central nervous system lymphoma following complete response after first-line chemotherapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e13531] [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: 11/20/2022] Open
Affiliation(s)
| | - Rochelle Fu
- Oregon Health and Science University, Portland, OR
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Ambady P, Fu R, Kersch C, Firkins J, Doolittle ND, Neuwelt EA. Patterns of recurrence in primary central nervous system lymphoma: Mechanistic inferences. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e19051] [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: 11/20/2022] Open
Affiliation(s)
| | - Rochelle Fu
- Oregon Health and Science University, Portland, OR
| | - Cymon Kersch
- Oregon Health & Science University, Portland, OR
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16
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Ambady P, Neuwelt E, Netto JP, Varallyay C, Lacy C, Huddleston A, Firkins J. DDEL-02INTRA-ARTERIAL CHEMOTHERAPY FOR RECURRENT PILOCYTIC ASTROCYTOMA. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov212.02] [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
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