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Devi S, Gedda DUK, Chawla S, Doucette J, Yadav N, Mirshahi S, de Moura LP, Velloso LA, Mekary RA. The effect of weight loss on hypothalamus structure and function in obese individuals: a systematic review and meta-analysis. Int J Neurosci 2024; 134:75-87. [PMID: 35659180 DOI: 10.1080/00207454.2022.2086127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Obesity presents with structural and functional hypothalamic dysfunction. However, it is unclear whether weight loss can lead to hypothalamic changes. We therefore aimed to conduct a systematic review and meta-analysis to determine the effect of body mass reduction in obese individuals on hypothalamic structure and function. METHODS PubMed, Embase and Cochrane databases were searched for studies that reported the change in hypothalamic structure and function after weight loss. Qualitative and quantitative analyses were performed on magnetic resonance imaging techniques, medio-basal hypothalamus T2-relaxation time, blood oxygen level dependent (BOLD) contrast, voxel-based morphometry (VBM) and biomarkers including glucose, insulin, leptin, ghrelin and inflammatory markers of interleukins. Mean differences between pre- and post-weight loss and 95% confidence intervals (CIs) were pooled using random-effects models. RESULTS Thirteen pre-post studies were included, of which six accounted for the meta-analysis. Studies showed a favorable decrease in T2-relaxation time (n = 1), favorable change in hypothalamic activity after weight loss on BOLD contrast (n = 4), with higher peak activities after surgical weight loss (n = 2). No differences were found in the gray matter density of the hypothalamus on VBM (n = 1). Pooled mean differences between pre- and post-surgical weight loss revealed a decrease of 8.53 mg/dl (95% CI: 5.17, 11.9) in glucose, 7.73 pmol/l (95% CI: 5.07, 10.4) in insulin, 15.5 ng/ml (95% CI: 9.40, 21.6) in leptin, 142.9 pg/ml (95% CI: 79.0, 206.8) in ghrelin and 9.43 pg/ml (95% CI: -6.89, 25.7) in IL-6 level. CONCLUSIONS Our study showed weight reduction in obesity led to limited structural change and significant functional changes in the hypothalamus.
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Affiliation(s)
- Sharmila Devi
- Faculty of Life Sciences and Medicine, King's College of London (KCL), London, UK
- Department of Neurosurgery, Computational Neurosurgical Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Durga Udaya Keerthi Gedda
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Shreya Chawla
- Faculty of Life Sciences and Medicine, King's College of London (KCL), London, UK
- Department of Neurosurgery, Computational Neurosurgical Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joanne Doucette
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Nishi Yadav
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Shervin Mirshahi
- Department of Neurosurgery, Computational Neurosurgical Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Leandro P de Moura
- Laboratory of Molecular Biology of Exercise (LaBMEx), School of Applied Sciences, University of Campinas (UNICAMP), Limeira, Brazil
- CEPECE - Center of Research in Sport Sciences, School of Applied Sciences, University of Campinas, Limeira, Brazil
| | - Lício A Velloso
- Department of Internal Medicine, Laboratory of Cell Signaling, University of Campinas, Campinas, Brazil
| | - Rania A Mekary
- Department of Neurosurgery, Computational Neurosurgical Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
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Rittenhouse BE, Alolayan S, Eguale T, Segal AR, Doucette J. The cost-effectiveness of metformin in the US diabetes prevention program trial: Simple interpretations need not apply. Prev Med 2024; 178:107819. [PMID: 38092328 DOI: 10.1016/j.ypmed.2023.107819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/02/2023] [Accepted: 12/09/2023] [Indexed: 01/07/2024]
Abstract
Based on previously published US Diabetes Prevention Program (DPP) cost-effectiveness analyses (CEAs) metformin continues to be promoted as "cost-effective." We review the DPP within-trial CEA to assess this claim. Treatment alternatives included placebo (plus standard lifestyle advice), branded metformin and individual lifestyle modification. We added generic metformin as an alternative. Original published CEA data were taken as given and re-analyzed according to accepted principles for calculating incremental cost-effectiveness ratios (ICERs) in the economic evaluation field. With more than two treatments as in the DPP, these require attention to the rankings of interventions according to cost or effect prior to stipulating appropriate ICERs to calculate. With proper ICERs neither branded nor generic metformin was cost-effective, regardless of the value assumed for the willingness to pay for the quality-adjusted life year outcome assessed. Metformin alternatives were technically inefficient compared to placebo or the lifestyle modification alternative. Net loss calculations indicated substantial costs/health losses to using metformin instead of the optimal lifestyle alternative in response to metformin having been inaccurately labelled "cost-effective" in the original CEA. That CEA and subsequent analyses and citations of such analyses continue to claim that both metformin and lifestyle modification are cost-effective in diabetes prevention based on DPP data. Using metformin implies substantial costs and health losses compared to the cost-effective lifestyle modification. It may be that metformin has a role in cost-effective diabetes prevention, but this has yet to be shown based on DPP data.
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Affiliation(s)
- Brian E Rittenhouse
- Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA 02115, United States of America.
| | | | - Tewodros Eguale
- Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA 02115, United States of America; Brigham and Women's Hospital, Boston, MA, United States of America.
| | - Alissa R Segal
- Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA 02115, United States of America; Joslin Diabetes Center, Boston, MA, United States of America.
| | - Joanne Doucette
- Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA 02115, United States of America.
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Huybregts JGJ, Barot KA, Recio C, Doucette J, Mekary RA, Vleggeert-Lankamp CLA. The optimal treatment of type II and III odontoid fractures in the elderly: an updated meta-analysis. Eur Spine J 2023; 32:3434-3449. [PMID: 37439865 DOI: 10.1007/s00586-023-07779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/12/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Odontoid fractures are the most common cervical spine fractures in the elderly, with a controversial optimal treatment. The objective of this review was to compare the outcome of surgical and conservative treatments in elderly (≥ 65 years), by updating a systematic review published by the authors in 2013. METHODS A comprehensive search was conducted in seven databases. Clinical outcome was the primary outcome. Fracture union- and stability were secondary outcomes. Pooled point estimates and their respective 95% confidence intervals (CIs) were derived using the random-effects model. A random-effects multivariable meta-regression model was used to correct for baseline co-variates when sufficiently reported. RESULTS Forty-one studies met the inclusion criteria, of which forty were case series and one a cohort study. No clinical differences in outcomes including the Neck Disability Index (NDI, 700 patients), Visual Analogue Scale pain (VAS, 180 patients), and Smiley-Webster Scale (SWS, 231 patients) scores were identified between surgical and conservative treatments. However, fracture union was higher in surgically treated patients (pooled incidence 72.7%, 95% CI 66.1%, 78.5%, 31 studies, 988 patients) than in conservatively treated patients (40.2%, 95% CI 32.0%, 49.0%, 22 studies, 912 patients). This difference remained after correcting for age and fracture type. Fracture stability (41 studies, 1917 patients), although numerically favoring surgery, did not appear to differ between treatment groups. CONCLUSION While surgically treated patients showed higher union rates than conservatively treated patients, no clinically relevant differences were observed in NDI, VAS pain, and SWS scores and stability rates. These results need to be further confirmed in well-designed comparative studies with proper adjustment for confounding, such as age, fracture characteristics, and osteoporosis degree.
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Affiliation(s)
- Jeroen G J Huybregts
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, PO Box 9600, 2300 RC, Leiden, The Netherlands.
- Department of Neurosurgery, Haaglanden Medical Center, University Neurosurgical Center Holland, The Hague, The Netherlands.
| | | | - Camila Recio
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Rania A Mekary
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- School of Pharmacy, MCPHS University, Boston, MA, USA
| | - Carmen L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Neurosurgery, Spaarne Hospital Haarlem/Hoofddorp, Hoofddorp, The Netherlands
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Yearley AG, Goedmakers CMW, Panahi A, Doucette J, Rana A, Ranganathan K, Smith TR. FDA-approved machine learning algorithms in neuroradiology: A systematic review of the current evidence for approval. Artif Intell Med 2023; 143:102607. [PMID: 37673576 DOI: 10.1016/j.artmed.2023.102607] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 09/08/2023]
Abstract
Over the past decade, machine learning (ML) and artificial intelligence (AI) have become increasingly prevalent in the medical field. In the United States, the Food and Drug Administration (FDA) is responsible for regulating AI algorithms as "medical devices" to ensure patient safety. However, recent work has shown that the FDA approval process may be deficient. In this study, we evaluate the evidence supporting FDA-approved neuroalgorithms, the subset of machine learning algorithms with applications in the central nervous system (CNS), through a systematic review of the primary literature. Articles covering the 53 FDA-approved algorithms with applications in the CNS published in PubMed, EMBASE, Google Scholar and Scopus between database inception and January 25, 2022 were queried. Initial searches identified 1505 studies, of which 92 articles met the criteria for extraction and inclusion. Studies were identified for 26 of the 53 neuroalgorithms, of which 10 algorithms had only a single peer-reviewed publication. Performance metrics were available for 15 algorithms, external validation studies were available for 24 algorithms, and studies exploring the use of algorithms in clinical practice were available for 7 algorithms. Papers studying the clinical utility of these algorithms focused on three domains: workflow efficiency, cost savings, and clinical outcomes. Our analysis suggests that there is a meaningful gap between the FDA approval of machine learning algorithms and their clinical utilization. There appears to be room for process improvement by implementation of the following recommendations: the provision of compelling evidence that algorithms perform as intended, mandating minimum sample sizes, reporting of a predefined set of performance metrics for all algorithms and clinical application of algorithms prior to widespread use. This work will serve as a baseline for future research into the ideal regulatory framework for AI applications worldwide.
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Affiliation(s)
- Alexander G Yearley
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
| | - Caroline M W Goedmakers
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA; Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Armon Panahi
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20052, USA
| | - Joanne Doucette
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA; School of Pharmacy, MCPHS University, 179 Longwood Ave, Boston, MA 02115, USA
| | - Aakanksha Rana
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA; Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA
| | - Kavitha Ranganathan
- Division of Plastic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Timothy R Smith
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
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Gerstl JVE, Rendon LF, Burke SM, Doucette J, Mekary RA, Smith TR. Complications and cosmetic outcomes of materials used in cranioplasty following decompressive craniectomy-a systematic review, pairwise meta-analysis, and network meta-analysis. Acta Neurochir (Wien) 2022; 164:3075-3090. [PMID: 35593924 DOI: 10.1007/s00701-022-05251-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Optimal reconstruction materials for cranioplasty following decompressive craniectomy (DC) remain unclear. This systematic review, pairwise meta-analysis, and network meta-analysis compares cosmetic outcomes and complications of autologous bone grafts and alloplasts used for cranioplasty following DC. METHOD PubMed, Embase, and Cochrane were searched from inception until April 2021. A random-effects pairwise meta-analysis was used to compare pooled outcomes and 95% confidence intervals (CIs) of autologous bone to combined alloplasts. A frequentist network meta-analysis was subsequently conducted to compare multiple individual materials. RESULTS Of 2033 articles screened, 30 studies were included, consisting of 29 observational studies and one randomized control trial. Overall complications were statistically significantly higher for autologous bone compared to combined alloplasts (RR = 1.56, 95%CI = 1.14-2.13), hydroxyapatite (RR = 2.60, 95%CI = 1.17-5.78), polymethylmethacrylate (RR = 1.50 95%CI = 1.08-2.08), and titanium (Ti) (RR = 1.56 95%CI = 1.03-2.37). Resorption occurred only in autologous bone (15.1%) and not in alloplasts (0.0%). When resorption was not considered, there was no difference in overall complications between autologous bone and combined alloplasts (RR = 1.00, 95%CI = 0.75-1.34), nor between any individual materials. Dehiscence was lower for autologous bone compared to combined alloplasts (RR = 0.39, 95%CI = 0.19-0.79) and Ti (RR = 0.34, 95%CI = 0.15-0.76). There was no difference between autologous bone and combined alloplasts with respect to infection (RR = 0.85, 95%CI = 0.56-1.30), migration (RR = 1.36, 95%CI = 0.63-2.93), hematoma (RR = 0.98, 95%CI = 0.53-1.79), seizures (RR = 0.83, 95%CI = 0.29-2.35), satisfactory cosmesis (RR = 0.88, 95%CI = 0.71-1.08), and reoperation (RR = 1.66, 95%CI = 0.90-3.08). CONCLUSIONS Bone resorption is only a consideration in autologous cranioplasty compared to bone substitutes explaining higher complications for autologous bone. Dehiscence is higher in alloplasts, particularly in Ti, compared to autologous bone.
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Affiliation(s)
- Jakob V E Gerstl
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA. .,University College London Medical School, London, WC1E 6DE, UK.
| | - Luis F Rendon
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Department of Neurosurgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Shane M Burke
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Department of Neurosurgery, Tufts Medical Center, Boston, MA, 02111, USA
| | - Joanne Doucette
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, 02115, USA
| | - Rania A Mekary
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, 02115, USA
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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Nawabi NLA, Duey AH, Kilgallon JL, Jessurun C, Doucette J, Mekary RA, Aziz-Sultan MA. Effects of the COVID-19 pandemic on stroke response times: a systematic review and meta-analysis. J Neurointerv Surg 2022; 14:642-649. [PMID: 35387860 DOI: 10.1136/neurintsurg-2021-018230] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/01/2021] [Accepted: 03/24/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES COVID-19 presents a risk for delays to stroke treatment. We examined how COVID-19 affected stroke response times. METHODS A literature search was conducted to identify articles covering stroke during COVID-19 that included time metrics data pre- and post-pandemic. For each outcome, pooled relative change from baseline and 95% CI were calculated using random-effects models. Heterogeneity was explored through subgroup analyses comparing comprehensive stroke centers (CSCs) to non-CSCs. RESULTS 38 included studies reported on 6109 patients during COVID-19 and 14 637 patients during the pre-COVID period. Pooled increases of 20.9% (95% CI 5.8% to 36.1%) in last-known-well (LKW) to arrival times, 1.2% (-2.9% to 5.3%) in door-to-imaging (DTI), 0.8% (-2.9% to 4.5%) in door-to-needle (DTN), 2.8% (-5.0% to 10.6%) in door-to-groin (DTG), and 19.7% (11.1% to 28.2%) in door-to-reperfusion (DTR) times were observed during COVID-19. At CSCs, LKW increased by 24.0% (-0.3% to 48.2%), DTI increased by 1.6% (-3.0% to 6.1%), DTN increased by 3.6% (1.2% to 6.0%), DTG increased by 4.6% (-5.9% to 15.1%), and DTR increased by 21.2% (12.3% to 30.1%). At non-CSCs, LKW increased by 12.4% (-1.0% to 25.7%), DTI increased by 0.2% (-2.0% to 2.4%), DTN decreased by -4.6% (-11.9% to 2.7%), DTG decreased by -0.6% (-8.3% to 7.1%), and DTR increased by 0.5% (-31.0% to 32.0%). The increases during COVID-19 in LKW (p=0.01) and DTR (p=0.00) were statistically significant, as was the difference in DTN delays between CSCs and non-CSCs (p=0.04). CONCLUSIONS Factors during COVID-19 resulted in significantly delayed LKW and DTR, and mild delays in DTI, DTN, and DTG. CSCs experience more pronounced delays than non-CSCs.
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Affiliation(s)
- Noah L A Nawabi
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA .,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Akiro H Duey
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - John L Kilgallon
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charissa Jessurun
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Joanne Doucette
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Library and Learning Resources, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pharmaceutical Business and Administrative Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Mohammad Ali Aziz-Sultan
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Lo YT, Lee H, Shui C, Lamba N, Korde R, Devi S, Chawla S, Nam Y, Patel R, Doucette J, Bunevicius A, Mekary RA. Intraoperative Magnetic Resonance Imaging for Low-Grade and High-Grade Gliomas: What Is the Evidence? A Meta-Analysis. World Neurosurg 2021; 149:232-243.e3. [PMID: 33540099 DOI: 10.1016/j.wneu.2021.01.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/08/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The benefit of intraoperative magnetic resonance imaging (iMRI) in gliomas remains unclear. We performed a meta-analysis of outcomes with iMRI-guided surgery in high-grade gliomas (HGGs) and low-grade gliomas (LGGs). METHODS Databases were searched until November 29, 2018 for randomized controlled trials (RCTs) and observational studies (OBS) comparing iMRI use with conventional neurosurgery. Pooled risk ratios (RRs) or hazard ratios were evaluated with the random-effects model. Outcomes included extent of resection (EOR), gross total resection (GTR), progression-free survival (PFS), overall survival (OS), and length of surgery (LOS), stratified by study design and glioma grade. RESULTS Fifteen articles (3 RCTs and 12 OBS) were included. In RCTs, GTR was higher in iMRI compared with conventional neurosurgery (RR, 1.42; 95% confidence interval [CI], 1.17-1.73; I2, 7%) overall, for LGGs (1.91; 95% CI, 1.19-3.06), but not HGGs (1.24; 95% CI, 0.89-1.73), with no difference in EOR, PFS, OS, and LOS. For OBS, GTR was higher (RR, 1.65; 95% CI, 1.43-1.90; I2, 4%) overall, and for LGGs (1.63; 95% CI, 1.17-2.28; I2, 0%) and HGGs (1.62; 95% CI, 1.36-1.92; I2, 19%). EOR was greater with iMRI (6%; 95% CI, 4%-8%; I2, 44%) overall, in LGGs (5%; 95% CI, 2%-8%; I2, 37%) and HGGs (7%; 95% CI, 4%-10%; I2, 13%). There was no difference in PFS, OS, and LOS with iMRI. CONCLUSIONS IMRI use improved GTR in gliomas, including LGGs. However, no PFS and OS benefit was shown in the meta-analysis.
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Affiliation(s)
- Yu Tung Lo
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Hyunkyung Lee
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Cher Shui
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nayan Lamba
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rasika Korde
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Sharmila Devi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Shreya Chawla
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Younjong Nam
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Romel Patel
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Joanne Doucette
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Adomas Bunevicius
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Neuroscience Institute, Lithuanian University of Health Science, Kaunas, Lithuania; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; School of Pharmacy, MCPHS University, Boston, Massachusetts, USA.
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Faulkner H, Chakankar S, Mammi M, Lo JYT, Doucette J, Al-Otaibi N, Abboud J, Le A, Mekary RA, Bunevicius A. Safety and efficacy of prothrombin complex concentrate (PCC) for anticoagulation reversal in patients undergoing urgent neurosurgical procedures: a systematic review and metaanalysis. Neurosurg Rev 2020; 44:1921-1931. [PMID: 33009989 DOI: 10.1007/s10143-020-01406-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/28/2020] [Accepted: 09/28/2020] [Indexed: 12/31/2022]
Abstract
Anticoagulant therapy poses a significant risk for patients undergoing emergency neurosurgery procedures, necessitating reversal with prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). Data on PCC efficacy lack consistency in this setting. This systematic review and metaanalysis aimed to evaluate efficacy and safety of PCC for anticoagulation reversal in the context of urgent neurosurgery. Articles from PubMed, Embase, and Cochrane databases were screened according to the PRISMA checklist. Adult patients receiving anticoagulation reversal with PCC for emergency neurosurgical procedures were included. When available, patients who received FFP were included as a comparison group. Pooled estimates of observational studies were calculated for efficacy and safety outcomes via random-effects modeling. Initial search returned 4505 articles, of which 15 studies met the inclusion criteria. Anticoagulants used included warfarin (83%), rivaroxaban (6.8%), phenprocoumon (6.1%), apixaban (2.2%), and dabigatran (1.5%). The mean International Normalized Ratio (INR) prePCC administration ranged from 2.3 to 11.7, while postPCC administration from 1.1 to 1.4. All-cause mortality at 30 days was 27% (95%CI 21, 34%; I2 = 44.6%; p-heterogeneity = 0.03) and incidence of thromboembolic events was 6.00% among patients treated with PCC (95%CI 4.00, 10.0%; I2 = 0%; p-heterogeneity = 0.83). Results comparing PCC and FFP demonstrated no statistically significant differences in INR reversal, mortality, or incidence of thromboembolic events. This metaanalysis demonstrated adequate safety and efficacy for PCC in the reversal of anticoagulation for urgent neurosurgical procedures. There was no significant difference between PCC and FFP, though further trials would be useful in demonstrating the safety and efficacy of PCC in this setting.
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Affiliation(s)
| | | | - Marco Mammi
- Neurosurgery Unit, Department of Neurosciences, University of Turin, via Cherasco 15, 10126, Turin, Italy
| | - Jack Yu Tung Lo
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Department of Neurosurgery, National Neuroscience Institute, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Joanne Doucette
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Nawaf Al-Otaibi
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Judi Abboud
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Andrew Le
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Rania A Mekary
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA. .,Neurosurgery Unit, Department of Neurosciences, University of Turin, via Cherasco 15, 10126, Turin, Italy.
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9
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Ou Z, Spring L, Nohria A, Seeger J, Doucette J, Cohen A, Murimi-Worstell I. PCN83 Real-World Prescription Patterns of HER2+/HR- Metastatic Breast Cancer Patients after Ado-Trastuzumab Emtansine Approval: A Retrospective Cohort Study Using Electronic Health Record DATA with Cancer Registries. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Pande A, Lamba N, Mammi M, Gebrehiwet P, Trenary A, Doucette J, Papatheodorou S, Bunevicius A, Smith TR, Mekary RA. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric and adult population: a systematic review and meta-analysis. Neurosurg Rev 2020; 44:1227-1241. [PMID: 32476100 DOI: 10.1007/s10143-020-01320-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/13/2020] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
Treatment options for hydrocephalus include endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS). Some ambiguity remains regarding indications, safety, and efficacy for these procedures in different clinical scenarios. The objective of the present study was to pool the available evidence to compare outcomes among patients with hydrocephalus undergoing ETV versus VPS. A systematic search of the literature was conducted via PubMed, EMBASE, and Cochrane Library through 11/29/2018 to identify studies evaluating failure and complication rates, following ETV or VPS. Pooled effect estimates were calculated using random effects. Heterogeneity was assessed by the Cochrane Q test and the I2 value. Heterogeneity sources were explored through subgroup analyses and meta-regression. Twenty-three studies (five randomized control trials (RCTs) and 18 observational studies) were meta-analyzed. Comparing ETV to VPS, failure rate was not statistically significantly different with a pooled relative risk (RR) of 1.48, 95%CI (0.85, 2.59) for RCTs and 1.17 (0.89, 1.53) for cohort studies; P-interaction: 0.44. Complication rates were not statistically significantly different between ETV and VPS in RCTs (RR: 1.34, 95%CI: 0.50, 3.59) but were statistically significant for prospective cohort studies (RR: 0.47, 95%CI: 0.30, 0.78); P-interaction: 0.07. Length of hospital stay was no different, when comparing ETV and VPS. These results remained unchanged when stratifying by intervention type and when regressing on age when possible. No significant differences in failure rate were observed between ETV and VPS. ETV was found to have lower complication rates than VPS in prospective cohort studies but not in RCTs. Further research is needed to identify the specific patient populations who may be better suited for one intervention versus another.
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Affiliation(s)
- Apurva Pande
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Nayan Lamba
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Mammi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Neurosurgery Unit, Department of Neurosciences, University of Turin, Turin, Italy
| | | | - Alyssa Trenary
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Joanne Doucette
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | | | - Adomas Bunevicius
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA. .,Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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11
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Dickstein D, Egerman M, Doucette J, Sharma S, Liu J, Gupta V, Miles B, Posner M, Westra W, Misiukiewicz K, Genden E, Bakst R. The Rise of HPV in the Elderly: A Changing Landscape of Oropharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Smith C, Lamba N, Ou Z, Vo QA, Araujo-Lama L, Lim S, Joshi D, Doucette J, Papatheodorou S, Tafel I, Aglio LS, Smith TR, Mekary RA, Zaidi H. The prevalence of complications associated with lumbar and thoracic spinal deformity surgery in the elderly population: a meta-analysis. J Spine Surg 2019; 5:223-235. [PMID: 31380476 DOI: 10.21037/jss.2019.03.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background The prevalence of spinal deformities increases with age, affecting between 30% and 68% of the elderly population (ages ≥65). The reported prevalence of complications associated with surgery for spinal deformities in this population ranges between 37% and 71%. Given the wide range of reported complication rates, the decision to perform surgery remains controversial. Methods A comprehensive search was conducted using PubMed, Embase, and Cochrane to identify studies reporting complications for spinal deformity surgery in the elderly population. Pooled prevalence estimates for individual complication types were calculated using the random-effects model. Results Of 5,586 articles, 14 met inclusion criteria. Fourteen complication types were reported, with at least 2 studies for each complication with the following pooled prevalence: reoperation (prevalence 19%; 95% CI, 9-36%; 107 patients); hardware failure (11%; 95% CI, 5-25%; 52 patients); infection (7%; 95% CI, 4-12%; 262 patients); pseudarthrosis (6%; 95% CI, 3-12%; 149 patients); radiculopathy (6%; 95% CI, 1-33%; 116 patients); cardiovascular event (5%; 95% CI, 1-32%; 121 patients); neurological deficit (5%; 95% CI, 2-15%; 248 patients); deep vein thrombosis (3%; 95% CI, 1-7%; 230 patients); pulmonary embolism (3%; 95% CI, 1-7%; 210 patients); pneumonia (3%; 95% CI, 1-11%; 210 patients); cerebrovascular or stroke event (2%; 95% CI, 0-9%; 85 patients); death (2%; 95% CI, 1-9%; 113 patients); myocardial infarction (2%; 95% CI, 1-6%; 210 patients); and postoperative hemorrhage (1%; 95% CI, 0-10%; 85 patients). Conclusions Most complication types following spinal deformity surgery in the elderly had prevalence point estimates of <6%, while all were at least ≤19%. Additional studies are needed to further explore composite prevalence estimates and prevalence associated with traditional surgical approaches as compared to minimally-invasive procedures in the elderly.
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Affiliation(s)
- Colleen Smith
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Nayan Lamba
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zhonghui Ou
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Quynh-Anh Vo
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Lita Araujo-Lama
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Sanghee Lim
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Dhaivat Joshi
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Joanne Doucette
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | | | - Ian Tafel
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Linda S Aglio
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy R Smith
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA.,Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hasan Zaidi
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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Smith C, Lamba N, Ou Z, Vo QA, Araujo-Lama L, Lim S, Joshi D, Doucette J, Papatheodorou S, Tafel I, Aglio LS, Smith TR, Mekary RA, Zaidi H. The prevalence of complications associated with lumbar and thoracic spinal deformity surgery in the elderly population: a meta-analysis. J Spine Surg 2019. [PMID: 31380476 DOI: 10.21037/jss.2019.03.06.pmid:31380476;pmcid:pmc6626743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND The prevalence of spinal deformities increases with age, affecting between 30% and 68% of the elderly population (ages ≥65). The reported prevalence of complications associated with surgery for spinal deformities in this population ranges between 37% and 71%. Given the wide range of reported complication rates, the decision to perform surgery remains controversial. METHODS A comprehensive search was conducted using PubMed, Embase, and Cochrane to identify studies reporting complications for spinal deformity surgery in the elderly population. Pooled prevalence estimates for individual complication types were calculated using the random-effects model. RESULTS Of 5,586 articles, 14 met inclusion criteria. Fourteen complication types were reported, with at least 2 studies for each complication with the following pooled prevalence: reoperation (prevalence 19%; 95% CI, 9-36%; 107 patients); hardware failure (11%; 95% CI, 5-25%; 52 patients); infection (7%; 95% CI, 4-12%; 262 patients); pseudarthrosis (6%; 95% CI, 3-12%; 149 patients); radiculopathy (6%; 95% CI, 1-33%; 116 patients); cardiovascular event (5%; 95% CI, 1-32%; 121 patients); neurological deficit (5%; 95% CI, 2-15%; 248 patients); deep vein thrombosis (3%; 95% CI, 1-7%; 230 patients); pulmonary embolism (3%; 95% CI, 1-7%; 210 patients); pneumonia (3%; 95% CI, 1-11%; 210 patients); cerebrovascular or stroke event (2%; 95% CI, 0-9%; 85 patients); death (2%; 95% CI, 1-9%; 113 patients); myocardial infarction (2%; 95% CI, 1-6%; 210 patients); and postoperative hemorrhage (1%; 95% CI, 0-10%; 85 patients). CONCLUSIONS Most complication types following spinal deformity surgery in the elderly had prevalence point estimates of <6%, while all were at least ≤19%. Additional studies are needed to further explore composite prevalence estimates and prevalence associated with traditional surgical approaches as compared to minimally-invasive procedures in the elderly.
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Affiliation(s)
- Colleen Smith
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Nayan Lamba
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zhonghui Ou
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Quynh-Anh Vo
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Lita Araujo-Lama
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Sanghee Lim
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Dhaivat Joshi
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Joanne Doucette
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | | | - Ian Tafel
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Linda S Aglio
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy R Smith
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA.,Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hasan Zaidi
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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14
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Uricchio M, Gupta S, Jakowenko N, Levito M, Vu N, Doucette J, Liew A, Papatheodorou S, Khawaja AM, Aglio LS, Aziz-Sultan MA, Zaidi H, Smith TR, Mekary RA. Computed Tomography Angiography Versus Digital Subtraction Angiography for Postclipping Aneurysm Obliteration Detection. Stroke 2019; 50:381-388. [DOI: 10.1161/strokeaha.118.023614] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Matthew Uricchio
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
| | - Saksham Gupta
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
| | - Nicholas Jakowenko
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
| | - Marissa Levito
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
| | - Nguyen Vu
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
| | - Joanne Doucette
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
| | - Aaron Liew
- National University of Ireland, Galway (A.L.)
| | | | - Ayaz M. Khawaja
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
| | - Linda S. Aglio
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
- Department of Anesthesiology, Perioperative and Pain Management, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (L.S.A.)
| | - Mohammad Ali Aziz-Sultan
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
| | - Hasan Zaidi
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
| | - Timothy R. Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
| | - Rania A. Mekary
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
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15
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Lamba N, Noormohamed N, Simjian T, Alsheikh MY, Jamal A, Doucette J, Zaidi H, Smith TR, Mekary RA. Fertility after transsphenoidal surgery in patients with prolactinomas: A meta-analysis. Clin Neurol Neurosurg 2019; 176:53-60. [DOI: 10.1016/j.clineuro.2018.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/20/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
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16
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Anderson PF, Shannon C, Bickett S, Doucette J, Herring P, Kepsel A, Lyons T, McLachlan S, Wu L. Systematic reviews and tech mining: A methodological comparison with case study. Res Synth Methods 2018; 9:540-550. [DOI: 10.1002/jrsm.1318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 12/26/2022]
Affiliation(s)
| | - Carol Shannon
- Taubman Health Sciences Library; University of Michigan; Ann Arbor Michigan
| | - Skye Bickett
- PCOM Library, Philadelphia College of Osteopathic Medicine-Georgia Campus; Suwanee Georgia
| | - Joanne Doucette
- University Libraries, MCPHS University; Boston Massachusetts
| | - Pamela Herring
- Harriet F. Ginsburg Health Sciences Library, University of Central Florida College of Medicine; Orlando Florida
| | - Andrea Kepsel
- Michigan State University Libraries, Michigan State University; East Lansing Michigan
| | | | | | - Lin Wu
- Health Sciences Library, University of Tennessee Health Science Center Library; Memphis Tennessee
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17
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Alreshidi M, Cote DJ, Dasenbrock HH, Acosta M, Can A, Doucette J, Simjian T, Hulou MM, Wheeler LA, Huang K, Zaidi HA, Du R, Aziz-Sultan MA, Mekary RA, Smith TR. Coiling Versus Microsurgical Clipping in the Treatment of Unruptured Middle Cerebral Artery Aneurysms: A Meta-Analysis. Neurosurgery 2018; 83:879-889. [DOI: 10.1093/neuros/nyx623] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/12/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Open microsurgical clipping of unruptured intracranial aneurysms has long been the gold standard, yet advancements in endovascular coiling techniques have begun to challenge the status quo.
OBJECTIVE
To compare endovascular coiling with microsurgical clipping among adults with unruptured middle cerebral artery aneurysms (MCAA) by conducting a meta-analysis.
METHODS
A systematic search was conducted from January 2011 to October 2015 to update a previous meta-analysis. All studies that reported unruptured MCAA in adults treated by microsurgical clipping or endovascular coiling were included and cumulatively analyzed.
RESULTS
Thirty-seven studies including 3352 patients were included. Using the random-effects model, pooled analysis of 11 studies of microsurgical clipping (626 aneurysms) revealed complete aneurysmal obliteration in 94.2% of cases (95% confidence interval [CI] 87.6%-97.4%). The analysis of 18 studies of endovascular coiling (759 aneurysms) revealed complete obliteration in 53.2% of cases (95% CI: 45.0%-61.1%). Among clipping studies, 22 assessed neurological outcomes (2404 aneurysms), with favorable outcomes in 97.9% (95% CI: 96.8%-98.6%). Among coiling studies, 22 examined neurological outcomes (826 aneurysms), with favorable outcomes in 95.1% (95% CI: 93.1%-96.5%). Results using the fixed-effect models were not materially different.
CONCLUSION
This updated meta-analysis demonstrates that surgical clipping for unruptured MCAA remains highly safe and efficacious. Endovascular treatment for unruptured MCAAs continues to improve in efficacy and safety; yet, it results in lower rates of occlusion.
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Affiliation(s)
- Meshal Alreshidi
- Massachusetts College of Pharmacy and Health Sciences (MCPHS), Boston, Massachusetts
| | - David J Cote
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hormuzdiyar H Dasenbrock
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Acosta
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anil Can
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joanne Doucette
- Massachusetts College of Pharmacy and Health Sciences (MCPHS), Boston, Massachusetts
| | - Thomas Simjian
- Massachusetts College of Pharmacy and Health Sciences (MCPHS), Boston, Massachusetts
| | - M Maher Hulou
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lee A Wheeler
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin Huang
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hasan A Zaidi
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rose Du
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Ali Aziz-Sultan
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rania A Mekary
- Massachusetts College of Pharmacy and Health Sciences (MCPHS), Boston, Massachusetts
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Smith
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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18
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Alotaibi NM, Noormohamed N, Cote DJ, Alharthi S, Doucette J, Zaidi HA, Mekary RA, Smith TR. Physiologic Growth Hormone-Replacement Therapy and Craniopharyngioma Recurrence in Pediatric Patients: A Meta-Analysis. World Neurosurg 2017; 109:487-496.e1. [PMID: 28987837 DOI: 10.1016/j.wneu.2017.09.164] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/03/2017] [Revised: 09/22/2017] [Accepted: 09/23/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE A systematic review and meta-analysis were conducted to examine the effect of growth hormone-replacement therapy (GHRT) on the recurrence of craniopharyngioma in children. METHODS PubMed, Embase, and Cochrane databases were searched through April 2017 for studies that evaluated the effect of GHRT on the recurrence of pediatric craniopharyngioma. Pooled effect estimates were calculated with fixed- and random-effects models. RESULTS Ten studies (n = 3487 patients) met all inclusion criteria, including 2 retrospective cohorts and 8 case series. Overall, 3436 pediatric patients were treated with GHRT after surgery and 51 were not. Using the fixed effect model, we found that the overall craniopharyngioma recurrence rate was lower among children who were treated by GHRT (10.9%; 95% confidence interval 9.80%-12.1%; I2 = 89.1%; P for heterogeneity <0.01; n = 10 groups) compared with those who were not (35.2%; 95% confidence interval 23.1%-49.6%; I2 = 61.7%; P for heterogeneity = 0.11; n = 3); the P value comparing the 2 groups was <0.01. Among patients who were treated with GHRT, subgroup analysis revealed that there was a greater prevalence of craniopharyngioma recurrence among studies conducted outside the United States (P < 0.01), single-center studies (P < 0.01), lower impact factor studies (P = 0.03), or studies with a lower quality rating (P = 0.01). Using the random-effects model, we found that the results were not materially different except for when stratifying by GHRT, impact factor, or study quality; this led to nonsignificant differences. Both Begg's rank correlation test (P = 0.7) and Egger's linear regression test (P = 0.06) indicated no publication bias. CONCLUSIONS This meta-analysis demonstrated a lower recurrence rate of craniopharyngioma among children treated with GHRT than those who were not.
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Affiliation(s)
- Nawaf M Alotaibi
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts, USA
| | - Nadia Noormohamed
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts, USA
| | - David J Cote
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital Department of Neurosurgery, Harvard Medical School, Boston, USA.
| | - Salman Alharthi
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts, USA
| | - Joanne Doucette
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts, USA
| | - Hasan A Zaidi
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital Department of Neurosurgery, Harvard Medical School, Boston, USA
| | - Rania A Mekary
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital Department of Neurosurgery, Harvard Medical School, Boston, USA; Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts, USA
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital Department of Neurosurgery, Harvard Medical School, Boston, USA
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De B, Rhome R, Doucette J, Buckstein M. Dose escalation of definitive radiation is not associated with improved survival for cervical esophageal cancer: a National Cancer Data Base (NCDB) analysis. Dis Esophagus 2017; 30:1-10. [PMID: 28375481 DOI: 10.1093/dote/dow037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/30/2016] [Indexed: 12/11/2022]
Abstract
For cervical esophageal cancer (CEC), National Comprehensive Cancer Network guidelines support RT to 50-50.4 Gy with chemotherapy but acknowledge higher doses may be appropriate. This study uses the National Cancer Database (NCDB) to characterize RT practices and identify if a dose-response relationship exists for overall survival (OS) for definitive treatment of CEC. We queried the NCDB for patients diagnosed with Stage I-III CEC from 2004 to 2013, and selected patients receiving definitive RT with doses between 50 and 74 Gy. Using multivariate logistic regression, the database was analyzed to determine factors associated with use of RT > 50.4 Gy. Patients were then stratified into three dose categories. Predictors of OS were analyzed with univariate and multivariate methods using the Kaplan-Meier curves, the log-rank test, and the Cox proportional hazards analysis. We stratified 789 patients with CEC who were treated with definitive radiation ± chemotherapy: 50-50.4 Gy ('standard'), >50.4 and <66 Gy ('medium'), and 66-74 Gy ('high'). Of these patients, 215 (27%) received standard doses, 375 (48%) received medium doses, and 199 (25%) received high doses. Patients with Medicaid insurance and those with Stage II disease were less likely (P < 0.05) to receive >50.4 Gy. Sex, histology, distance to treatment facility, and academic/community facility type were not significantly associated with receipt of >50.4 Gy. There was no association between dose and OS for the medium or high groups when using univariate analysis or analysis adjusted for demographic, facility, and clinical attributes. Stage III disease and the Charlson-Deyo scores of 1 or 2 were associated with higher mortality (P < 0.05), while female sex and use of chemotherapy were associated with lower mortality (P < 0.01). Nearly three-fourths of CEC patients in the United States are treated with RT > 50.4 Gy. Higher radiation doses were not associated with increased OS in CEC patients in the NCDB.
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Affiliation(s)
- B De
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - R Rhome
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - J Doucette
- Division of Biostatistics, Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - M Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York City, USA
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Alotaibi N, Zaidi H, Noormohamed N, Cote D, Crocker E, Doucette J, Bi W, Alharthy S, Quevedo P, Mekary R, Smith T. Comparison of Physiologic Growth Hormone Replacement Therapy to No Replacement on Craniopharyngioma Recurrence in Pediatric Patients. J Neurol Surg B Skull Base 2017. [DOI: 10.1055/s-0037-1600744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Hasan Zaidi
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | | | - David Cote
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Erin Crocker
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | | | - Wenya Bi
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | | | - Pablo Quevedo
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | | | - Timothy Smith
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
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Briceno V, Zaidi H, Doucette J, Onomichi K, Alreshidi A, Mekary R, Smith T. Efficacy of Transsphenoidal Surgery in Achieving Biochemical Cure of Growth Hormone-secreting Pituitary Adenomas Among Patients with Cavernous Sinus Invasion: A Systematic Review and Meta-analysis. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600650] [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: 10/20/2022]
Affiliation(s)
| | - Hasan Zaidi
- Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, United States
| | | | | | | | | | - Timothy Smith
- Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, United States
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El Helou S, Samiee-Zafarghandy S, Fusch G, Wahab MGA, Aliberti L, Bakry A, Barnard D, Doucette J, El Gouhary E, Marrin M, Meyer CL, Mukerji A, Nwebube A, Pogorzelski D, Pugh E, Schattauer K, Shah J, Shivananda S, Thomas S, Twiss J, Williams C, Dutta S, Fusch C. Introduction of microsystems in a level 3 neonatal intensive care unit-an interprofessional approach. BMC Health Serv Res 2017; 17:61. [PMID: 28109276 PMCID: PMC5251231 DOI: 10.1186/s12913-017-1989-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/06/2017] [Indexed: 11/13/2022] Open
Abstract
Background Growth of neonatal intensive care units in number and size has raised questions towards ability to maintain continuity and quality of care. Structural organization of intensive care units is known as a key element for maintaining the quality of care of these fragile patients. The reconstruction of megaunits of intensive care to smaller care units within a single operational service might help with provision of safe and effective care. Methods/Design The clinical team and patient distribution lay out, admission and discharge criteria and interdisciplinary round model was reorganized to follow the microstructure philosophy. A working group met weekly to formulate the implementation planning, to review the adaptation and adjustment process and to ascertain the quality of implementation following the initiation of the microsystem model. Discussion In depth examination of microsystem model of care in this study, provides systematic evaluation of this model on variable aspects of health care. The individual projects of this trial can be source of solid evidence for guidance of future decisions on optimized model of care for the critically ill newborns. Trial registration ClinicalTrial.gov, NCT02912780. Retrospectively registered on 22 September 2016.
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Affiliation(s)
- Salhab El Helou
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Samira Samiee-Zafarghandy
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Gerhard Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Muzafar Gani Abdul Wahab
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Lynda Aliberti
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Ahmad Bakry
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Deborah Barnard
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Joanne Doucette
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Enas El Gouhary
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Michael Marrin
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Carrie-Lynn Meyer
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Amit Mukerji
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Anne Nwebube
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - David Pogorzelski
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Edward Pugh
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Karen Schattauer
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Jay Shah
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sandesh Shivananda
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sumesh Thomas
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Jennifer Twiss
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Connie Williams
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sourabh Dutta
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Christoph Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,Department of Pediatrics, General Hospital, Paracelsus Medical School, Nuremberg, Germany.
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Doucette J. Copyright Blogs: "Scholarly Communications @ Duke"; "Copyright Librarian"; and "The Public Domain". Collection Management 2015. [DOI: 10.1080/01462679.2015.1014290] [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]
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Stey A, Doucette J, Florman S, Emre S. Donor and Recipient Factors Predicting Time to Graft Failure Following Orthotopic Liver Transplantation: A Transplant Risk Index. Transplant Proc 2013; 45:2077-82. [DOI: 10.1016/j.transproceed.2013.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Choong K, AlFaleh K, Doucette J, Gray S, Rich B, Verhey L, Paes B. Remifentanil for endotracheal intubation in neonates: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2010; 95:F80-4. [PMID: 20231228 DOI: 10.1136/adc.2009.167338] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of remifentanil as a premedication in neonates undergoing elective endotracheal intubation. DESIGN A double-blind randomised controlled trial. SETTING Tertiary care neonatal intensive care unit. PATIENTS Haemodynamically stable term and preterm neonates requiring elective endotracheal intubation. INTERVENTIONS Infants in the intervention arm received remifentanil (3 microg/kg) and normal saline placebo. The control group received fentanyl (2 microg/kg) and succinylcholine (2 mg/kg). Both groups also received atropine (20 microg/kg) as part of the premedication regime. MAIN OUTCOME MEASURES The primary outcome was time to successful intubation. Secondary outcomes included time to return of spontaneous respirations, oxygen saturation, heart rate and blood pressure changes during the procedure, adverse events and a survey of intubation conditions. RESULTS A total of 15 infants were randomised to each group. Baseline characteristics were similar in both groups. The median time to successful intubation was not statistically different (247 s in the remifentanil group vs 156 s in the fentanyl group, p=0.88). The intubation conditions were rated more favourably with fentanyl by the intubators. Although not statistically significant, chest wall rigidity was observed more commonly with remifentanil. CONCLUSIONS Although remifentanil is comparable to fentanyl and succinylcholine in attenuating adverse physiologic responses during neonatal intubation, muscle rigidity is a concern at doses of 3 microg/kg. Further trials are required to evaluate ideal dosing regimens and combinations of agents for use with remifentanil in neonates.
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Affiliation(s)
- K Choong
- Division of Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Choong KLM, Faleh KA, Doucette J, Gray S, Rich B, Verhey L, Paes B. Remifentanil and Atropine for Intubation in Neonates: a Randomized Clinical Trial. Paediatr Child Health 2009. [DOI: 10.1093/pch/14.suppl_a.12a] [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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Kaplan R, Steinberg M, Doucette J. Retention of retrospective print journals in the digital age: trends and analysis. J Med Libr Assoc 2006; 94:387-93, e198-200. [PMID: 17082829 PMCID: PMC1629447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
PURPOSE The issue of retaining retrospective print journals is examined in light of the shift to electronic titles, the reallocation of library budgets from print to electronic, and the changing research practices of today's library users. This article also examines the evolving role of the physical library and its impact on space allocation. METHODS To determine current practice and opinion, a survey of health sciences librarians and academic librarians was conducted. To demonstrate the use patterns of older journal issues, citation analyses and interlibrary loan statistics were examined. RESULTS All methods indicate that recent material is accessed more frequently than older material, with a significant drop in use of materials greater than 15 years old. Materials greater than 20 years old constituted less than 5% of interlibrary loans and less than 9% of articles noted in the citation analysis. CONCLUSIONS It is possible to eliminate older years of a print journal collection without a large impact on the needs of researchers. Librarians' preference to maintain full runs of journal titles may be motivated by reasons outside of actual usage or patrons needs.
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Shah A, Sidi P, Doucette J, Estrella L, Cunningham-Rundles C. Clinic Care Patterns of Patients with Suspected Immunodefects. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lemyre B, Doucette J, Kalyn A, Gray S, Marrin ML. Morphine for elective endotracheal intubation in neonates: a randomized trial [ISRCTN43546373]. BMC Pediatr 2004; 4:20. [PMID: 15461825 PMCID: PMC524358 DOI: 10.1186/1471-2431-4-20] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Accepted: 10/05/2004] [Indexed: 11/26/2022] Open
Abstract
Background Elective endotracheal intubations are still commonly performed without premedication in many institutions. The hypothesis tested in this study was that morphine given prior to elective intubations in neonates would decrease fluctuations in vital signs, shorten the duration of intubation and reduce the number of attempts. Methods From December 1999 to September 2000, infants of all gestations admitted to a level III neonatal intensive care unit and requiring an elective endotracheal intubation were randomly assigned to receive morphine 0.2 mg/kg IV or placebo 5 minutes before intubation. Duration of severe hypoxemia (HR< 90/min and Sp02<85%), duration of procedure, duration of hypoxemia (Sp02<85%), number of attempts and change in mean blood pressure were compared between groups. Results 34 infants (median 989 g and 28 weeks gestation) were included. The duration of severe hypoxemia was similar between groups. Duration of procedure, duration of hypoxemia, number of attempts and increases in mean blood pressure were also similar between groups. 94% of infants experienced bradycardia during the procedure. Conclusion We failed to demonstrate the effectiveness of morphine in reducing the physiological instability or time needed to perform elective intubations. Alternatives, perhaps with more rapid onset of action, should be considered.
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Affiliation(s)
- Brigitte Lemyre
- Department of Pediatrics, Division of Neonatology, University of Ottawa, Ottawa, Canada
| | - Joanne Doucette
- Department of Pediatrics, Division of Newborn Medicine, Hamilton Health Sciences Corporation, McMaster University Medical Center, Hamilton, Canada
| | - Angela Kalyn
- Department of Pediatrics, Division of Newborn Medicine, Hamilton Health Sciences Corporation, McMaster University Medical Center, Hamilton, Canada
| | - Shari Gray
- Department of Pharmacy, Hamilton Health Sciences Corporation, McMaster University Medical Center, Hamilton, Canada
| | - Michael L Marrin
- Department of Pediatrics, Division of Newborn Medicine, Hamilton Health Sciences Corporation, McMaster University Medical Center, Hamilton, Canada
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Abstract
PURPOSE To examine the relationship of family coping, resources, and strains on family adjustment over time following the NICU experience. DESIGN Longitudinal, correlational study based on the Resiliency Model of Family Stress, Adjustment and Adaptation. SAMPLE Data were collected, through mailed questionnaires, from 71 couples, 18 to 24 months following the birth of their infant. The data are a follow-up from a previous study conducted at the time of the infant's birth. MAIN OUTCOME VARIABLES The dependent variable in the study was family adjustment, measured by the McMaster Family Assessment Device. The independent variables were family resources, as measured by the Family Inventory of Resource Management; family coping, as measured by the Family Crisis Oriented Evaluation Scales; family strain, as measured by the Family Inventory of Life Events and Changes; and parent gender, family system (first-time parent or not), and the child's health, as measured by the Demographic Information Questionnaire. RESULTS Family adjustment improved over time for mothers but decreased for fathers. Fathers of infants with ongoing health problems reported significantly poorer family adjustment. Family resources were related to family adjustment and decreased over time for both parents. Families used more coping mechanisms and different coping patterns over time.
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Affiliation(s)
- Joanne Doucette
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada.
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Abstract
The present study investigated whether young children are gullible and readily deceived by another's lies. Specifically, this study examined whether young children believe a lie teller's statement when the statement violates their developing knowledge of a distinction between reality and fantasy. In the first three experiments 3- to 6-year-olds (N = 293) were presented with either a story or a live staged event in which an individual made an implausible statement about a misdeed (claiming that a ghost jumped out of a book and broke a glass). A significant age effect was obtained: 5- and 6-year-olds tended to report that the individual who made the implausible statement had actually committed the misdeed, whereas 3- and 4-year-olds tended to accept the claim of the protagonist. Experiment 4 revealed that 5- and 6-year-olds (N = 43) not only disbelieved an individual's implausible statement but also inferred that the individual was lying and had a deceptive intent. In contrast, Experiment 5 revealed that 3- and 4-year-olds (N = 41) had difficulty disbelieving an individual's implausible claim about an inanimate object (i.e., the claim that a chair came alive and broke the glass). The findings suggest that 5- and 6-year-olds are not so gullible as previously thought, and that they use their well-developed real-world knowledge to detect scapegoating lies. In contrast, many younger children tend to believe another's implausible lies, perhaps due to the fact that the knowledge needed to detect such lies has not yet been consolidated.
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Affiliation(s)
- Kang Lee
- Department of Psychology, Queen's University, Kingston, Ontario, Canada.
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Herbert R, Dropkin J, Warren N, Sivin D, Doucette J, Kellogg L, Bardin J, Kass D, Zoloth S. Impact of a joint labor-management ergonomics program on upper extremity musculoskeletal symptoms among garment workers. Appl Ergon 2001; 32:453-460. [PMID: 11534790 DOI: 10.1016/s0003-6870(01)00024-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study evaluated the effect of an ergonomics intervention program on the prevalence and intensity of symptoms of upper extremity work-related musculoskeletal disorders among 36 garment workers performing an operation called spooling. Adjustable chairs were introduced and workers were trained in their use. Symptom surveys were administered prior to and 6 months after introduction of adjustable chairs. Quantitative pre- and post-intervention measurement of joint position was performed utilizing videotapes among a subgroup of nineteen. Eighty nine percent of the cohort reported pain in either the neck or at least one upper extremity anatomic site prior to the adjustable chair intervention. Among subjects reporting pain at baseline, there were significantly decreased pain levels in 10 of 11 anatomic sites after the intervention. Among all subjects, the proportion reporting pain decreased for each anatomic site following the intervention, with statistically significant decreases in 3 sites. However, there were only modest declines in awkward posture among the videotaped subgroup. This study suggests that introduction of an ergonomics program focused on education and introduction of an adjustable chair may diminish musculoskeletal symptomatology in apparel manufacturing workers.
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Affiliation(s)
- R Herbert
- Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Brin MF, Lyons KE, Doucette J, Adler CH, Caviness JN, Comella CL, Dubinsky RM, Friedman JH, Manyam BV, Matsumoto JY, Pullman SL, Rajput AH, Sethi KD, Tanner C, Koller WC. A randomized, double masked, controlled trial of botulinum toxin type A in essential hand tremor. Neurology 2001; 56:1523-8. [PMID: 11402109 DOI: 10.1212/wnl.56.11.1523] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.4] [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: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of botulinum toxin type A injection in essential tremor of the hand. BACKGROUND Botulinum toxin type A is an effective treatment for dystonia, spasticity, and other movement disorders and has been found to be useful in open-label studies and one double-masked study of essential hand tremor. METHODS One hundred thirty-three patients with essential tremor were randomized to low-dose (50 U) or high-dose (100 U) botulinum toxin type A (Botox) or vehicle placebo treatment. Injections were made into the wrist flexors and extensors. Patients were followed for 16 weeks. The effect of treatment was assessed by clinical rating scales, measures of motor tasks and functional disability, and global assessment of treatment. Hand strength was evaluated by clinical rating and by a dynamometer. RESULTS Both doses of botulinum toxin type A significantly reduced postural tremor on the clinical rating scales after 4 to 16 weeks. However, kinetic tremor was significantly reduced only at the 6-week examination. Measures of motor tasks and functional disability were not consistently improved with botulinum toxin type A treatment. Grip strength was reduced for the low- and high-dose botulinum toxin type A groups as compared with the placebo group. Adverse reactions consisted mainly of dose-dependent hand weakness. CONCLUSION Botulinum toxin type A injections for essential tremor of the hands resulted in significant improvement of postural, but not kinetic, hand tremors and resulted in limited functional efficacy. Hand weakness is a dose-dependent significant side effect of treatment at the doses used in this study.
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Affiliation(s)
- M F Brin
- Department of Neurology, Columbia University, New York, NY, USA
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Abstract
Asthma morbidity and mortality are not distributed homogeneously among populations. To assess the relationship between asthma hospitalization rates and socioeconomic factors, we conducted an ecologic analysis using small geographical areas defined by postal zip code in New York City. Asthma hospitalization rates correlated with low median family income, percentage of minorities in the population, and percentage of children under the age of 18. Lack of access to preventive health care, poor housing conditions, environmental exposures, and genetic susceptibility may contribute to high incidence of asthma in some neighborhoods. This report supports the role of socioeconomic factors in asthma and serves to provide data for regulatory and health agencies to concentrate their efforts on neighborhoods most in need.
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Affiliation(s)
- L Claudio
- Department of Community Medicine, Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
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Balcain A, Lendrum BL, Bowler P, Doucette J, Maskell M. Action research applied to a preceptorship program. J Nurs Staff Dev 1997; 13:193-7. [PMID: 9287626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In this article the authors describe the development of a framework designed to discuss expectations between preceptors, orientees, nursing unit managers and clinical nurse educators. Action research theory provided the framework for this process. Preceptors found the process of articulating expectations helpful, relevant, and meaningful to their practice.
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Affiliation(s)
- A Balcain
- Women's Health & Wellness Consultants, Burlington, Ontario, Canada
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Abstract
BACKGROUND Serious fall injury represents a little studied, yet common and potentially preventable, cause of morbidity and mortality among older persons. We determined the frequency of, and risk factors for, experiencing serious fall injury events among older persons in the community. SUBJECTS A representative sample of 1103 community-living persons aged 72 years and older underwent comprehensive baseline and 1-year evaluations. MAIN OUTCOME MEASURES During a median 31 months of follow-up, fall data were obtained using fall calendars. Injury data were obtained from telephone interviews and from surveillance of emergency room and hospital records. RESULTS At least one fall was experienced by 546 (49%) participants. A total of 123 participants, representing 23% of fallers and 12% of the cohort, experienced 183 serious fall injury events. The factors independently associated with experiencing a serious injury during a fall included cognitive impairment (adjusted odds ratios 2.2; 95% confidence interval 1.5, 3.2); presence of at least two chronic conditions (2.0; 1.4, 2.9); balance and gait impairment (1.8; 1.3, 2.7); and low body mass index (1.8; 1.2, 2.5). In a separate analysis, including only subjects who fell, female gender (1.8; 1.1, 2.9) as well as most of the above factors were associated with experiencing a fall injury. CONCLUSIONS Several readily identifiable factors appeared to distinguish the subgroup of older fallers at risk for suffering a serious fall injury. These factors should help guide who and what to target in prevention efforts.
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Affiliation(s)
- M E Tinetti
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA
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Abstract
OBJECTIVE To identify the factors associated with automobile crashes, moving violations, and being stopped by police in a cohort of elderly drivers. DESIGN Prospective cohort study. SETTING Urban community. PARTICIPANTS All 283 persons who drove between 1990 and 1991, selected from a representative cohort of community-living persons aged 72 years and older in New Haven, Connecticut. MEASUREMENTS Data on independent variables in five domains (demographic, health, psychosocial, activity, and physical performance) were collected in structured interviews before events occurred. The outcome measure was the self-report of involvement in automobile crashes, moving violations, or being stopped by police in a 1-year period. RESULTS Of the 283 drivers, 13% reported a crash, a moving violation, or being stopped by police in 1 year. The baseline factors associated with the occurrence of adverse events in multivariable analysis (with adjustment for driving frequency and housing type) were the following: poor design copying on the Mini-Mental State Examination (relative risk, 2.7; 95% CI, 1.5 to 5.0), fewer blocks walked (relative risk, 2.3; CI, 1.3 to 4.0), and more foot abnormalities (relative risk, 1.9; CI, 1.1 to 3.3). These risk factors were combined for assessment of their ability to predict the occurrence of adverse driving events. If no factors were present, 6% of drivers had events; if 1 factor was present, 12% had events; if 2 factors were present, 26% had events; and if 3 factors were present, 47% had events. CONCLUSIONS In this urban population, several simple clinical measures correlated with the risk for adverse driving events.
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Affiliation(s)
- R A Marottoli
- West Haven Veterans Affairs Medical Center, Connecticut
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Abstract
OBJECTIVE In a previous study of outpatients with chronic mental illness who were treated with neuroleptic medication, the authors found a higher incidence of tardive dyskinesia among blacks than among whites. In this study the authors examined psychosocial, clinical, treatment, and medical correlates of race that might explain this finding. METHODS Extensive baseline data were obtained for 398 outpatients at risk for tardive dyskinesia. Pearson and Mantel-Haenszel chi square analyses were used to determine significant associations between a large number of variables and race. RESULTS AND DISCUSSION Compared with whites, nonwhites were more likely to be younger, less skilled, and unmarried; to report contacts with relatives outside the home; to have a diagnosis of schizophrenia; and to receive higher doses of neuroleptic drugs primarily through depot medications. Nonwhites were less likely to receive nonneuroleptic psychotropics, to wear dentures, and to report social contact with fathers. None of these racial differences explained more than a trivial portion of the association between race and the incidence of tardive dyskinesia. CONCLUSIONS These results suggest the need for studies of differences in diagnostic and prescribing practices for black and white patients and of differences in the action and side effects of neuroleptics.
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Ling ZD, Yeoh E, Webb BT, Farrell K, Doucette J, Matheson DS. Intravenous immunoglobulin induces interferon-gamma and interleukin-6 in vivo. J Clin Immunol 1993; 13:302-9. [PMID: 8245176 DOI: 10.1007/bf00920238] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Immunoglobulin is known to be an immunomodulator. It can induce protein mediators from mononuclear cells, particularly monocytes in vitro. Intravenous immunoglobulin (IVIg) has been used as a therapy in several clinical situations. In this study, the influence of IVIg infusion on the plasma levels of two protein mediators, interferon-gamma (IFN-gamma) and interleukin-6 (IL-6), was assessed in patients with secondary generalized epilepsy. Compared to preinfusion levels, plasma interferon-gamma was increased in 18 of 18 patients 20 min after the 6- to 8-hr infusion of IVIg. Plasma interferon-gamma levels reached their peak at various times from 20 min to 3 days post IVIg infusion, dependent upon the individual patient. Plasma IL-6 levels also increased after IVIg infusion. Generally, IL-6 reached its peak level after IFN-gamma. No activated T cells or B cells were observed as determined by the expression of surface CD25, CD23, and HLA-DR 20 min following the infusion when the IFN-gamma and IL-6 levels were assessed. The expression of the high-affinity receptor for IgG, CD64, on monocytes was significantly enhanced after IVIg infusion, while the low-affinity receptor for IgG, CD32, was only slightly increased. Cytoplasmic staining of PBMC indicates that both CD16-positive and CD16-negative cells may contribute to the increase seen in plasma IFN-gamma. These data raise the possibility that the therapeutic effects of intravenous immunoglobulin may be related, at least in part, to the immunomodulatory activity as demonstrated by the changes in plasma levels of IFN-gamma and IL-6.
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Affiliation(s)
- Z D Ling
- Department of Paediatrics, B.C.'s Children's Hospital, University of British Columbia, Vancouver, Canada
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Abstract
One hundred forty-seven female patients with retrospectively classified (AJCCS 1977) Stage III and nonmetastatic noninflammatory Stage IV breast carcinoma from June 1958 to December 1978 were studied to determine the effects of primary radiation on local recurrence and survival. Fifty-one patients recurred in the breast; 24 patients recurred in the local-regional area of breast and draining lymphatics and 15 patients recurred in the axilla only. Distant metastases developed in 97 patients. The 5 year actuarial survival was 24%. Decreased recurrence rates were associated with megavoltage and higher doses of radiation (34% vs. 65%); with smaller tumors (27% vs. 57%); with total extirpation of gross tumor (33% vs. 53%); and with those tumors that were given a "boost dose" (26% vs. 58%). The addition of systemic treatment did not appreciably alter either local-regional recurrence or survival. However, most of the patients received endocrine ablation or single-agent chemotherapy. Polyagent chemotherapy was used late in the series, making its true impact on survival difficult to evaluate.
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Abstract
We report the radiation therapy of keratoacanthoma in 13 patients using orthovoltage X rays and electrons. All patients had an excellent cosmetic result, and time to regression was dose dependent up to a dose corresponding to TDF 50; increasing dose beyond this level did not accelerate time to regression past 2.4 months. We also note a heretofore undocumented association between keratoacanthoma and second malignancy.
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Abstract
From January 1962 to May 1979, 23 patients with biopsy-proved intramedullary spinal cord tumors were treated initially with total resection, subtotal resection, irradiation, or subtotal resection and irradiation. Local control was achieved in 1/2 patients after total resection, 1/3 after subtotal resection, 8/9 after subtotal resection and radiation therapy, and 5/8 after radiation therapy alone. The patients with ependymomas exhibited a radiation dose-response relationship; of eight patients followed five or more years postirradiation, local control was achieved in 2/3 with time dose fraction (TDF) less than 55, 2/3 with TDF 55-65, and 2/2 with TDF greater than 65. The actuarial 5- and 10-year survival rates were 58% and 23% for astrocytoma, and 100% and 73% for patients with ependymoma, respectively. Neurological deficits improved or became totally normal after initial irradiation. Patterns of failure, management of recurrences, and radiotherapeutic techniques and dose recommendations are discussed.
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Goitein M, Wittenberg J, Mendiondo M, Doucette J, Friedberg C, Ferrucci J, Gunderson L, Linggood R, Shipley WU, Fineberg HV. The value of CT scanning in radiation therapy treatment planning: a prospective study. Int J Radiat Oncol Biol Phys 1979; 5:1787-98. [PMID: 528242 DOI: 10.1016/0360-3016(79)90562-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Chu AM, Wood W, Doucette J. The treatment of inflammatory breast carcinoma by radiation. Int J Radiat Oncol Biol Phys 1977. [DOI: 10.1016/0360-3016(77)90334-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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