1
|
Zemanick ET, Emerman I, McCreary M, Mayer-Hamblett N, Warden MN, Odem-Davis K, VanDevanter DR, Ren CL, Young J, Konstan MW. Heterogeneity of CFTR modulator-induced sweat chloride concentrations in people with cystic fibrosis. J Cyst Fibros 2024:S1569-1993(24)00015-8. [PMID: 38360461 DOI: 10.1016/j.jcf.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/03/2024] [Accepted: 02/04/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Sweat chloride (SC) concentrations in people with cystic fibrosis (PwCF) reflect relative CF transmembrane conductance regulator (CFTR) protein function, the primary CF defect. Populations with greater SC concentrations tend to have lesser CFTR function and more severe disease courses. CFTR modulator treatment can improve CFTR function within specific CF genotypes and is commonly associated with reduced SC concentration. However, SC concentrations do not necessarily fall to concentrations seen in the unaffected population, suggesting potential for better CFTR treatment outcomes. We characterized post-modulator SC concentration variability among CHEC-SC study participants by genotype and modulator. METHODS PwCF receiving commercially approved modulators for ≥90 days were enrolled for a single SC measurement. Clinical data were obtained from chart review and the CF Foundation Patient Registry (CFFPR). Variability of post-modulator SC concentrations was assessed by cumulative SC concentration frequencies. RESULTS Post-modulator SC concentrations (n = 3787) were collected from 3131 PwCF; most (n = 1769, 47 %) were collected after elexacaftor/tezacaftor/ivacaftor (ETI) treatment. Modulator use was associated with lower SC distributions, with post-ETI concentrations the lowest on average. Most post-ETI SC concentrations were <60 mmol/L (79 %); 26 % were <30 mmol/L. Post-ETI distributions varied by genotype. All genotypes containing at least one F508del allele had individuals with post-ETI SC ≥60 mmol/L, with the largest proportion being F508del/minimal function (31 %). CONCLUSIONS Post-modulator SC concentration heterogeneity was observed among all genotypes and modulators, including ETI. The presence of PwCF with post-modulator SC concentrations within the CF diagnostic range suggests room for additional treatment-associated CFTR restoration in this population.
Collapse
Affiliation(s)
- E T Zemanick
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - I Emerman
- Seattle Children's Hospital, Seattle, WA, United States
| | - M McCreary
- Seattle Children's Hospital, Seattle, WA, United States
| | - N Mayer-Hamblett
- Seattle Children's Hospital, Seattle, WA, United States; University of Washington, Seattle, WA, United States
| | - M N Warden
- Seattle Children's Hospital, Seattle, WA, United States
| | - K Odem-Davis
- Seattle Children's Hospital, Seattle, WA, United States
| | - D R VanDevanter
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - C L Ren
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - J Young
- Seattle Children's Hospital, Seattle, WA, United States
| | - M W Konstan
- Case Western Reserve University School of Medicine, Cleveland, OH, United States; Rainbow Babies and Children's Hospital, Cleveland, OH, United States
| |
Collapse
|
2
|
Young J, Seeberg KA, Aakre KM, Borgeraas H, Nordstrand N, Wisløff T, Hjelmesæth J, Omland T, Hertel JK. The liver-heart axis in patients with severe obesity: The association between liver fibrosis and chronic myocardial injury may be explained by shared risk factors of cardiovascular disease. Clin Biochem 2024; 123:110688. [PMID: 37995847 DOI: 10.1016/j.clinbiochem.2023.110688] [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: 07/06/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Severe obesity is associated with increased risk of non-alcoholic fatty liver disease and cardiovascular disease. We hypothesized that liver fibrosis as quantified by the Enhanced Liver Fibrosis (ELF) test would be predictive of myocardial injury and fibrosis, expressed by higher concentrations of cardiac troponin T and I measured by high-sensitivity assays (hs-cTnT and hs-cTnI, respectively). MATERIAL AND METHODS We performed cross-sectional analyses of baseline data from 136 patients (mean age 45 years, 38 % male) with severe obesity participating in the non-randomized clinical trial Prevention of Coronary Heart Disease in Morbidly Obese Patients (ClinicalTrials.gov NCT00626964). Associations between ELF scores, hs-cTnT, and hs-cTnI concentrations were assessed using linear regression analysis. RESULTS ELF scores were associated with hs-cTnT in the unadjusted model (B 0.381, 95 % Confidence Interval [CI] 0.247, 0.514), but the association was attenuated upon adjustment for potential confounders (B -0.031, 95 % CI -0.155, 0.093). Similarly, for hs-cTnI, an observed association with ELF scores in the unadjusted model was attenuated upon adjustment for potential confounders ((B 0.432, 95 % CI 0.179, 0.685) and (B 0.069, 95 % CI -0.230, 0.367), respectively). Age, sex, hypertension, and estimated glomerular filtration rate were amongst the shared predictors of ELF score, hs-cTnT, and hs-cTnI that provided the univariable models with the highest R-squared and lowest Akaike Information Criterion values. CONCLUSIONS Contrary to our hypothesis, ELF score did not predict myocardial injury and fibrosis, but we rather demonstrated an association between liver fibrosis and myocardial injury and fibrosis may be explained by shared risk factors of cardiovascular disease.
Collapse
Affiliation(s)
- J Young
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - K A Seeberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| | - K M Aakre
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - H Borgeraas
- Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| | - N Nordstrand
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - T Wisløff
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - J Hjelmesæth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| | - T Omland
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - J K Hertel
- Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| |
Collapse
|
3
|
Oles RE, Terrazas MC, Loomis LR, Hsu CY, Tribelhorn C, Ferre PB, Ea A, Bryant M, Young J, Carrow HC, Sandborn WJ, Dulai P, Sivagnanam M, Pride D, Knight R, Chu H. Pangenome comparison of Bacteroides fragilis genomospecies unveil genetic diversity and ecological insights. bioRxiv 2023:2023.12.20.572674. [PMID: 38187556 PMCID: PMC10769428 DOI: 10.1101/2023.12.20.572674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Bacteroides fragilis is a Gram-negative commensal bacterium commonly found in the human colon that differentiates into two genomospecies termed division I and II. We leverage a comprehensive collection of 694 B. fragilis whole genome sequences and report differential gene abundance to further support the recent proposal that divisions I and II represent separate species. In division I strains, we identify an increased abundance of genes related to complex carbohydrate degradation, colonization, and host niche occupancy, confirming the role of division I strains as gut commensals. In contrast, division II strains display an increased prevalence of plant cell wall degradation genes and exhibit a distinct geographic distribution, primarily originating from Asian countries, suggesting dietary influences. Notably, division II strains have an increased abundance of genes linked to virulence, survival in toxic conditions, and antimicrobial resistance, consistent with a higher incidence of these strains in bloodstream infections. This study provides new evidence supporting a recent proposal for classifying divisions I and II B. fragilis strains as distinct species, and our comparative genomic analysis reveals their niche-specific roles.
Collapse
Affiliation(s)
- Renee E Oles
- Department of Pathology, University of California, San Diego, La Jolla, CA
- Department of Pediatrics, School of Medicine, University of California, La Jolla, CA
| | | | - Luke R Loomis
- Department of Pathology, University of California, San Diego, La Jolla, CA
| | - Chia-Yun Hsu
- Department of Pathology, University of California, San Diego, La Jolla, CA
| | - Caitlin Tribelhorn
- Department of Pediatrics, School of Medicine, University of California, La Jolla, CA
| | - Pedro Belda Ferre
- Department of Pediatrics, School of Medicine, University of California, La Jolla, CA
| | - Allison Ea
- Department of Pathology, University of California, San Diego, La Jolla, CA
| | - MacKenzie Bryant
- Department of Pediatrics, School of Medicine, University of California, La Jolla, CA
| | - Jocelyn Young
- Department of Pediatrics, School of Medicine, University of California, La Jolla, CA
- Rady Children's Hospital, San Diego, CA, United States
| | - Hannah C Carrow
- Department of Pathology, University of California, San Diego, La Jolla, CA
| | - William J Sandborn
- Division of Gastroenterology, University of California, San Diego, La Jolla, CA
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA
| | - Parambir Dulai
- Division of Gastroenterology, University of California, San Diego, La Jolla, CA
- Division of Gastroenterology, Northwestern University, Chicago, Illinois
| | - Mamata Sivagnanam
- Department of Pediatrics, School of Medicine, University of California, La Jolla, CA
- Rady Children's Hospital, San Diego, CA, United States
| | - David Pride
- Department of Pathology, University of California, San Diego, La Jolla, CA
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA
- Center for Innovative Phage Applications and Therapeutics (IPATH), University of California, San Diego, La Jolla, CA
- Center of Advanced Laboratory Medicine (CALM), University of California, San Diego, La Jolla, CA
| | - Rob Knight
- Department of Pediatrics, School of Medicine, University of California, La Jolla, CA
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA
- Shu Chien-Gene Lay Department of Bioengineering, University of California San Diego, La Jolla, CA
- Department of Computer Science & Engineering, University of California, San Diego, La Jolla, CA
- Halıcıoğlu Data Science Institute, University of California, San Diego, La Jolla, CA
| | - Hiutung Chu
- Department of Pathology, University of California, San Diego, La Jolla, CA
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA
- Chiba University-UC San Diego Center for Mucosal Immunology, Allergy and Vaccines (cMAV), University of California, San Diego, La Jolla, CA
| |
Collapse
|
4
|
Talbot M, Gear M, Young J, Milner D, Bunting A, Bozzo A. Risk assessment of aviators with a total hip arthroplasty. BMJ Mil Health 2023:e002557. [PMID: 37844962 DOI: 10.1136/military-2023-002557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Max Talbot
- Department of National Defence and the Canadian Armed Forces, Montréal, Québec, Canada
- Department of Surgery, McGill University Health Centre, Montréal, Québec, Canada
| | - M Gear
- Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - J Young
- Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - D Milner
- Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - A Bunting
- Department of Surgery, McGill University Health Centre, Montréal, Québec, Canada
| | - A Bozzo
- Department of Surgery, McGill University Health Centre, Montréal, Québec, Canada
| |
Collapse
|
5
|
Abstract
Dysphagia is an important clinical symptom that increases in prevalence with age. Both oropharyngeal and esophageal processes can contribute to dysphagia, and these can be differentiated with a careful history. Neuromuscular processes are more prevalent than structural causes in oropharyngeal dysphagia, therefore, investigation should start with a modified barium swallow. In contrast, structural processes dominate in esophageal dysphagia, and endoscopy can offer biopsy and therapy by way of dilation. Manometry is performed for esophageal dysphagia when no structural etiology is found. Specific management of dysphagia is dependent on the etiology and mechanism of dysphagia.
Collapse
Affiliation(s)
- Edward Hurtte
- Division of Gastroenterology, Washington University School of Medicine, Campus Box 8124, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Jocelyn Young
- United Health Services Hospitals, Johnson City, NY, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, Campus Box 8124, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| |
Collapse
|
6
|
Huang JS, Smith N, Hamilton J, Young J, Choi L. Harnessing Electronic Medical Record Tools to Provide Proceduralist Feedback on Pediatric Endoscopy Quality Metrics. J Pediatr Gastroenterol Nutr 2023; 77:422-425. [PMID: 37364063 DOI: 10.1097/mpg.0000000000003872] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
In 2022, the Pediatric Endoscopy Quality Improvement Network published quality metrics related to pediatric endoscopy. We utilized electronic medical record (EMR) tools to collect pediatric endoscopy quality metrics (PEQM) and to standardize proceduralist feedback. EMR tools were created to capture and display PEQM: (1) an endoscopy documentation template, (2) nursing documentation of events during endoscopy for timed calculations, and (3) a data dashboard. Dashboard metrics provided individualized PEQM feedback relative to group performance and ideals where available. Utilization of the endoscopy documentation tools and data dashboard was measured. Utility was assessed using a survey based on the Technology Adoption Model. Adoption of documentation tools has been nearly universal with positive survey outcomes. Robust dashboard visualization has been demonstrated. Use of EMR documentation tools standardized PEQM collection. Future capture and sharing of common PEQM data across institutions could help determine PEQM benchmarks.
Collapse
Affiliation(s)
- Jeannie S Huang
- From the Department of Pediatrics, University of California San Diego, La Jolla, CA
- the Department of Gastroenterology, Rady Children's Hospital, San Diego, CA
- the Department of Clinical Informatics, Rady Children's Hospital, San Diego, CA
| | - Nicole Smith
- the Department of Clinical Informatics, Rady Children's Hospital, San Diego, CA
| | - Jennine Hamilton
- the Department of Clinical Informatics, Rady Children's Hospital, San Diego, CA
| | - Jocelyn Young
- From the Department of Pediatrics, University of California San Diego, La Jolla, CA
- the Department of Gastroenterology, Rady Children's Hospital, San Diego, CA
| | - Lillian Choi
- From the Department of Pediatrics, University of California San Diego, La Jolla, CA
- the Department of Gastroenterology, Rady Children's Hospital, San Diego, CA
| |
Collapse
|
7
|
VanDevanter DR, Zemanick ET, Konstan MW, Ren CL, Odem-Davis K, Emerman I, Young J, Mayer-Hamblett N. Willingness of people with cystic fibrosis receiving elexacaftor/tezacaftor/ivacaftor (ETI) to participate in randomized modulator and inhaled antimicrobial clinical trials. J Cyst Fibros 2023; 22:652-655. [PMID: 37100705 PMCID: PMC10523954 DOI: 10.1016/j.jcf.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To assess the feasibility of enrolling people with CF (pwCF) taking the CFTR modulator elexacaftor/tezacaftor/ivacaftor (ETI) in clinical trials of a new modulator. METHODS PwCF receiving ETI at CHEC-SC study (NCT03350828) enrollment were surveyed for interest in 2-week to 6-month placebo- (PC) and active-comparator (AC) modulator studies. Those taking inhaled antimicrobials (inhABX) were surveyed for interest in PC inhABX studies. RESULTS Of 1791 respondents, 75% [95% CI 73, 77] would enroll in a 2-week PC modulator study versus 51% [49, 54] for a 6-month study; 82% [81, 84] and 63% [61, 65] would enroll in 2-week and 6 month AC studies; 77% [74, 80] of 551 taking inhABX would enroll in a 2-week PC inhABX study versus 59% [55, 63] for a 6-month study. Previous clinical trial experience increased willingness. CONCLUSIONS Study designs will affect feasibility of future clinical trials of new modulators and inhABX in people receiving ETI.
Collapse
Affiliation(s)
- D R VanDevanter
- Case Western Reserve University School of Medicine, Cleveland, OH United States.
| | - E T Zemanick
- University of Colorado, Anschutz Medical Campus, Aurora CO United States
| | - M W Konstan
- Case Western Reserve University School of Medicine, Cleveland, OH United States; Rainbow Babies and Children's Hospital, Cleveland, OH United States
| | - C L Ren
- Children's Hospital of Philadelphia, Philadelphia, PA United States
| | - K Odem-Davis
- Seattle Children's Hospital, Seattle, WA United States
| | - I Emerman
- Seattle Children's Hospital, Seattle, WA United States
| | - J Young
- Seattle Children's Hospital, Seattle, WA United States
| | - N Mayer-Hamblett
- Seattle Children's Hospital, Seattle, WA United States; University of Washington, Seattle, WA United States
| |
Collapse
|
8
|
Mayer-Hamblett N, Zemanick ET, Odem-Davis K, VanDevanter D, Warden M, Rowe SM, Young J, Konstan MW, For-The-Chec-Sc-Study-Group. Characterizing CFTR modulated sweat chloride response across the cf population: Initial results from the CHEC-SC study. J Cyst Fibros 2023; 22:79-88. [PMID: 35871974 PMCID: PMC10103635 DOI: 10.1016/j.jcf.2022.07.008] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND CHEC-SC is an ongoing epidemiologic study characterizing modulator-induced sweat chloride (SC) responses across the CF population, with interim results available prior to the availability of triple combination modulator therapy. METHODS Eligible participants had been prescribed a modulator for ≥90 days with re-enrollment allowed upon establishment of a new modulator. Pre-modulator SC values were obtained from chart review; post-modulator sweat was collected and analyzed locally. SC changes were descriptively summarized with biologic sex effects adjusted for age, weight, and CFTR genotype. Heterogeneity in ivacaftor SC response was characterized in relation to published CFTR functional responses. RESULTS 1848 participants provided 2004 SC measurements, 26.2% on ivacaftor, 39.1% on lumacaftor/ivacaftor, and 34.7% on tezacaftor/ivacaftor. Average SC changes for all modulators were consistent with those reported in previous clinical studies, with greater variation in SC response observed among rarer mutations and notable shifts in the proportion with SC <60mmol/L independent of the magnitude of SC change. Ivacaftor induced in vitro CFTR functional change was significantly correlated with ivacaftor-modulated SC response (Pearson correlation= ‒0.52, 95% CI: ‒0.773, ‒0.129). Average SC change from ivacaftor to tezacaftor/ivacaftor was ‒4.9 mmol/L (n=17,95% CI:‒9.3, ‒0.5) and differed from those switching from lumacaftor/ivacaftor (10.0 mmol/L, n=139, 95% CI:7.8,12.3). Sex at birth was not associated with SC response. CONCLUSIONS CHEC-SC is the largest study characterizing modulator-induced SC changes across the CF population. There was a strong association between ivacaftor induced in vitro CFTR function and SC response across a genotypically heterogenous cohort. Biological sex was not associated with SC response.
Collapse
Affiliation(s)
- N Mayer-Hamblett
- University of Washington, Seattle, WA, United States; Seattle Children's Hospital, Seattle, WA, United States.
| | - E T Zemanick
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - K Odem-Davis
- Seattle Children's Hospital, Seattle, WA, United States
| | - D VanDevanter
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - M Warden
- Seattle Children's Hospital, Seattle, WA, United States
| | - S M Rowe
- University of Alabama at Birmingham, Birmingham, AL, England
| | - J Young
- Seattle Children's Hospital, Seattle, WA, United States
| | - M W Konstan
- Case Western Reserve University School of Medicine, Cleveland, OH, United States; Rainbow Babies and Children's Hospital, Cleveland, OH, United States
| | | |
Collapse
|
9
|
Teuwen LA, Young J, Davies A, Hudson J, Bourlon de los Rios M, Prenen H, Segelov E. 432P Representation of countries and gender in abstracts at the 2022 American Society of Clinical Oncology Annual Scientific Meeting (ASCO ASM). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
|
10
|
Barratt J, Dellanna F, Portoles J, Choukroun G, de Nicola L, Reusch M, Young J, Dimković N. Tolérance du roxadustat par rapport aux agents stimulant l’érythropoïèse dans le traitement de l’anémie chez les patients atteints de maladie rénale chronique non dialysés ou incidents en dialyse : analyse groupée de quatre études de phase 3. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.312] [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: 10/14/2022]
|
11
|
Laidsaar-Powell R, Butow P, Brown B, Mander K, Young J, Stone E, Chin V, Banks E, Lim C, Rankin N. EP10.01-005 Australian Lung Cancer Survivors Experiences of Novel Treatments, Healthcare, and Ongoing Physical and Psychological Needs. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
12
|
Barratt J, Dellanna F, Portoles J, Choukroun G, De Nicola L, Reusch M, Young J, Jiletcovici A, Dimković N. Bilan martial des patients traités par roxadustat pour anémie liée à leur maladie rénale chronique : analyse post hoc chez les patients non dialysés ou incidents en dialyse inclus dans quatre études de phase 3. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.313] [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: 10/14/2022]
|
13
|
Chin V, Arora H, Senabouth A, Hernandez JA, McCloy R, Simes J, Boyer M, Hogg P, Young J, Joshua A, Brown B, Watkins N, Powell J. EP16.03-041 Single Cell RNA Sequencing Reveals Phenotypic Predispositions to Developing Lung Cancer in Never-Smokers. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
14
|
Dalgaard F, Fudim M, Al-Khatib S, Friedman D, Abraham WT, Cleland JF, Curtis AB, Gold MR, Kutyifa V, Linde C, Young J, Ali-Ahmad F, Olivas-Martinez A, Inoue LYT, Sanders GD. Cardiac resynchronization therapy in patients with a history of atrial fibrillation: insights from five major clinical trials. Europace 2022. [DOI: 10.1093/europace/euac053.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Heart, Lung, and Blood Institute
Background
Many patients with heart failure who are considered for cardiac resynchronization therapy (CRT) have a history of (h/o) atrial fibrillation (AF) but there are doubts about the efficacy of CRT in patients with AF.
Purpose
To investigate the association of CRT on morbidity and mortality among patients with and without a h/o AF.
Methods
Original, patient-level data from five clinical trials of CRT that permitted enrolment of patients with a h/o AF were included: COMPANION, MADIT-CRT, BLOCK HF, REVERSE, and MIRACLE trial. Patients with permanent or persistent AF were excluded from these trials, and therefore from this analysis. The outcomes of interest were the composite endpoint of time to heart failure hospitalization (HFH) or all-cause mortality or all-cause mortality alone. The association of CRT (versus no CRT) with outcomes for patients with and without a h/o AF was assessed using a Bayesian-Weibull survival regression model with random terms for the trial-specific treatment effects and the trial-specific baseline hazard functions including an interaction between history of paroxysmal AF and CRT. All results are presented as hazard ratios (HRs) with 95% posterior credible intervals (CIs) and posterior probabilities of no association, adjusting for baseline characteristics.
Results
A total of 4062 patients were included, 661 (16.3%) of whom had a h/o AF. Patients with a h/o AF were older (mean [SD] age 68 [10] years versus 64 [11] years) and had a higher proportion of ischemic cardiomyopathy (67% versus 53%, p<0.001), a higher baseline serum creatinine (1.3 mg/dl versus 1.2 mg/dl, p<0.001), and a lower left ventricular ejection fraction (25% versus 26%, p<0.001). The HRs for all outcomes and the interaction term are shown in Table 1. For the overall population, CRT delayed the time to HFH or all-cause mortality (HR: 0.74, 95% CI: 0.62 – 0.87, p=0.005); for patients with a h/o AF, it did not (HR: 0.87, 95% CI: 0.64 to 1.19, p=0.37). In this patient-level meta-analysis, CRT was not associated with a reduction in mortality, overall or by h/o AF. Howevber, the interaction (estimate shown as a ratio of HRs) between those with or without a h/o AF and the effects of CRT was not significant for either outcome (Table 1).
Conclusion
In the largest post hoc analysis to date, we confirm the benefits of CRT in patients without a h/o AF in reducing HFH or mortality. There was no statistically significant interaction between CRT and h/o AF for any analysed outcome.
Collapse
Affiliation(s)
- F Dalgaard
- Gentofte University Hospital, Gentofte, Denmark
| | - M Fudim
- Duke Clinical Research Institute, Durham, United States of America
| | - S Al-Khatib
- Duke Clinical Research Institute, Durham, United States of America
| | - D Friedman
- Duke Clinical Research Institute, Durham, United States of America
| | - WT Abraham
- The Ohio State University, Division of Cardiovascular Medicine, Columbus, United States of America
| | - JF Cleland
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - AB Curtis
- University At Buffalo, Department of Medicine, Buffalo, United States of America
| | - MR Gold
- Medical University of South Carolina, Charleston, United States of America
| | - V Kutyifa
- University of Rochester Medical Center, Division of Cardiology, Rochester, United States of America
| | - C Linde
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - J Young
- Cleveland Clinic, Cleveland, United States of America
| | - F Ali-Ahmad
- Duke Clinical Research Institute, Durham, United States of America
| | - A Olivas-Martinez
- University of Washington, Department of Biostatistics, Seattle, United States of America
| | - LYT Inoue
- University of Washington, Department of Biostatistics, Seattle, United States of America
| | - GD Sanders
- Duke Clinical Research Institute, Durham, United States of America
| |
Collapse
|
15
|
Bruce N, Young J. 347 A Bit of a Headache: Management of Head Injuries in a District General Hospital. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Head Injury is a common presentation in our DGH, which covers a large rural area and is now a regional trauma centre. We audited our management of head injuries against current guidelines and planned a new pathway to ensure patients receive the correct advice and follow up on discharge.
Method
Data was requested from IT for all head injury episodes in 2019, to reflect usual numbers pre-pandemic.
Electronic letters, radiology and notes were used to identify whether imaging criteria was met/carried out, discharge destinations, re-presentations, specialty discussions, and head injury advice on discharge.
Results
307 individual patients identified. 13 re-presentations. 10 required neurosurgical discussions
Destinations
226 (73.6%) discharged direct from ED. Admissions: Surgical - 37 (12%), Medical - 6 (2%), Paeds – 14 (4.5%), ITU 2 (0.7%), Did not wait – 2 (0.7%), Not Recorded – 7 (2.3%)
Imaging
100 patients met NICE criteria for CT, 100% were documented in notes and had CT. 76% reported normal, 18% had a bleed, contusion, or haematoma.
HI advice
90% of ED discharges, 16% of Surgical and 16% of medical discharges had head injury discharge advice documented
Conclusions
Guidelines were met for 100% of patients requiring imaging. Head injury advice was well documented in ED but fell down in ward paperwork. We have written a robust pathway where all inpatients have a proforma completed during admission with prompts for discharge advice and rehab referral where appropriate, this is currently undergoing a re-audit to ensure improvement and if successful will become an established part of the trauma pathway in our hospital.
Collapse
Affiliation(s)
- N. Bruce
- NHS Borders, Melrose, United Kingdom
| | - J. Young
- NHS Borders, Melrose, United Kingdom
| |
Collapse
|
16
|
Hobbs J, Marks B, Young J. 238 The Use of MRCP in the Assessment of Choledocholithiasis in Patients Presenting with Symptomatic Gallstone Disease. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Magnetic Resonance Cholangiopancreatography (MRCP) is the investigation of choice for choledocholithiasis; however, use is varied and guidelines vague. The National Institute for Health and Care (NICE) recommend MRCP when common bile duct (CBD) dilatation ≥ 8mm or liver function tests (LFTs) are abnormal but do not quantify this further. The Sunflower Study classifies patients as “high-risk” for choledocholithiasis if alanine aminotransferase (ALT) ≥ 80 IU/L, alkaline phosphatase (ALP) ≥ 200 IU/L or CBD ≥ 8mm. We aimed to assess compliance with NICE criteria and determine what biochemical abnormalities are most associated with choledocholithiasis.
Method
A retrospective analysis of inpatient MRCPs performed at QEH between March and May 2021 was performed (n = 72). Pre-MRCP bloods and imaging were used to assess concordance with NICE guidelines. We compared LFTs between patients with and without choledocholithiasis, looking for significant differences.
Results
84.7% of MRCPs were performed in accordance with NICE guidance, of which 31.1% demonstrated choledocholithiasis. No cases of choledocholithiasis were identified if NICE criteria were not fulfilled. A significant difference between the mean values of gamma glutamyltransferase (GGT) and ALP was noted between patients with and without choledocholithiasis.
Conclusions
We identified that the majority of MRCPs were performed in accordance with guidance. Significantly, no cases of choledocholithiasis were identified if these criteria were not met. Although our sample size was small, we found the most specific biochemical markers were ALP and GGT and propose that further research with larger cohorts may help develop a risk stratification tool to aid decision making.
Collapse
Affiliation(s)
- J. Hobbs
- Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - B. Marks
- County Durham and Darlington NHS Foundation Trust, Darlington, United Kingdom
| | - J. Young
- Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| |
Collapse
|
17
|
Young J, Mercieca L, Ceci M, Pisani D, Betts A, Boffa M. A case of bullous pemphigoid after the SARS-CoV-2 mRNA vaccine. J Eur Acad Dermatol Venereol 2022; 36:e13-e16. [PMID: 34547137 PMCID: PMC8661451 DOI: 10.1111/jdv.17676] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/16/2021] [Indexed: 12/16/2022]
Affiliation(s)
- J. Young
- Department of DermatologyMater Dei HospitalMsidaMalta
| | - L. Mercieca
- Department of DermatologyMater Dei HospitalMsidaMalta
| | - M. Ceci
- Department of PathologyMater Dei HospitalMsidaMalta
| | - D. Pisani
- Department of PathologyMater Dei HospitalMsidaMalta
| | - A. Betts
- Department of PathologyMater Dei HospitalMsidaMalta
| | - M.J. Boffa
- Department of DermatologyMater Dei HospitalMsidaMalta
| |
Collapse
|
18
|
Lin R, Ritter E, Flynn J, Ho C, Ruiz J, Jakubowski A, Papadopoulos E, Shaffer B, Castro-Malaspina H, Cho C, Ponce D, Barker J, Tamari R, Sauter C, Gyurkocza B, van den Brink M, Young J, Perales M, Devlin S, Wong P, Giralt S. Aging-related, Senescence-associated Secretory Phenotype and Allogeneic Hematopoietic Cell Transplantation Outcomes in Older Adults. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
19
|
Mao AW, Barck H, Young J, Paley A, Mao JH, Chang H. Identification of a novel cancer microbiome signature for predicting prognosis of human breast cancer patients. Clin Transl Oncol 2021; 24:597-604. [PMID: 34741726 DOI: 10.1007/s12094-021-02725-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/27/2021] [Accepted: 10/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Prognosis of breast cancer (BC) patients differs considerably and identifying reliable prognostic biomarker(s) is imperative. With evidence that the microbiome plays a critical role in the response to cancer therapies, we aimed to identify a cancer microbiome signature for predicting the prognosis of BC patients. METHODS The TCGA BC microbiome data (TCGA-BRCA-microbiome) was downloaded from cBioPortal. Univariate and multivariate Cox regression analyses were used to examine association of microbial abundance with overall survival (OS) and to identify a microbial signature for creating a prognostic scoring model. The performance of the scoring model was assessed by the area under the ROC curve (AUC). Nomograms using the microbial signature, clinical factors, and molecular subtypes were established to predict OS and progression-free survival (PFS). RESULTS Among 1406 genera, the abundances of 94 genera were significantly associated with BC patient OS in TCGA-BRCA-microbiome dataset. From that set we identified a 15-microbe prognostic signature and developed a 15-microbial abundance prognostic scoring (MAPS) model. Patients in low-risk group significantly prolong OS and PFS as compared to those in high-risk group. The time-dependent ROC curves with MAPS showed good predictive efficacy both in OS and PFS. Moreover, MAPS is an independent prognostic factor for OS and PFS over clinical factors and PAM50-based molecular subtypes and superior to the previously published 12-gene signature. The integration of MAPS into nomograms significantly improved prognosis prediction. CONCLUSION MAPS was successfully established to have independent prognostic value, and our study provides a new avenue for developing prognostic biomarkers by microbiome profiling.
Collapse
Affiliation(s)
- A W Mao
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - H Barck
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - J Young
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - A Paley
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - J -H Mao
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA. .,Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
| | - H Chang
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA. .,Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
| |
Collapse
|
20
|
Maselli D, Carstens D, Yang D, Mu F, Young J, Cook E, Betts K, Chung Y. P061 BENRALIZUMAB IS EFFECTIVE IN REDUCING ASTHMA EXACERBATIONS: RESULTS FROM THE ZEPHYR 2 STUDY. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
21
|
Qiu Y, McEwen C, Bhagirath V, Chan N, Eikelboom J, Eikelboom R, Young J, Whitlock R, Belley-Cote E. Evaluating direct oral anticoagulants versus vitamin K antagonists for treatment of left ventricular thrombus: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Left ventricular thrombi are associated with high rates of stroke and systemic embolism (1). While vitamin K antagonists (VKAs) have historically been the anticoagulant of choice, they have a narrow therapeutic window and require frequent monitoring. Direct oral anticoagulants (DOACs) offer more predictable anticoagulation but the use of DOACs to treat left ventricular thrombus has not been well studied (1,2). Guideline recommendations around the topic are based on expert consensus and very low-quality evidence.
Purpose
This systematic review and meta-analysis compares DOACs or VKAs in the treatment of left ventricular thrombus. Outcomes of interest were stroke and systemic embolism, thrombus resolution, any bleeding, major bleeding, and mortality.
Methods
We searched CENTRAL, MEDLINE, EMBASE, CINAHL, ACPJC, and Web of Science for studies comparing DOACs and VKAs in the treatment of left ventricular thrombus. We also searched reference lists from included studies and relevant conferences' proceedings. Two reviewers independently screened titles and abstracts and then the full-text of potentially relevant citations in duplicate. They then extracted data and evaluated risk of bias in duplicate. The data was analyzed using Revman 5.3. We used the DerSimonian and Laird random-effects model to pool the weighted effect of estimates across all studies. The pooled relative risks (RRs) were calculated with corresponding 95% confidence intervals (CIs). We assessed the quality of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
Results
Of 443 citations screened, 12 observational studies (n=2,225) were included. We found no randomized controlled trial addressing the question. Most included studies were at high risk of bias due to unmatched baseline variables. We found no significant difference in any of our outcomes with DOACs versus VKAs: stroke and systemic embolism (RR 1.14, 95% CI [0.82, 1.58], p=0.43), thrombus resolution (RR 1.02, 95% CI [0.91, 1.15], p=0.69), any bleeding (RR 1.47, 95% CI [0.65, 3.33], p=0.36), major bleeding (RR 0.22, 95% CI [0.01, 4.21], p=0.32), and mortality (RR 0.99, 95% CI [0.67, 1.45], p=0.95). Evidence for each of these outcomes was of very low-quality due to risk of bias, inconsistency, and imprecision of the studies.
Conclusions
Very low quality evidence suggests no difference in outcomes with DOACs versus VKAs in the treatment of left ventricular thrombus. More robust data are needed to guide clinicians.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- Y Qiu
- Michael G. DeGroote School of Medicine, Hamilton, Canada
| | - C McEwen
- Michael G. DeGroote School of Medicine, Hamilton, Canada
| | - V Bhagirath
- Division of Hematology and Thromboembolism, Department of Medicine, Hamilton, Canada
| | - N Chan
- Division of Hematology and Thromboembolism, Department of Medicine, Hamilton, Canada
| | - J Eikelboom
- Population Health Research Institute, Hamilton, Canada
| | - R Eikelboom
- Max Rady College of Medicine, Department of Cardiac Surgery, Winnipeg, Canada
| | - J Young
- McMaster University, Health Sciences Library, Hamilton, Canada
| | - R Whitlock
- Population Health Research Institute, Hamilton, Canada
| | - E Belley-Cote
- Population Health Research Institute, Hamilton, Canada
| |
Collapse
|
22
|
Boyle C, Young J. 219 Have New National Guidelines Changed Practice in Referrals with Suspected Ureteric Colic? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To assess how many patients had a non-contrast CT as first-line investigation for suspected renal colic, and how this was affected by the release of the 2019 NICE guidelines. A secondary aim was to assess the proportion of patients who had CT KUBs that demonstrated a ureteric calculus.
Method
CT KUB scans performed over two separate 3 month periods were identified. These reflected periods of time before and after the new NICE guidelines. Electronic records were used to assess if the patients had an ultrasound performed as the initial diagnostic investigation, instead of a CT scan. The results of the scans were reviewed to identify if a ureteric or renal calculus had been positively identified.
Results
In the period before the new guidelines, 61 patients were scanned. 4 had an ultrasound to assess for a stone prior to a CT. All of these patients were medical inpatients. None of the ultrasounds diagnosed a stone. 22/61 patients had CT-proven stones (36%) In the period after the new guidelines, 79 patients were scanned. 12 had an ultrasound to assess for a stone prior to a CT. 8 were medical patients, 3 were surgical and 1 was gynaecological. 1 ultrasound diagnosed a stone. 28/79 patients had CT-proven stones (35.4%)
Conclusions
The release of new guidelines did not improved compliance with suggested imaging pathways. This clearly demonstrates an area for improvement. It is also worth noting that only 1/3 of referrals with suspected renal colic did actually have a stone, which has implications for specialty referral pathways.
Collapse
Affiliation(s)
- C Boyle
- Borders General Hospital, Melrose, United Kingdom
| | - J Young
- Borders General Hospital, Melrose, United Kingdom
| |
Collapse
|
23
|
Qiu Y, McEwen C, Bhagirath V, Chan N, Eikelboom J, Eikelboom R, Young J, Whitlock R, Belley-Cote E. EVALUATING DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTAGONISTS FOR TREATMENT OF LEFT VENTRICULAR THROMBUS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
24
|
Flaender M, Young J, Duchemin-Pelletier E, Lorintiu O, Compere L, Champetier T, Ventre E. MYOTONIC DYSTROPHY. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
25
|
Cohen S, Singh R, Khalid N, Young J, Aldiwani M, Roy D, Edwards I. 468 IMPROVING ADVANCE CARE PLANNING SKILLS IN JUNIOR DOCTORS. Age Ageing 2021. [DOI: 10.1093/ageing/afab116.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Junior doctors are increasingly encountering Advance Care Planning (ACP) when they look after frail, older or multi-morbid patients during their hospital rotations. However, there remains a lack of formal training and resources, particularly with DNACPR discussions and when engaging patients and their loved ones with Emergency Health Care Planning (EHCP). We aimed to assess the need for ACP, improve the infrastructure by which ACP is delivered, and better support junior doctors to have these difficult conversations.
Method
Discharges from the Geriatrics Department at Kettering General Hospital were reviewed initially in May 2019 and again in January 2020 following intervention. We introduced a focused communication skills training session delivered at departmental teaching, which included a combination of simulation training and lectures. We additionally designed and implemented an EHCP template to aid junior doctors’ discussions. This could also be copied to the discharge letter, to facilitate safe transfer of care to primary care.
Results
In May 2019 of 32 patients, 100% met at least one SPICTTM criterion, with median of 4 criteria, thus indicating a high need for ACP in this cohort. Despite this, only one discharge letter included an EHCP and two had a request for GP colleagues to complete one. Evaluation of discharges again in January of 2020 reconfirmed a similar need for ACP, but following our interventions, the number of EHCP’s performed had increased. Of 22 identified patients 4 had a completed EHCP and 3 were requested for completion by their GP. Qualitative questionnaires demonstrated an improvement in both knowledge and confidence amongst junior doctors following the training session.
Conclusion
We have shown that there is a necessity for ACP to be considered for Geriatrics inpatients, and that providing structure and training in this challenging area offers benefit to both patients and junior doctors.
Collapse
Affiliation(s)
| | | | | | | | | | - D Roy
- Kettering General Hospital
| | | |
Collapse
|
26
|
Desai S, Laplant B, Macon W, Young J, King R, Wang Y, Inwards D, Micallef I, Johnston PB, Porrata LF, Ansell SM, Habermann TM, Witzig TE, Nowakowski GS. INTERIM PET/CT PREDICTS OUTCOMES OF DIFFUSE LARGE B‐CELL LYMPHOMA (DLBCL) TREATED WITH FRONTLINE LENALIDOMIDE/RCHOP (R2CHOP): LONG‐TERM ANALYSIS OF MC078E. Hematol Oncol 2021. [DOI: 10.1002/hon.83_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- S. Desai
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - B. Laplant
- Mayo Clinic Department of Quantitative Health Sciences Rochester Minnesota USA
| | - W. Macon
- Mayo Clinic Department of Laboratory Medicine and Pathology Rochester Minnesota USA
| | - J. Young
- Mayo Clinic Division of Nuclear Medicine Department of Radiology Rochester Minnesota USA
| | - R. King
- Mayo Clinic Department of Laboratory Medicine and Pathology Rochester Minnesota USA
| | - Y. Wang
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - D. Inwards
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - I. Micallef
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - P. B. Johnston
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - L. F. Porrata
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - S. M. Ansell
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - T. M. Habermann
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - T. E. Witzig
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - G. S. Nowakowski
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| |
Collapse
|
27
|
Bakshy K, Heimeier D, Schwartz JC, Glass EJ, Wilkinson S, Skuce RA, Allen AR, Young J, McClure JC, Cole JB, Null DJ, Hammond JA, Smith TPL, Bickhart DM. Development of polymorphic markers in the immune gene complex loci of cattle. J Dairy Sci 2021; 104:6897-6908. [PMID: 33685702 DOI: 10.3168/jds.2020-19809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
The addition of cattle health and immunity traits to genomic selection indices holds promise to increase individual animal longevity and productivity, and decrease economic losses from disease. However, highly variable genomic loci that contain multiple immune-related genes were poorly assembled in the first iterations of the cattle reference genome assembly and underrepresented during the development of most commercial genotyping platforms. As a consequence, there is a paucity of genetic markers within these loci that may track haplotypes related to disease susceptibility. By using hierarchical assembly of bacterial artificial chromosome inserts spanning 3 of these immune-related gene regions, we were able to assemble multiple full-length haplotypes of the major histocompatibility complex, the leukocyte receptor complex, and the natural killer cell complex. Using these new assemblies and the recently released ARS-UCD1.2 reference, we aligned whole-genome shotgun reads from 125 sequenced Holstein bulls to discover candidate variants for genetic marker development. We selected 124 SNPs, using heuristic and statistical models to develop a custom genotyping panel. In a proof-of-principle study, we used this custom panel to genotype 1,797 Holstein cows exposed to bovine tuberculosis (bTB) that were the subject of a previous GWAS study using the Illumina BovineHD array. Although we did not identify any significant association of bTB phenotypes with these new genetic markers, 2 markers exhibited substantial effects on bTB phenotypic prediction. The models and parameters trained in this study serve as a guide for future marker discovery surveys particularly in previously unassembled regions of the cattle genome.
Collapse
Affiliation(s)
- K Bakshy
- Dairy Forage Research Center, USDA-ARS, Madison, WI 53706
| | - D Heimeier
- The Pirbright Institute, Ash Road, Pirbright, Surrey GU24 0NF, UK
| | - J C Schwartz
- The Pirbright Institute, Ash Road, Pirbright, Surrey GU24 0NF, UK
| | - E J Glass
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush EH25 9RG, Edinburgh, UK
| | - S Wilkinson
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush EH25 9RG, Edinburgh, UK
| | - R A Skuce
- Agri-Food and Biosciences Institute, Stormont, Belfast, Northern Ireland BT4 3SD, UK
| | - A R Allen
- Agri-Food and Biosciences Institute, Stormont, Belfast, Northern Ireland BT4 3SD, UK
| | - J Young
- Dairy Forage Research Center, USDA-ARS, Madison, WI 53706
| | - J C McClure
- Dairy Forage Research Center, USDA-ARS, Madison, WI 53706
| | - J B Cole
- Animal Genomics and Improvement Laboratory, USDA-ARS, Beltsville, MD 20705
| | - D J Null
- Animal Genomics and Improvement Laboratory, USDA-ARS, Beltsville, MD 20705
| | - J A Hammond
- The Pirbright Institute, Ash Road, Pirbright, Surrey GU24 0NF, UK
| | - T P L Smith
- Meat Animal Research Center, USDA-ARS, Clay Center, NE 68933
| | - D M Bickhart
- Dairy Forage Research Center, USDA-ARS, Madison, WI 53706.
| |
Collapse
|
28
|
Young J, Mizzi S, Mercieca L, Boffa MJ. A non-healing ulcer caused by a retained fish spine. J Eur Acad Dermatol Venereol 2021; 35:e693-e695. [PMID: 34050999 DOI: 10.1111/jdv.17416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J Young
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - S Mizzi
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - L Mercieca
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - M J Boffa
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| |
Collapse
|
29
|
McLean R, Young J, Musbahi A, Lee JX, Hidayat H, Abdalla N, Chowdhury S, Baker E, Etherson K. 94 An Observational Cohort Study to Evaluate Volume and Severity of Emergency General Surgery Admissions During The COVID-19 Pandemic: Is There A “Lockdown” Effect? Br J Surg 2021. [PMCID: PMC8135742 DOI: 10.1093/bjs/znab134.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction The COVID-19 pandemic has led to changes in NHS surgical service provision. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. This study aimed to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and outcomes. Method Two cohorts of adult emergency general surgery admissions 30 days immediately before (16/2/2020 to 15/3/2020), and after UK government advice (16/3/2020 to 15/4/2020). Data were collected relating to patient characteristics, disease severity, clinical outcomes, and compared between these groups. Results Following lockdown, a significant reduction in median daily admissions from 7 to 3 (p < 0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of AKI, and more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p = 0.001), all-cause 30-day mortality (8.5% vs. 2.9%, p = 0.028), but no significant difference was observed in operative 30-day mortality. Conclusions There appears to be a “lockdown” effect on general surgical admissions with fewer admissions, more acutely unwell patients, and an increase in all-cause 30-day mortality. Patients should be advised to present promptly, and this should be reinforced for future lockdowns during the pandemic.
Collapse
Affiliation(s)
- R McLean
- University Hospital of North Tees, Stockton, United Kingdom
| | - J Young
- University Hospital of North Tees, Stockton, United Kingdom
| | - A Musbahi
- University Hospital of North Tees, Stockton, United Kingdom
| | - J X Lee
- University Hospital of North Tees, Stockton, United Kingdom
| | - H Hidayat
- University Hospital of North Tees, Stockton, United Kingdom
| | - N Abdalla
- University Hospital of North Tees, Stockton, United Kingdom
| | - S Chowdhury
- University Hospital of North Tees, Stockton, United Kingdom
| | - E Baker
- University Hospital of North Tees, Stockton, United Kingdom
| | - K Etherson
- University Hospital of North Tees, Stockton, United Kingdom
| |
Collapse
|
30
|
Young J, Kalczynski J, Emerling A, Bianchi W. Renal angiomyolipoma rupture in a young female with COVID-19. Am J Emerg Med 2021; 47:316.e1-316.e3. [PMID: 33741199 PMCID: PMC7879133 DOI: 10.1016/j.ajem.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/28/2021] [Accepted: 02/06/2021] [Indexed: 11/29/2022] Open
Abstract
While primarily a respiratory illness, infection with the novel coronavirus (COVID-19) is associated with pathologic changes in coagulation, characterized by both thromboembolic and bleeding events. We present the case of a 22-year-old female diagnosed with renal angiomyolipoma (AML) rupture 2 weeks after COVID-19 infection, ultimately requiring admission for hemorrhage control via endovascular embolization. Emergency medicine physicians should maintain a high index of suspicion for renal AML rupture and other spontaneous bleeding events in patients with recent COVID-19 infection due to a possible correlation between the two.
Collapse
Affiliation(s)
- Jocelyn Young
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States.
| | - Jeffrey Kalczynski
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States
| | - Alec Emerling
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States
| | - William Bianchi
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States
| |
Collapse
|
31
|
James GD, Symeonides S, Marshall J, Young J, Clack G. Assessment of various continual reassessment method models for dose-escalation phase 1 oncology clinical trials: using real clinical data and simulation studies. BMC Cancer 2021; 21:7. [PMID: 33402104 PMCID: PMC7786936 DOI: 10.1186/s12885-020-07703-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background The continual reassessment method (CRM) identifies the maximum tolerated dose (MTD) more efficiently and identifies the true MTD more frequently compared to standard methods such as the 3 + 3 method. An initial estimate of the dose-toxicity relationship (prior skeleton) is required, and there is limited guidance on how to select this. Previously, we compared the CRM with six different skeletons to the 3 + 3 method by conducting post-hoc analysis on a phase 1 oncology study (AZD3514), each CRM model reduced the number of patients allocated to suboptimal and toxic doses. This manuscript extends this work by assessing the ability of the 3 + 3 method and the CRM with different skeletons in determining the true MTD of various “true” dose-toxicity relationships. Methods One thousand studies were simulated for each “true” dose toxicity relationship considered, four were based on clinical trial data (AZD3514, AZD1208, AZD1480, AZD4877), and four were theoretical. The 3 + 3 method and 2-stage extended CRM with six skeletons were applied to identify the MTD, where the true MTD was considered as the largest dose where the probability of experiencing a dose limiting toxicity (DLT) is ≤33%. Results For every true dose-toxicity relationship, the CRM selected the MTD that matched the true MTD in a higher proportion of studies compared to the 3 + 3 method. The CRM overestimated the MTD in a higher proportion of simulations compared to the 3 + 3 method. The proportion of studies where the correct MTD was selected varied considerably between skeletons. For some true dose-toxicity relationships, some skeletons identified the true MTD in a higher proportion of scenarios compared to the skeleton that matched the true dose-toxicity relationship. Conclusion Through simulation, the CRM generally outperformed the 3 + 3 method for the clinical and theoretical true dose-toxicity relationships. It was observed that accurate estimates of the true skeleton do not always outperform a generic skeleton, therefore the application of wide confidence intervals may enable a generic skeleton to be used. Further work is needed to determine the optimum skeleton.
Collapse
Affiliation(s)
- G D James
- Medical Statistics Consultancy Ltd, London, W4 5XF, UK.
| | - S Symeonides
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - J Marshall
- Oncology Biometrics, Oncology R&D, AstraZeneca, Cambridge, UK
| | - J Young
- Aptus Clinical Ltd, Alderley Park, Macclesfield, Cheshire, SK10 4TF, UK
| | - G Clack
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| |
Collapse
|
32
|
Lorintiu O, Young J, Chapuis V, Compere L, Duchemin-Pelletier E, Anselmo S, Ventre E. MUSCLE FUNCTION & HOMEOSTASIS / MOLECULAR THERAPEUTIC APPROACHES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
33
|
Young J, Mdanat F, Dharmasena A, Cannon P, Leatherbarrow B, Hammerbeck-Ward C, Rutherford S, Ataullah S. Combined neurosurgical and orbital intervention for spheno-orbital meningiomas - the Manchester experience. Orbit 2020; 39:251-257. [PMID: 31658848 DOI: 10.1080/01676830.2019.1673782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/12/2019] [Accepted: 09/21/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Surgical resection of spheno-orbital meningioma (SOM) is challenging, requiring a multidisciplinary surgical approach. We present our experience of the surgical management of patients with SOM. METHODS A retrospective analysis of patients with SOM who underwent joint neurosurgical and orbital surgical procedures between January 2000 and June 2017. Pre-operative clinical signs, indication for surgery, surgical complications and post-operative outcomes were recorded. RESULTS Twenty-four operations were performed. Mean age was 49.5 years. Ninety-two percent of patients were female. Pre-operatively mean Snellen acuity vision was 6/12; 13 (54%) had an RAPD; 12 (50%) had reduced colour vision; 16 (67%) had a visual field defect. The majority (21 patients, 88%) had proptosis (average 4.5 mm ± 2.8 mm). The indication for surgery was evidence of visual dysfunction in 17 (71%), the remaining 7 (29%) had high risk of visual loss clinically or radiologically. Three-months post operatively, vision was stable in 13 (58%), improved in 6 (21%) and worse in 5 (17%). Average long-term follow-up was 82 months (1-220). Fourteen (58%) maintain improved or stable visual function. Four (17%) had reduced vision due to regrowth of the tumour at an average of 24 months. CONCLUSION SOMs are very challenging to treat surgically. In this cohort the patients were predominantly young females with aggressive disease. Visual function was improved or stabilised in 79% of the patients.
Collapse
Affiliation(s)
- J Young
- Oculoplastic Department, Manchester Royal Eye Hospital , Manchester, UK
| | - F Mdanat
- School of Medical Sciences, The University of Manchester , Manchester, UK
| | - A Dharmasena
- Oculoplastic Department, Manchester Royal Eye Hospital , Manchester, UK
| | - P Cannon
- Oculoplastic Department, Manchester Royal Eye Hospital , Manchester, UK
| | - B Leatherbarrow
- Oculoplastic Department, Manchester Royal Eye Hospital , Manchester, UK
| | - C Hammerbeck-Ward
- Neurosurgical Department, Salford Royal Foundation Trust , Salford, UK
| | - S Rutherford
- Neurosurgical Department, Salford Royal Foundation Trust , Salford, UK
| | - S Ataullah
- Oculoplastic Department, Manchester Royal Eye Hospital , Manchester, UK
| |
Collapse
|
34
|
Bauer D, Young J, Norman K. A Rapid Alternative to Culture Based Mycoplasma Detection. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
35
|
Cambos S, Mohammedi K, Castinetti F, Saie C, Young J, Chanson P, Tabarin A. Persistent cortisol response to desmopressin predicts recurrence of Cushing's disease in patients with post-operative corticotropic insufficiency. Eur J Endocrinol 2020; 182:489-498. [PMID: 32187576 DOI: 10.1530/eje-19-0770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/18/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cushing's disease (CD) may recur despite corticotropic insufficiency (COI) following pituitary surgery. The predictive value of the desmopressin test (DT) for recurrence in this setting remains controversial. We have evaluated whether the disappearance of the response to DT predicts a low probability recurrence in a large cohort of patients with post-operative COI. DESIGN Multicentre retrospective study. METHODS Ninety-five patients with CD (women 82%, age 41 ± 14 years), responding preoperatively to DT and with early post-operative COI (08 00 am cortisol: <138 nmol/L), underwent a DT within 3 months post-surgery. Association between DT findings and the prediction of recurrence was tested using regression and ROC analyses. RESULTS Recurrence occurred in 17/95 patients within 29 to 91 months. The cortisol peak (327, 95% CI (237-417) vs 121 (79-164) nmol/L, P = 0.0001) and absolute increment during DT (208 (136-280) vs 56 (22-90) nmol/L, P = 0.005) were greater in the recurrence vs remission group. Cortisol peak (AUC: 0.786 (0.670-0.902)) and increment (0.793 (0.672-0.914)) yielded a higher prognostic performance for recurrence than did the early post-operative 08 00 am cortisol (0.655 (0.505-0.804)). In the context of COI, cortisol peak >100 nmol/L and increment >30 nmol/L had a high negative predictive value (94, 95% CI (88-100) and 94, (88-100), respectively). Patients with a cortisol peak ≤100 nmol/L (vs >100) or an increment ≤30 nmol/L (vs >30) were less likely to have CD recurrence (odds ratios: 0.12, 95% CI (0.03-0.41) and 0.11 (0.02-0.36), respectively). CONCLUSION The disappearance of the response to the post-operative DT was independently associated with a lower odds of CD recurrence and offers an incremental prognostic value, which may help to stratify patients with COI and refine their follow-up according to the risk of recurrence.
Collapse
Affiliation(s)
- S Cambos
- CHU Bordeaux, Hôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France
| | - K Mohammedi
- CHU Bordeaux, Hôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France
| | - F Castinetti
- Department of Endocrinology, Aix Marseille University, Marseille Medical Genetics, INSERM, and Assistance Publique-Hopitaux de Marseille, French Reference Center for Rare Pituitary Diseases, Marseille, France
| | - C Saie
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
| | - J Young
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
- Université Paris Saclay, Univ Paris-Sud, Faculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, France
- INSERM 1185, Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - P Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
- Université Paris Saclay, Univ Paris-Sud, Faculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, France
- INSERM 1185, Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - A Tabarin
- CHU Bordeaux, Hôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France
- INSERM and University of Bordeaux Neurocentre Magendie, Bordeaux, France
| |
Collapse
|
36
|
Cowen L, Loomis E, Young J. Does Changing Residency Obstetric Call to a Group Model Significantly Impact Patient Continuity? Fam Med 2020; 52:213-216. [PMID: 32159834 DOI: 10.22454/fammed.2020.436708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Group sharing of prenatal care and inpatient obstetric (OB) call is increasingly replacing single-provider longitudinal models including in family medicine (FM) residencies. Such change in care models could impact continuity of prenatal and delivery care.The University of Rochester's family medicine residency program changed the resident maternal care coverage to an obstetric group model from a single-provider model in 2016 to improve work-life balance, which provided an opportunity to examine how these two practice styles impacted provider continuity. METHODS We performed a retrospective chart review of family medicine resident-assigned obstetric patients receiving care at the University of Rochester's residency clinic. The study evaluated provider continuity differences in two models of prenatal care and obstetric call: (1) single provider model (SPM) with one primary provider and one backup support resident vs (2) OB group-provider model (GPM) with three to four resident providers and one primary provider. RESULTS The average number of different providers seen significantly increased in the GPM vs SPM (3.47 vs 2.87, P=.02), however the average percentage of prenatal visits with either a primary or designated backup provider was not statistically different (83.1% vs 90.1%, P=.07). Among delivery continuity measures, there was no significant difference between models in the percentage of deliveries attended by the primary or designated backup residents compared with nongroup providers. (76.9% vs 82.3%, P=.51). CONCLUSIONS This study provides quantitative evidence on how differing models of residency maternal care coverage impact continuity of care. Study findings did not show an inferiority of an OB group-provider model compared to a single-provider model when considering how often patients were seen prenatally and delivered by providers from their continuity group.
Collapse
Affiliation(s)
- Lauren Cowen
- University of Rochester Family Medicine Residency, Rochester, NY
| | - Elizabeth Loomis
- University of Rochester Family Medicine Residency, Rochester, NY
| | - Jocelyn Young
- University of Rochester Family Medicine Residency, Rochester, NY
| |
Collapse
|
37
|
Aluzaite K, Wu HH, Young J, Brockway B, Hyslop B, Schultz M. Perceived versus objective quality and duration of sleep in long-stay hospital inpatients: mixed methods study. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
38
|
Ogdahl WP, Young J, Frandrup J, Hanna LLH, Sun X. Evaluation of Beef Cattle Temperament Attributes Using Infrared Thermography Technology. Meat and Muscle Biology 2019. [DOI: 10.22175/mmb.10831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesThe objective of this study was to evaluate beef cattle temperament scores using infrared thermography technology.Materials and MethodsAngus and Angus × Hereford calves (total n = 650) were brought through a handling chute system over two weaning sessions (October 2016 and 2017). Beef cattle temperament was subjectively quantified by (1) temperament score (TS), the disposition of the animal observed by an individual evaluator on a scale of 1 (calm) to 5 (excitable); (2) docility score (DS), the level of observed calmness of the animal displayed (1 = calm to 6 = excitable); and (3) qualitative behavior assessment (QBA), scored on twelve different attributes, (i.e., active, relaxed, etc.). There were two traits measured on a four-platform standing scale: (1) the standard deviation of total weight over time (SSD); and (2) the SSD’s coefficient of variation (CVSSD). Thermal images of the animal’s head were acquired by industrial fixed focus infrared camera (TiS40, Fluke Corporation, Everett, WA). The maximum, minimum, average, and standard deviation of temperature of the eye region were extracted from the thermal images. Stepwise and linear regression analyses to estimate subjective temperament traits from thermal imaging data and scale data were conducted using the reg procedure in SAS (v. 9.4, SAS Institute, Inc., Cary, NC). Correlations were estimated using the corr procedure in SAS.ResultsThe results showed low correlations between thermal imaging and subjective temperament traits. The correlations that were significant were around an absolute value of 0.1. However, all four thermal imaging traits were significantly correlated when the animal exhibited distress observed by QBA. When fitting only thermal imaging data into the regression analyses, R2 values were all under 0.03. When including SSD and CVSSD, there were a few traits with an R2 > 0.1 and none having an R2 > 0.15. The QBA traits that had an R2 between 0.1 and 0.15 were active, fearful, calm, apathetic, happy, and distressed for both linear and stepwise regressions.ConclusionAdditional validation research on this thermal imaging technology needs to be conducted with temperamental cattle as this current data was collected using observed calmer cattle, to give a more realistic application to beef cattle production. Overall this result shows potential to achieve beef cattle temperament evaluation with thermal imaging.Figure 1.
Collapse
Affiliation(s)
| | - J. Young
- North Dakota State University Animal Sciences
| | - J. Frandrup
- North Dakota State University Animal Sciences
| | | | - X. Sun
- North Dakota State University Agricultural and Biosystems Engineering
| |
Collapse
|
39
|
Frandrup J, Hall J, Reed D, Young J, Ward A, Sun X. Predicting Early Stages of Beef Respiratory Disease Using Thermal Imaging Technology. Meat and Muscle Biology 2019. [DOI: 10.22175/mmb.10721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesThe objective of this research was to utilize thermal imaging technology to estimate body temperature, so that an early stage of BRD can be detected.Materials and MethodsNinety-two steers were restrained in a squeeze chute that is housed in an indoor handling facility on 6 separate occasions. At least one image was taken of each side of the head using a thermal infrared camera (FLIR E8 WiFi, FLIR, Wilsonville, OR). The distance at which the images were taken was approximately 1 m from the steer. The rectal temperature was used as the control method to compare thermal imaging data. After thermal image acquisition, images were analyzed using the FLIR ResearchIR Max software (v. 4.40.8.28, FLIR, Wilsonville, OR), with the regions of interest being the eye and nasal cavity.ResultsThe analysis focused on minimum (MIN), maximum (MAX), mean, standard deviation (SD), and range of temperatures in the regions of interest. The REG procedure in SAS (v. 9.4, SAS Institute, Inc., Cary, NC) was used to perform stepwise regression to predict rectal temperature from the outdoor temperature (OTEMP) and all imaging features. When OTEMP was greater than –17.8°C, the regression model contained OTEMP, left nasal MAX, left nasal SD, and left eye MAX temperature and right eye temperature range, with an R2 of 0.24. When OTEMP was above freezing (0°C), the regression model contained left nasal temperature range, right eye temperature range, and average nasal mean temperature, with an R2 increase to 0.50. When using all data, the regression model fit left nasal MAX, right nasal MIN, average nasal mean, and left eye MAX temperatures and right eye temperature range, with an R2 of 0.08. These results show that thermal imaging technology has higher prediction accuracy in warmer temperature ranges than extreme cold conditions.ConclusionMore validation research on this thermal imaging technology needs to be conducted at warmer temperatures since all the current data was collected on cold winter days and a large portion of U.S. cattle are reared in more temperate and warmer areas than North Dakota such as Nebraska, Kansas, Texas, Oklahoma, and Florida. Overall, these results show promise for using thermal imaging technology to help detect BRD in an earlier stage by detecting fever before other clinical signs of BRD are present.
Collapse
Affiliation(s)
- J. Frandrup
- North Dakota State University Animal Science
| | - J. Hall
- North Dakota State University Animal Science
| | - D. Reed
- North Dakota State University Animal Science
| | - J. Young
- North Dakota State University Animal Science
| | - A. Ward
- North Dakota State University Animal Science
| | - X. Sun
- North Dakota State University Agricultural & Biosystems Engineering
| |
Collapse
|
40
|
Liu JH, Sun X, Young J, Newman D. Correlation of Computer Vision System Data with Traditional Methods of Evaluating Pork Color and Marbling on the Ventral Side on the Whole Loin and on Individual Loin Chops. Meat and Muscle Biology 2019. [DOI: 10.22175/mmb.10716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesPork quality is a combination of many different attributes, including color, intramuscular fat percentage (IMF), pH, drip loss, and tenderness. Currently, in the pork industry, color and marbling of the whole loins are commonly assessed subjectively by a trained evaluator according to the National Pork Board’s color and marbling standard cards. However, subjective color (SCS) and marbling (SMS) scores can be influenced by lighting and evaluator fatigue. Colorimeters are a common technology that are utilized for measurement of color in the meat industry but have their limitations as they only measure a small portion of the surface and cannot separate lean and fat tissue. Ether extract is commonly used for crude fat determination, but it requires a longer time for analysis and a sample that will be consumed by the process. Computer vision system (CVS) is a technology that has been applied in the food industry and is a non-invasive, efficient, and consistent method. Therefore, the objectives of this study were to compare pork color and marbling measured from the whole loin versus its individual chops and to compare the results from different pork quality measurement methods on the same sample.Materials and MethodsWhole pork loins (n = 1400) were obtained from 6 major pork processing plants, with SCS, SMS, Hunter L, a, and b, and CVS images being collected on the ventral side of the loin in the plant. Samples were vacuum packed, shipped, and stored at 4°C for 14 d. Then whole loins were sliced into chops and the third (A) and 10th (B) rib chops were evaluated for SCS and SMS after a 10 min bloom. After SCS and SMS evaluation, Hunter L, a, and b, and CVS images were collected. The A and B chops were vacuum packaged, shipped, trimmed, freeze dried, and then evaluated for crude fat percentage (CF%) using ether extract method. The CF% of the whole loin was estimated as the average of the A and B chops. From the CVS images, lean and fat pixels were segmented to estimate L*, a*, and b* of the lean tissue and CVS IMF.ResultsA lower L* was found for both CVS and colorimeter when evaluating the whole loin (63.06 & 53.63, respectively) compared to the average of A and B chops (68.65 & 58.10, respectively). However, for SCS, individual chops, on average, were darker than the whole loin (2.88 vs. 2.67, respectively). Of all color measurements, Hunter L had the highest correlation when comparing the whole loin to A and B chops (r = 0.72 and 0.72, respectively). When comparing marbling results of the whole loin to the A and B chops, a moderate correlation was found using both SMS (r = 0.67 and 0.60, respectively) and CVS IMF (r = 0.52 and 0.54, respectively). When comparing methods, CVS L* had a stronger correlation with Hunter L than SCS for the whole loin and A and B chops. (r = 0.40 vs. 0.34, 0.82 vs. 0.47, and 0.84 vs. 0.40, respectively). For IMF, SMS had a stronger correlation with CF% than CVS IMF (r = 0.48 vs. 0.34, 0.62 vs. 0.39, and 0.54 vs. 0.38, respectively).ConclusionThese results show great potential for CVS to be used in evaluating pork quality, specifically color and marbling. Additionally, it is possible to predict individual chop color and marbling based on the ventral side of the loin. Further research should be conducted to look at more technologies that can predict pork quality attributes.
Collapse
Affiliation(s)
- J.-H. Liu
- North Dakota State University Animal Science Department
| | - X. Sun
- North Dakota State University Agricultural and Biosystems Engineering
| | - J. Young
- North Dakota State University Animal Science Department
| | - D. Newman
- Arkansas State University Animal Science Department
| |
Collapse
|
41
|
Van Heel M, Bijttebier P, Claes S, Colpin H, Goossens L, Hankin B, Van Den Noortgate W, Verschueren K, Young J, Van Leeuwen K. Parenting, Effortful Control, and Adolescents' Externalizing Problem Behavior: Moderation by Dopaminergic Genes. J Youth Adolesc 2019; 49:252-266. [PMID: 31650442 DOI: 10.1007/s10964-019-01149-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/03/2019] [Indexed: 12/19/2022]
Abstract
Research shows that genetics and effortful control play an important role in the link between parenting and problem behavior. However, little is known about how these factors act simultaneously. This article used a moderated mediation model to examine whether effortful control mediated the link between parenting and externalizing problem behavior, and whether dopaminergic genes (i.e., polygenic index score including DAT1, DRD2, DRD4, COMT) moderated this link. Two three-wave studies were conducted on community samples (adolescents: Study 1: N = 457; Mage = 15.74; Study 2: N = 221; Mage = 12.84). There was no mediation by effortful control, but a moderation by dopaminergic reactivity was observed. Despite inconsistent evidence, this article indicates that the development of externalizing problem behavior is subject to genetic characteristics and parenting.
Collapse
Affiliation(s)
| | | | | | | | | | - B Hankin
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | | | - J Young
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | |
Collapse
|
42
|
Brown B, Simes J, Boyer M, Joshua A, Hogg P, Young J. P2.16-36 Patterns of Care in a Prospective Clinical Cohort of Patients with Lung Cancer - Preliminary Analyses from the EnRICH Program. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Brown B, Simes J, Boyer M, Hogg P, Joshua A, Young J. P1.16-47 Embedding Research (and Evidence) in Cancer Healthcare - EnRICH. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
44
|
Aldous S, Pickering J, Young J, George P, Watson A, Troughton R, Pemberton C, Richards M, Cullen L, Than M. P2674Rapid rule-out of myocardial infarction with a novel high precision point-of-care troponin assay appears safe and effective. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0992] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
High sensitivity troponin assays were developed to improve analytical sensitivity and precision at the decision cut-points for the diagnosis and rule out of acute myocardial infarction (AMI). Central laboratory assays have achieved this but point of care assays, which have the ability to accelerate decision making due to much shorter turnaround times, have remained lacking.
Purpose
To ascertain the threshold for decision making and subsequent clinical utility for ruling out AMI on presentation in patients attending the emergency department acutely with chest pain, using a high precision point of care troponin assay (TnI Nx), (i-STAT, Abbott).
Methods
We measured arrival TnI-Nx concentrations in stored plasma samples in adults presenting acutely to the emergency department with chest pain. The primary outcome was an AMI or cardiac death on index admission or within 30 days. We used 2000 bootstrapped data sets to derive and validate a suitable threshold for TnI-Nx before calculating diagnostic test performance. We pre-specified this threshold must have a <1% false negative rate for the primary outcome. We compared this with a core laboratory high sensitivity troponin I (hs-TnI) (Abbott Architect) using the early rule-out cut-point (European Society of Cardiology) at the limit of detection (2 ng/L).
Results
We recruited 1320 patients of whom 192 (14.1%) had the primary outcome. The TnI-Nx threshold was determined to be 8 ng/L with subsequent sensitivity of 99.0% (95% confidence interval: 97.3% to 100%), negative predictive value of 99.7% (99.2% to 100%) and specificity of 59.0% (56.0% to 62.0%). The hs-TnI had a sensitivity of 99.5% (98.2% to 100%), negative predictive value of 99.7% (99.0% to 100%), and specificity of 28.4% (25.8% to 31.2%) at 2ng/L.
Conclusion
A high precision point of care assay, TnI-Nx, with a decision threshold of 8ng/L, has comparable rule out performance compared with a core laboratory high sensitivity assay and therefore could potentially be used for early decision making in the assessment of acute chest pain.
Acknowledgement/Funding
Research grant from Abbott Point of Care. Senior Research Fellowship from ECF, CMRF and CDHB. Clinical Research Fellowship from NZ HRC
Collapse
Affiliation(s)
- S Aldous
- Christchurch Hospital, Christchurch, New Zealand
| | - J Pickering
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - J Young
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - P George
- Christchurch Hospital, Christchurch, New Zealand
| | - A Watson
- Christchurch Hospital, Christchurch, New Zealand
| | - R Troughton
- Christchurch Hospital, Christchurch, New Zealand
| | - C Pemberton
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - M Richards
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - L Cullen
- Royal Brisbane and Women's Hospital, Emergency Department, Brisbane, Australia
| | - M Than
- Christchurch Hospital, Christchurch, New Zealand
| |
Collapse
|
45
|
Mazza D, Lin X, Emery J, Walter F, Young J, Barnes D, Mitchell P, Brijnath B, Martin A, O’Byrne K. MA22.06 Longer Lung Cancer Time Intervals Amongst Culturally and Linguistically Diverse Patient Than Anglo-Australian Patients. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
46
|
Farley T, Walkden NR, Militello F, Sanna M, Young J, Silburn SS, Harrison J, Kogan L, Lupelli I, Henderson SS, Kirk A, Bradley JW. Filament identification in wide-angle high speed imaging of the mega amp spherical tokamak. Rev Sci Instrum 2019; 90:093502. [PMID: 31575268 DOI: 10.1063/1.5109470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
A new tomographic inversion technique is presented for the identification of plasma filaments in wide-angle visible camera data. The technique works on the assumption that background subtracted images of filaments can be represented as a superposition of uniformly emitting magnetic equilibrium field lines. A large collection of equilibrium magnetic field lines is traced and projected onto the camera field of view and combined to form a geometry matrix describing the coordinate transformation from magnetic field aligned coordinates to image pixel coordinates. Inverting this matrix enables the reprojection of the emission in the camera images onto a field aligned basis, from which filaments are readily identifiable. The inversion is a poorly conditioned problem which is overcome using a least-squares approach with Laplacian regularization. Blobs are identified using the "watershed" algorithm and 2D Gaussians are fitted to get the positions, widths, and amplitudes of the filaments. A synthetic camera diagnostic generating images containing experimentally representative filaments is utilized to rigorously benchmark the accuracy and reliability of the technique. 74% of synthetic filaments above the detection amplitude threshold are successfully detected, with 98.8% of detected filaments being true positives. The accuracy with which filament properties and their probability density functions are recovered is discussed, along with sources of error and methods to minimize them.
Collapse
Affiliation(s)
- T Farley
- EURATOM/CCFE Fusion Association, Culham Science Center, Abingdon OX14 3DB, United Kingdom
| | - N R Walkden
- EURATOM/CCFE Fusion Association, Culham Science Center, Abingdon OX14 3DB, United Kingdom
| | - F Militello
- EURATOM/CCFE Fusion Association, Culham Science Center, Abingdon OX14 3DB, United Kingdom
| | - M Sanna
- Department of Electrical and Electronic Engineering, University of Cagliari, Cagliari, Italy
| | - J Young
- EURATOM/CCFE Fusion Association, Culham Science Center, Abingdon OX14 3DB, United Kingdom
| | - S S Silburn
- EURATOM/CCFE Fusion Association, Culham Science Center, Abingdon OX14 3DB, United Kingdom
| | - J Harrison
- EURATOM/CCFE Fusion Association, Culham Science Center, Abingdon OX14 3DB, United Kingdom
| | - L Kogan
- EURATOM/CCFE Fusion Association, Culham Science Center, Abingdon OX14 3DB, United Kingdom
| | - I Lupelli
- EURATOM/CCFE Fusion Association, Culham Science Center, Abingdon OX14 3DB, United Kingdom
| | - S S Henderson
- EURATOM/CCFE Fusion Association, Culham Science Center, Abingdon OX14 3DB, United Kingdom
| | - A Kirk
- EURATOM/CCFE Fusion Association, Culham Science Center, Abingdon OX14 3DB, United Kingdom
| | - J W Bradley
- Department of Electrical Engineering and Electronics, The University of Liverpool, Liverpool L69 3GJ, United Kingdom
| |
Collapse
|
47
|
Todd O, Clegg A, Young J, Godfrey M. 44MANAGING HYPERTENSION IN PEOPLE WITH FRAILTY: AN EXPLORATION OF A PATIENT LED APPROACH. Age Ageing 2019. [DOI: 10.1093/ageing/afz075.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- O Todd
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Royal Infirmary
| | - A Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Royal Infirmary
| | - J Young
- Bradford Institute of Health Research, Bradford Royal Infirmary
| | - M Godfrey
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Royal Infirmary
| |
Collapse
|
48
|
Gunkelman M, Young J, Hammer C. Influence of trimming and shoeing on hoof temperature and digital cushion thickness in mature horses. J Equine Vet Sci 2019. [DOI: 10.1016/j.jevs.2019.03.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
49
|
Gabriel L, Young J, Hoesli I, Girard T, Dell-Kuster S. Generalisability of randomised trials of the programmed intermittent epidural bolus technique for maintenance of labour analgesia: a prospective single centre cohort study. Br J Anaesth 2019; 123:e434-e441. [PMID: 31331592 DOI: 10.1016/j.bja.2019.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/25/2019] [Accepted: 02/02/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Several randomised controlled trials show that maintenance of labour epidural analgesia with programmed intermittent epidural bolus reduces the maternal motor block compared with maintenance with a continuous infusion. However, these trials were usually restricted to healthy nulliparous parturients. To assess the generalisability of these randomised controlled trials to 'real-world' conditions, we compared maternal motor function (modified Bromage score) over time between healthy nulliparous and parous women using routinely collected quality-control data. METHODS After ethical approval, all parturients receiving programmed intermittent epidural bolus labour analgesia between June 2013 and October 2014 were included in this prospective cohort study. Bupivacaine 0.1% with fentanyl 2 μg ml-1 was used allowing for patient-controlled bolus every 20 min. The maternal motor function (primary outcome) was regularly assessed from insertion of the epidural catheter until delivery. RESULTS Of the 839 parturients included, 553 (66%) were nulliparous and 286 (34%) were parous. The parous women had a shorter median duration of epidural analgesia (3 h 59 min vs 5 h 45 min) and a higher incidence of spontaneous delivery (66% vs 37%). The probability of being in a certain Bromage category at birth was similar in nulliparous and parous women in a general additive model adjusting for duration of epidural analgesia, number of rescue top-ups, and number of catheter manipulations (cumulative odds ratio: 1.18; 95% confidence interval: 0.98-1.41). Parous women required a higher time-weighted number and volume of rescue top-ups. CONCLUSIONS The results of the randomised controlled trials on a reduced motor block with programmed intermittent epidural bolus seem generalisable to parturients typically not included in these trials.
Collapse
Affiliation(s)
- L Gabriel
- University of Basel, Basel, Switzerland
| | - J Young
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - I Hoesli
- University of Basel, Basel, Switzerland; Department of Obstetrics and Antenatal Care, University Hospital Basel, Basel, Switzerland
| | - T Girard
- University of Basel, Basel, Switzerland; Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - S Dell-Kuster
- University of Basel, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland; Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
50
|
Cowen L, Hartman SG, Loomis E, Srinivasan S, Gasbarro C, Young J. Clinician and Staff Perceptions of Barriers to Providing Contraception in Primary Care. PRiMER 2019; 3:2. [PMID: 32537573 DOI: 10.22454/primer.2019.228141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction Short interpregnancy periods increase the likelihood of preterm delivery and low birth weight,1 both of which are significant causes of infant morbidity and mortality.2 Since nearly half of pregnancies in the United States are unplanned,3 opportunities exist to better understand barriers to contraceptive services. Studying these barriers as perceived by clinical staff can better guide programs to improve interpregnancy spacing. Methods Between September and November 2017, 76 staff and 95 primary care clinicians from two family medicine residency practices (Highland Family Medicine (HFM) in Rochester, New York and St Margaret Family Medicine (SM) in Pittsburgh, Pennsylvania) completed surveys. Questions assessed perceived barriers to providing contraceptive services, contraception knowledge, and opportunities for improvement. Survey-based analysis focused on comparative descriptive statistics between staff and provider responses. Results Clinicians ranked side effects and patient lack of awareness and misconceptions about contraceptive methods more highly than staff (P=0.0073 and P=0.0001, respectively). Staff identified childcare and work absence as more significant barriers (P=0.0114 and P=0.0380, respectively). Providers felt appointment timing was the largest constraint to contraceptive care. Staff perceived financial limitations and scheduling to be the top barriers. Nonclinician staff exhibited significant knowledge gaps regarding contraception. Conclusions Numerous modifiable barriers contribute to difficulty providing contraceptive services. Providers and staff largely agree on the perceived barriers, but there is a significant gap in nonclinician staff knowledge of contraception. Education can address one of the leading concerns, but improvement efforts should also address areas such as availability of devices, scheduling issues, and resident supervision.
Collapse
Affiliation(s)
- Lauren Cowen
- University of Rochester Family Medicine Residency, Rochester, NY
| | | | - Elizabeth Loomis
- University of Rochester Family Medicine Residency, Rochester, NY
| | - Sukanya Srinivasan
- University of Pittsburgh Medical Center St Margaret Family Medicine Residency, Pittsburgh, PA
| | - Christina Gasbarro
- University of Pittsburgh Medical Center St Margaret Family Medicine Residency, Pittsburgh, PA
| | - Jocelyn Young
- University of Rochester Family Medicine Residency, Rochester, NY
| |
Collapse
|