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Falize C, Savage M, Jeanes YM, Dyall SC. Evaluating the relationship between the nutrient intake of lactating women and their breast milk nutritional profile: a systematic review and narrative synthesis. Br J Nutr 2024; 131:1196-1224. [PMID: 38053371 PMCID: PMC10918524 DOI: 10.1017/s0007114523002775] [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: 06/06/2023] [Revised: 10/05/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023]
Abstract
Maternal diet influences breast milk nutritional profile; however, it is unclear which nutrients and contaminants are particularly responsive to short- and long-term changes in maternal intake, and the impact of specific exclusion diets, such as vegan or vegetarian. This study systematically reviewed the literature on the effects of maternal nutrient intake, including exclusion diets, on both the nutrient and contaminant content of breast milk. The electronic databases, PubMed, CENTRAL, Web of Science and CINALH were systematically searched until 4 June 2023, with additionally searches of reference lists (PROSPERO, CRD42020221577). The quality of the studies was examined using Cochrane Risk of Bias tool and Newcastle-Ottawa scale. Eighty-eight studies (n 6577) met the search criteria. Due to high heterogeneity, meta-analysis was not possible. There was strong evidence of response to maternal intakes for DHA and EPA, vitamins A, E and K, iodine and Se in breast milk composition, some evidence of response for α-linolenic acid, B vitamins, vitamin C and D, ovalbumin, tyrosine and contaminants, and insufficient evidence to identify the effects arachidonic acid, Cu, Fe, Zn and choline. The paucity of evidence and high heterogeneity among studies reflects the need for more high-quality trials. However, this review identified the importance of maternal intake in the nutritional content of breast milk for a wide range of nutrients and supports the recommendation for supplementation of DHA and vitamin B12 for those on restrictive diets.
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Affiliation(s)
- Coralie Falize
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - M. Savage
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Yvonne M. Jeanes
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Simon C. Dyall
- School of Life and Health Sciences, University of Roehampton, London, UK
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2
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Zhang Y, Umehara K, Romeo AA, Singh N, Cantrill C, Savage M, Chen E, Zhang W, Parrot NJ, Paehler A. Evaluation of the drug disposition of RO7049389 with in vitro data and human mass balance supported by physiologically based pharmacokinetic modelling. Br J Clin Pharmacol 2023; 89:3079-3091. [PMID: 37264516 DOI: 10.1111/bcp.15809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023] Open
Abstract
AIMS RO7049389 (linvencorvir) is a developmental oral treatment for chronic hepatitis B virus infection. The aim of this work was to conduct mass balance (MB) and absolute bioavailability (BA) analyses in healthy volunteers, alongside in vitro evaluations of the metabolism of RO7049389 and a major circulating active metabolite M5 in human hepatocytes, and physiologically based pharmacokinetic (PBPK) modelling to refine the underlying drug disposition paradigm. METHODS Participants in the clinical study (MB: Caucasian, male, n = 6; BA: Caucasian and Asian, male and female, n = 16, 8 in each ethnic groups) received oral [14 C] or unlabelled RO7049389 (600/1000 mg) followed by 100 μg intravenous [13 C]RO7049389. Metabolic pathways with fractions metabolized-obtained from the in vitro incubation results of 10 μM [14 C]RO7049389 and 1 μM M5 with (long-term cocultured) human hepatocytes in the absence and presence of the cytochrome P450 3A4 (CYP3A4) inhibitor itraconazole-were used to complement the PBPK models, alongside the clinical MB and BA data. RESULTS The model performance in predicting the pharmacokinetic profiles of RO7049389 and M5 aligned with clinical observations in Caucasians and was also successfully applied to Asians. Accordingly, the drug disposition pathways for RO7049389 were postulated with newly characterized estimates of the fractions: biliary excretion by P-glycoprotein (~41%), direct glucuronidation via uridine 5'-diphosphoglucuronosyltransferase 1A3 (~11%), hexose conjugation (~6%), oxidation by CYP3A4 (~28%) and other oxidation reactions (~9%). CONCLUSION These results support the ongoing clinical development program for RO7049389 and highlight the broader value of PBPK and MB analyses in drug development.
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Affiliation(s)
- Yuchen Zhang
- Roche Pharma Research & Early Development, China Innovation Center of Roche, Shanghai, China
| | - Kenichi Umehara
- Roche Pharma Research & Early Development, Roche Innovation Center, Basel, Switzerland
| | - Andrea A Romeo
- Roche Pharma Research & Early Development, Roche Innovation Center, Basel, Switzerland
| | | | - Carina Cantrill
- Roche Pharma Research & Early Development, Roche Innovation Center, Basel, Switzerland
| | | | | | - Wen Zhang
- Roche Pharma Research & Early Development, China Innovation Center of Roche, Shanghai, China
| | - Neil John Parrot
- Roche Pharma Research & Early Development, Roche Innovation Center, Basel, Switzerland
| | - Axel Paehler
- Roche Pharma Research & Early Development, Roche Innovation Center, Basel, Switzerland
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3
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Day D, Grech L, Nguyen M, Bain N, Kwok A, Harris S, Chau H, Chan B, Blennerhassett R, Nott L, Hamad N, Tognela A, Hoffman D, McCartney A, Webber K, Wong J, Underhill C, Sillars B, Winkel A, Savage M, Loe BS, Freeman D, Segelov E. Serious Underlying Medical Conditions and COVID-19 Vaccine Hesitancy: A Large Cross-Sectional Analysis from Australia. Vaccines (Basel) 2022; 10:vaccines10060851. [PMID: 35746458 PMCID: PMC9230066 DOI: 10.3390/vaccines10060851] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 05/10/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 01/27/2023] Open
Abstract
As COVID-19 vaccinations became available and were proven effective in preventing serious infection, uptake amongst individuals varied, including in medically vulnerable populations. This cross-sectional multi-site study examined vaccine uptake, hesitancy, and explanatory factors amongst people with serious and/or chronic health conditions, including the impact of underlying disease on attitudes to vaccination. A 42-item survey was distributed to people with cancer, diabetes, or multiple sclerosis across ten Australian health services from 30 June to 5 October 2021. The survey evaluated sociodemographic and disease-related characteristics and incorporated three validated scales measuring vaccine hesitancy and vaccine-related beliefs generally and specific to their disease: the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale and the Disease Influenced Vaccine Acceptance Scale-Six. Among 4683 participants (2548 [54.4%] female, 2108 [45.0%] male, 27 [0.6%] other; mean [SD] age, 60.6 [13.3] years; 3560 [76.0%] cancer, 842 [18.0%] diabetes, and 281 [6.0%] multiple sclerosis), 3813 (81.5%) self-reported having at least one COVID-19 vaccine. Unvaccinated status was associated with younger age, female sex, lower education and income, English as a second language, and residence in regional areas. Unvaccinated participants were more likely to report greater vaccine hesitancy and more negative perceptions toward vaccines. Disease-related vaccine concerns were associated with unvaccinated status and hesitancy, including greater complacency about COVID-19 infection, and concerns relating to vaccine efficacy and impact on their disease and/or treatment. This highlights the need to develop targeted strategies and education about COVID-19 vaccination to support medically vulnerable populations and health professionals.
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Affiliation(s)
- Daphne Day
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
- Correspondence: ; Tel.: +61-3-8572-2392
| | - Lisa Grech
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
| | - Mike Nguyen
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
| | - Nathan Bain
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
| | - Alastair Kwok
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
| | - Sam Harris
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC 3550, Australia;
| | - Hieu Chau
- Department of Oncology, Latrobe Regional Hospital, Traralgon, VIC 3844, Australia;
| | - Bryan Chan
- Department of Oncology, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia;
- School of Medicine, Griffith University, Birtinya, QLD 4575, Australia;
| | - Richard Blennerhassett
- Central Coast Haematology, North Gosford, NSW 2250, Australia;
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Louise Nott
- Icon Cancer Centre Hobart, Hobart, TAS 7000, Australia;
| | - Nada Hamad
- Department of Haematology, St Vincent’s Hospital Sydney, Darlinghurst, NSW 2010, Australia;
- School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Kensington, NSW 2052, Australia
- School of Medicine, University of Notre Dame Australia, Chippendale, NSW 2007, Australia
| | - Annette Tognela
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW 2560, Australia;
| | | | - Amelia McCartney
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
| | - Kate Webber
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
| | - Jennifer Wong
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
- Monash Diabetes, Monash Health, Clayton, VIC 3168, Australia
| | - Craig Underhill
- Border Medical Oncology, Albury, NSW 2640, Australia;
- Rural Medical School, University of New South Wales, Albury, NSW 2640, Australia
| | - Brett Sillars
- Department of Endocrinology, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia;
| | - Antony Winkel
- School of Medicine, Griffith University, Birtinya, QLD 4575, Australia;
- Department of Neurology, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia
| | - Mark Savage
- Department of Endocrinology, Bendigo Health, Bendigo, VIC 3550, Australia;
| | - Bao Sheng Loe
- The Psychometrics Centre, University of Cambridge, Cambridge CB2 1AG, UK;
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK;
- Oxford Health National Health Service Foundation Trust, Oxford OX3 7JX, UK
| | - Eva Segelov
- Department of Oncology, Monash Health, Clayton, VIC 3168, Australia; (M.N.); (N.B.); (A.K.); (A.M.); (K.W.); (E.S.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; (L.G.); (J.W.)
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4
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Hughes C, Savage M, Alexander C. Service evaluation of the impact of implementing a novel physiotherapy band 5 mixed research and clinical rotation. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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5
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Naing P, Murdoch D, Burstow D, Habibian M, Hnin Hlaing S, Savage M, Playford D, Scalia G. Impact of Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Implantation: The Experience From a Centre of Excellence. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.342] [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: 10/16/2022]
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6
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Grisanti C, Savage M, Raffel O, Murdoch D. Agreement Between Fractional Flow Reserve (FFR) and Resting Indices During Physiological Assessment of Intermediate Atherosclerotic Lesions. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.559] [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]
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7
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Lynch C, Savage M, Raffel C, Poon K, Murdoch D. Single Centre Retrospective Analysis of TAVI for Native Aortic Regurgitation Versus Severe Aortic Stenosis With New Generation Transcatheter Heart Valves. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.625] [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]
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8
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Savage M, Murdoch D, Ranasinghe I, Raffel O. Sex Differences in Time to Reperfusion and Mortality in ST-Segment Elevation Myocardial Infarction (STEMI): Insights From the Queensland Cardiac Outcomes Registry (QCOR). Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.621] [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: 10/16/2022]
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9
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Mulligan A, Burrage M, Savage M, Black P, Scalia G. Prevalence of Disproportionate RV Filling Pressures to LV Filling Pressures. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Savage M, Murdoch D, Ranasinghe I, Raffel O. Pre-Hospital Activation of ST-Segment Elevation Myocardial Infarction (STEMI): Insights From the Queensland Cardiac Outcomes Registry (QCOR). Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.614] [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: 10/16/2022]
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11
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Fowler S, Brink A, Cleary Y, Guenther A, Heinig K, Husser C, Kletzl H, Kratochwil NA, Mueller L, Savage M, Stillhart C, Tuerck DW, Ullah M, Umehara K, Poirier A. Addressing today's ADME challenges in the translation of in vitro absorption, distribution, metabolism and excretion characteristics to human: A case study of the SMN2 mRNA splicing modifier risdiplam. Drug Metab Dispos 2021; 50:65-75. [PMID: 34620695 DOI: 10.1124/dmd.121.000563] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/30/2021] [Indexed: 11/22/2022] Open
Abstract
Small molecules that present complex absorption, distribution, metabolism, and elimination (ADME) properties can be challenging to investigate as potential therapeutics. Acquiring data through standard methods can yield results that are insufficient to describe the in vivo situation, which can affect downstream development decisions. Implementing in vitro - in vivo - in silico strategies throughout the drug development process is effective in identifying and mitigating risks while speeding up their development. Risdiplam (EVRYSDI®) - an orally bioavailable, small molecule approved by the U.S. Food and Drug Administration and more recently by the European Medicines Agency for the treatment of patients {greater than or equal to}2 months of age with spinal muscular atrophy (SMA), is presented here as a case study. Risdiplam is a low turnover compound whose metabolism is mediated through a non-cytochrome P450 enzymatic pathway. Four main challenges of risdiplam are discussed: predicting in vivo hepatic clearance, determining in vitro metabolites with regard to metabolites in safety testing guidelines, elucidating enzymes responsible for clearance, and estimating potential drug-drug interactions. A combination of in vitro and in vivo results was successfully extrapolated and used to develop a robust physiologically based pharmacokinetic model of risdiplam. These results were verified through early clinical studies, further strengthening the understanding of the ADME properties of risdiplam in humans. These approaches can be applied to other compounds with similar ADME profiles, which may be difficult to investigate using standard methods. Significance Statement Risdiplam is the first approved, small molecule, survival of motor neuron 2 mRNA splicing modifier for the treatment of spinal muscular atrophy. The approach taken to characterize the absorption, distribution, metabolism and excretion (ADME) properties of risdiplam during clinical development incorporated in vitro-in vivo-in silico techniques, which may be applicable to other small molecules with challenging ADME. These strategies may be useful in improving the speed at which future drug molecules can be developed.
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Affiliation(s)
| | - Andreas Brink
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd, Switzerland
| | - Yumi Cleary
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd, Switzerland
| | - Andreas Guenther
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd, Switzerland
| | - Katja Heinig
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd, Switzerland
| | | | - Heidemarie Kletzl
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd, Switzerland
| | | | - Lutz Mueller
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd, Switzerland
| | - Mark Savage
- Unilabs York Bioanalytical Solutions, United Kingdom
| | - Cordula Stillhart
- Formulation & Process Sciences, Pharmaceutical R&D, F. Hoffmann-La Roche Ltd, Switzerland
| | | | - Mohammed Ullah
- Pharmaceutical Sciences, Roche Pharmaceutical Research and Early Development, Switzerland
| | - Kenichi Umehara
- Pharmaceutical Sciences, Roche Pharmaceutical Research and Early Development, Switzerland
| | - Agnès Poirier
- Pharmaceutical Sciences, F.Hoffmann-La Roche, Switzerland
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12
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Quadrelli S, Lynch C, Savage M, Gaikwad N, O'Rourke R, Raffel C, Hamilton-Craig C. Comparison Of On-site Clinician-operated Computational Fluid Dynamic 3Rd Generation Cffr For The Detection Of Lesion-specific Ischemia Compared To Invasive Ffr. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.208] [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: 11/24/2022]
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13
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Borovac J, Kwok C, Mohamed M, Fischman D, Savage M, Alraies C, Kalra A, Nolan J, Zaman A, Ahmed J, Bagur R, Mamas M. The predictive value of CHA2DS2-VASc score on adverse in-hospital outcomes among patients with the acute coronary syndrome and atrial fibrillation who undergo PCI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1657] [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
Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and having concomitant atrial fibrillation (AF) have a greater risk of adverse short- and long-term outcomes and death compared with patients in the same setting but without AF. On the other hand, the predictive value of CHA2DS2-VASc score in terms of in-hospital mortality and periprocedural adverse events following PCI among patients with ACS and AF is unknown.
Purpose
We retrospectively analyzed data of patients with the main admission diagnosis of ACS that underwent PCI and had AF during the 2004–2014 period from the large nationwide US National Inpatient Sample (NIS) database.
Methods
A CHA2DS2-VASc score was calculated for each patient and incorporated into a multivariable-adjusted logistic regression to determine its independent impact on in-hospital outcomes consisting of death, acute kidney injury (AKI), bleeding, vascular injury, and stroke/transient ischemic attack (TIA).
Results
A total of 283,890 patients with AF who underwent PCI following ACS were included in the analysis. The average reported prevalence of the AF in the whole cohort was 10.0% with a significant trend (p<0.001) of increase during the observed 10-year period. The average age of the cohort was 72.1±11 years, 63.4% were male while the median CHA2DS2-VASc score was 3 (IQR 2–4). Crude rates of adverse in-hospital outcomes were significantly higher among patient groups with higher CHA2DS2-VASc score (Table 1). Following adjustment for baseline covariates, incremental increase in CHA2DS2-VASc score was independently associated with an increased odds of in-hospital death (OR 1.20, CI 95% 1.18–1.22), periprocedural vascular injury (OR 1.18, 95% CI 1.17–1.20), bleeding (OR 1.17, 95% CI 1.16–1.18), stroke/TIA (OR 1.17, 95% CI 1.15–1.19), and AKI (OR 1.05, 95% CI 1.04–1.06) (Figure 1).
Conclusions
The CHA2DS2-VASc score provides important prognostic information in ACS patients with AF undergoing PCI and is independently associated with in-hospital death and periprocedural adverse events. Therefore, CHA2DS2-VASc score could be used as a practical and inexpensive tool for risk stratification in this population.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J.A Borovac
- Keele University, Stoke-on-Trent, United Kingdom
| | - C.S Kwok
- Keele University, Stoke-on-Trent, United Kingdom
| | - M.O Mohamed
- Keele University, Stoke-on-Trent, United Kingdom
| | - D.L Fischman
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - M Savage
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - C Alraies
- Detroit Medical Center, Detroit, United States of America
| | - A Kalra
- Cleveland Clinic, Cleveland, United States of America
| | - J Nolan
- Keele University, Stoke-on-Trent, United Kingdom
| | - A Zaman
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - J Ahmed
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - R Bagur
- Keele University, Stoke-on-Trent, United Kingdom
| | - M.A Mamas
- Keele University, Stoke-on-Trent, United Kingdom
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14
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Savage M, Savage LC. Doctors Routinely Share Health Data Electronically Under HIPAA, and Sharing With Patients and Patients' Third-Party Health Apps is Consistent: Interoperability and Privacy Analysis. J Med Internet Res 2020; 22:e19818. [PMID: 32876582 PMCID: PMC7495255 DOI: 10.2196/19818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 11/13/2022] Open
Abstract
Since 2000, federal regulations have affirmed that patients have a right to a complete copy of their health records from their physicians and hospitals. Today, providers across the nation use electronic health records and electronic information exchange for health care, and patients are choosing digital health apps to help them manage their own health and health information. Some doctors and health systems have voiced concern about whether they may transmit a patient's data upon the patient's request to the patient or the patient's health app. This hesitation impedes shared information and care coordination with patients. It impairs patients' ability to use the state-of-the-art digital health tools they choose to track and manage their health. It undermines the ability of patients' family caregivers to monitor health and to work remotely to provide care by using the nearly unique capabilities of health apps on people's smartphones. This paper explains that sharing data electronically with patients and patients' third-party apps is legally consistent under the Health Insurance Portability and Accountability Act (HIPAA) with routine electronic data sharing with other doctors for treatment or with insurers for reimbursement. The paper explains and illustrates basic principles and scenarios around sharing with patients, including patients' third-party apps. Doctors routinely and legally share health data electronically under HIPAA whether or not their organizations retain HIPAA responsibility. Sharing with patients and patients' third-party apps is no different and should be just as routine.
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Affiliation(s)
- Mark Savage
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
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15
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Neinstein A, Thao C, Savage M, Adler-Milstein J. Deploying Patient-Facing Application Programming Interfaces: Thematic Analysis of Health System Experiences. J Med Internet Res 2020; 22:e16813. [PMID: 31983680 PMCID: PMC7165308 DOI: 10.2196/16813] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Health systems have recently started to activate patient-facing application programming interfaces (APIs) to facilitate patient access to health data and other interactions. OBJECTIVE This study sought to ascertain health systems' understanding, strategies, governance, and organizational infrastructure around patient-facing APIs, as well as their business drivers and barriers, to facilitate national learning, policy, and progress toward adoption. METHODS We performed a content analysis of semistructured interviews with a convenience sample of 10 health systems known to be leading adopters of health technology, having either implemented or planning to implement patient-facing APIs. RESULTS Of the 10 health systems, eight had operational patient-facing APIs, with organizational strategy driven most by federal policy, the emergence of Health Records on iPhone, and feelings of ethical obligation. The two priority use cases identified were enablement of a patient's longitudinal health record and digital interactions with the health system. The themes most frequently cited as barriers to the increased use of patient-facing APIs were security concerns, an immature app ecosystem that does not currently offer superior functionality compared with widely adopted electronic health record (EHR)-tethered portals, a lack of business drivers, EHR vendor hesitation toward data sharing, and immature technology and standards. CONCLUSIONS Our findings reveal heterogeneity in health system understanding and approaches to the implementation and use of patient-facing APIs. Ongoing study, targeted policy interventions, and sharing of best practices appear necessary to achieve successful national implementation.
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Affiliation(s)
- Aaron Neinstein
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, United States
| | - Crishyashi Thao
- Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Mark Savage
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Adler-Milstein
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Abstract
OBJECTIVE To describe the characteristics of patients presenting to an Emergency Department (ED) following overdoses; to identify risk factors for intensive care unit (ICU) admission among these patients; and to identify the rate of mortality and repeat overdose presentations over four years. METHODS Adult patients presenting to ED following drug overdose during 2014 were included. Data were collected from medical notes and hospital databases. RESULTS During the study period, 654 patients presented to ED 800 times following overdose. Seventy-eight (9.8%) resulted in ICU admission, and 59 (7.4%) required intubation; 57.2% had no history of overdose presentations, and 72.9% involved patients with known psychiatric illness. Overdose of atypical antipsychotics (AAP), age and history of prior overdose independently predicted ICU admission. A third of patients (n = 196, 30%) had subsequent presentations to ED following overdose, in the four years from their index presentation, with an all-cause four-year mortality of 3.4% (n = 22). CONCLUSION A history of overdose, use of AAP and older age were risk factors for ICU admission following ED presentations. Over a third of patients had repeat overdose presentation in the four-year follow-up with a mortality of 3.4%.
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Affiliation(s)
- Mark Savage
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Ross Kung
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Cameron Green
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia; and Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Brandon Thia
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Dinushka Perera
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Frankston Hospital (Peninsula Health), Australia; and Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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17
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Aroney N, Markham R, Savage M, Murdoch D, Raffel C, Walters D. 906 Transcatheter Pulmonary Valve Replacement: Melody vs Sapien. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Savage M, Grisanti C, Murdoch D, Raffel O. 787 Are All STEMIs Created Equal? Angiographic Predictors of Early Mortality in a Large Australian Cohort. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Aroney N, Nour D, Challa A, Savage M, Murdoch D, Poon K, Scalia G, Raffel C. 883 Single Centre Experience: Mitraclip and Procedural Haemodynamics. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Wiemers P, Murdoch D, Savage M, Raffel O. 693 Are Indigenous Australian Females at Particular Disadvantage in Terms of Ischaemic Heart Disease? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Black P, Savage M, Pincus M, Murdoch D, Raffel C. 816 Diagnostic Accuracy of Myocardial Perfusion Scintigraphy at Predicting Significant Coronary Artery Disease on Invasive Angiography: The Impact of Gender and Body Mass Index. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.823] [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]
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22
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Aroney N, Markham R, Savage M, Poon K, Murdoch D, Raffel C, Walters D. 685 Transcatheter Pulmonary Valve Replacement: Melody vs Sapien. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Wiemers P, Savage M, Murdoch D, Raffel O. 704 Percutaneous Coronary Intervention in an Indigenous Australian Cohort – Experience From a Tertiary Metropolitan Centre. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Mohamed MO, Kirchhof P, Vidovich M, Savage M, Rashid M, Kwok CS, Thomas M, El Omar O, Al Ayoubi F, Fischman D, Mamas MA. P3611The effect of concomitant AF on in-hospital clinical outcomes of NSTE-ACS related hospitalizations in the United States: an analysis of rates, trends and predictors from 2004 to 2014. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0470] [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: 11/12/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is the most common arrhythmia in patients presenting with acute coronary syndrome (ACS).
Purpose
We sought to examine the rates, trends, and clinical outcomes of non-ST Elevation acute coronary syndrome (NSTE-ACS) related hospitalisations in the United States in patients with AF compared to those with sinus rhythm (SR).
Methods
We analysed the Nationwide Inpatient Sample (NIS) database from 2004 to 2014 for patients with a primary discharge diagnosis of NSTEMI or UA, and further stratified the cohort on the basis of diagnoses into SR and AF groups. Multivariate analysis was performed to identify the association between AF and MACCE (composite of mortality, stroke and cardiac complications), mortality, stroke, and bleeding.
Results
A total of 4,668,737 NSTE-ACS admissions were included in our analysis. The proportions of SR and AF groups were 82.4% (3,848,202) and 17.6% (820,535), respectively. The incidence of AF increased significantly over time from 16.5% in 2004 to 19.3% in 2014 (p<0.001). The AF group was at a greater risk of adverse outcomes with higher overall rates and adjusted relative risk of MACCE (12.9% vs. 5.3%; RR: 1.74 [1.72, 1.75]), mortality (6.5% vs. 3.3%. RR: 1.12 [1.11, 1.13]), stroke (2.7% vs. 1.5%; RR: 1.32 [1.30, 1.34]) and bleeding (14.7% vs. 8.8%; RR: 1.42 [1.41, 1.43]). The AF group was less likely to receive coronary angiography (47.1% vs. 58%) and PCI (18.7% vs. 32.6%) and more likely to undergo CABG (13.9% vs. 7.6%) in comparison to SR.
Figure 1. Crude rates of adverse events
Conclusion
The prevalence of concomitant Atrial Fibrillation amongst patients presenting with NSTE-ACS has increased over a decade. However, this high-risk group remains less likely to receive invasive coronary management for NSTE-ACS than patients with sinus rhythm, independent of their comorbidities, and are associated with worse clinical outcomes.
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Affiliation(s)
- M O Mohamed
- Keele University, Cardiovascular Research Group, Keele, United Kingdom
| | - P Kirchhof
- Birmingham City Hospital, Cardiology, Birmingham, United Kingdom
| | - M Vidovich
- University of Chicago Medicine, Cardiology, Chicago, United States of America
| | - M Savage
- Thomas Jefferson University Hospital, Cardiology, Philadelphia, United States of America
| | - M Rashid
- Keele University, Cardiovascular Research Group, Keele, United Kingdom
| | - C S Kwok
- Keele University, Cardiovascular Research Group, Keele, United Kingdom
| | - M Thomas
- Birmingham City Hospital, Cardiology, Birmingham, United Kingdom
| | - O El Omar
- University of Manchester, Manchester, United Kingdom
| | - F Al Ayoubi
- King Khalid University Hospital (KKUH), Cardiology, Riyadh, Saudi Arabia
| | - D Fischman
- Thomas Jefferson University Hospital, Cardiology, Philadelphia, United States of America
| | - M A Mamas
- Keele University, Cardiovascular Research Group, Keele, United Kingdom
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25
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Kwok CS, Achenbach S, Curzen N, Fischman DL, Savage M, Bagur R, Kontopantelis E, Martin G, Steg PG, Mamas MA. P6510Frailty and in-hospital outcomes in percutaneous coronary interventions. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1100] [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: 11/13/2022] Open
Abstract
Abstract
Background
Frailty may be an important marker for poor outcomes in percutaneous coronary intervention (PCI) and there is limited literature on outcomes based on frailty from national cohorts.
Purpose
This study evaluates the prevalence of frailty, changes in frailty over time and outcomes associated with frailty in a national American cohort of patients who underwent PCI.
Methods
The study included adults who underwent PCI in the National Inpatients Sample between 2004 and 2014. Frailty risk was determined using a validated Hospital Frailty Risk Score (HFRS) using the cutoffs <5, 5–15 and >15 corresponding to low, intermediate and high HFRS.
Results
There were 7,306,007 PCI admissions in this cohort. A total of 94.58%, 5.39% and 0.03% of admissions were for low HFRS, intermediate HFRS and high HFRS, respectively. The proportion of intermediate or high frailty risk patients increased over time from 1.9% in 2004 to 11.7% in 2014. In-hospital death increased from 1.0% with low HFRS to 13.9% with high HFRS and average length of stay increased from 2.9±3.3 days to 17.1±15.5 days from low to high HFRS. Greater frailty risk was associated with greater average inpatient cost which was $17,743±11,059, $38,824±34,809 and $56,119±49,772 for low, intermediate and high HFRS, respectively. There were increased adverse outcomes with high frailty including greater in-hospital death (OR 9.91 95% CI 7.17–13.71), in-hospital bleeding complications (OR 4.99 95% CI 3.82–6.51), in-hospital vascular complications (OR 3.96 95% CI 3.00–5.23) and in-hospital stroke (OR 10.49 95% CI 8.28–13.29) comparing high to low HFRS.
Conclusions
More than 1 in 20 patients who undergo PCI have intermediate or high risk of frailty which has significantly increased over time. There are poor outcomes and increased inpatient costs associated with greater frailty. Improvements in education of healthcare workers and increased awareness of frailty could facilitate frailty-tailored care to minimise risk of adverse outcomes and its associated costs.
Acknowledgement/Funding
Research and Development Department at the Royal Stoke Hospital, Keele University and Biosensors International
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Affiliation(s)
- C S Kwok
- University Hospital of North Staffordshire, Stoke On Trent, United Kingdom
| | - S Achenbach
- Friedrich Alexander University, Department of Cardiology, Erlangen, Germany
| | - N Curzen
- University Hospital Southampton NHS Foundation Trust, Department of Cardiology, Southampton, United Kingdom
| | - D L Fischman
- Thomas Jefferson University Hospital, Department of Medicine (Cardiology), Philadelphia, United States of America
| | - M Savage
- Thomas Jefferson University Hospital, Department of Medicine (Cardiology), Philadelphia, United States of America
| | - R Bagur
- Keele University, Keele Cardiovascular Research Group, Stoke-on-Trent, United Kingdom
| | - E Kontopantelis
- University of Manchester, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester, United Kingdom
| | - G Martin
- University of Manchester, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester, United Kingdom
| | - P G Steg
- National Institute of Health and Medical Research (INSERM home), INSERM U-1148, all in Paris, France; Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M A Mamas
- Keele University, Keele Cardiovascular Research Group, Stoke-on-Trent, United Kingdom
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26
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Crowhurst J, Savage M, Murdoch D, Raffel C. Radiation Burden of Patient Obesity During Percutaneous Coronary Intervention. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Khan L, Murdoch D, Savage M, Raffel C, Poon K. Ultrasound Guided Technique for Percutaneous Transfemoral Transcatheter Aortic Valve Implantation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.707] [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: 10/26/2022]
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28
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Sankhla V, Murdoch D, Savage M, Poon K, Raffles C, Walters D. Transcatheter Aortic Valve Implantation and Concurrent Mitral Regurgitation, an Australian Perspective. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Savage M, Murdoch D, Crowhurst J, Raffel C. Trends in Pre-hospital Notification (PHN) in ST Segment Elevation Myocardial Infarction (STEMI) and Clinical Outcomes – Longitudinal Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Bagot KL, Cadilhac DA, Kim J, Vu M, Savage M, Bolitho L, Howlett G, Rabl J, Dewey HM, Hand PJ, Denisenko S, Donnan GA, Bladin CF. Transitioning from a single-site pilot project to a state-wide regional telehealth service: The experience from the Victorian Stroke Telemedicine programme. J Telemed Telecare 2018; 23:850-855. [PMID: 29081268 DOI: 10.1177/1357633x17734004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Scaling of projects from inception to establishment within the healthcare system is rarely formally reported. The Victorian Stroke Telemedicine (VST) programme provided a very useful opportunity to describe how rural hospitals in Victoria were able to access a network of Melbourne-based neurologists via telemedicine. The VST programme was initially piloted at one site in 2010 and has gradually expanded as a state-wide regional service operating with 16 hospitals in 2017. The aim of this paper is to summarise the factors that facilitated the state-wide transition of the VST programme. A naturalistic case-study was used and data were obtained from programme documents, e.g. minutes of governance committees, including the steering committee, the management committee and six working groups; operational and evaluation documentation, interviews and research field-notes taken by project staff. Thematic analysis was undertaken, with results presented in narrative form to provide a summary of the lived experience of developing and scaling the VST programme. The main success factors were attaining funding from various sources, identifying a clinical need and evidence-based solution, engaging stakeholders and facilitating co-design, including embedding the programme within policy, iterative evaluation including performing financial sustainability modelling, and conducting dissemination activities of the interim results, including promotion of early successes.
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Affiliation(s)
- Kathleen L Bagot
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia.,2 School of Clinical Sciences at Monash Health, 22457 Monash University , Australia
| | - Dominique A Cadilhac
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia.,2 School of Clinical Sciences at Monash Health, 22457 Monash University , Australia
| | - Joosup Kim
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia.,2 School of Clinical Sciences at Monash Health, 22457 Monash University , Australia
| | - Michelle Vu
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Mark Savage
- 3 Bendigo Health, Medical Services, 22457 Monash University , Australia
| | - Les Bolitho
- 4 Internal Medicine Department, 72537 Northeast Health Wangaratta , Australia
| | - Glenn Howlett
- 5 Medical Services, Echuca Regional Health, Australia
| | - Justin Rabl
- 6 Clinical Services, Goulburn Valley Health, Australia
| | - Helen M Dewey
- 7 Eastern Health Clinical School, 22457 Monash University , Australia
| | - Peter J Hand
- 8 Department of Medicine and Neurology, Royal Melbourne Hospital, Australia
| | - Sonia Denisenko
- 9 Victorian Stroke Clinical Network, Department of Health and Human Services, Australia
| | - Geoffrey A Donnan
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Christopher F Bladin
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
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31
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Adusumalli S, Markham R, Savage M, Murdoch D, Walters D, Poon K, Scalia G. Calcium Area Index: A Powerful and Novel Tool to Predict Balloon Rupture During Percutaneous Balloon Aortic Valvuloplasty. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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32
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Loon JCP, Saraswat A, Savage M, Walters D, Dautov R. Super High Pressure OPN Balloon: A Single-Centre Experience. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Walters D, Savage M, Anthony P, Crowhurst J, Poon K, Bett J, Scalia G, Raffel C, Clarke A. Outcomes of Transcatheter Aortic Valve Implantation in High Surgical Risk and Inoperable Patients With Aortic Stenosis: A Single Australian Centre Experience. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.955] [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]
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34
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Kyranis S, Markham R, Webber M, Aroney N, Savage M, Raffel C. The Obesity Paradox: Do Super Obese Patients Have Less Coronary Artery Disease? Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.998] [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]
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35
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Saraswat A, Rajapakse S, Savage M, Walters D. Use of Instantaneous Wave-Free Ratio in Haemodynamic Assessment of Left Main Coronary Artery Lesion: A Single-Centre Experience. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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36
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Kyranis S, Markham R, Aroney N, Webber M, Savage M, Lee W, Whitby M, Walters D, Crowhurst J. Radiation Exposure in Emergency Percutaneous Coronary Intervention. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.976] [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]
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37
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Lee A, Savage M, Markham R, Gaikwad N, Walters D. Patient Age at Time of Coronary Artery Bypass Grafting Predicts Incidence of Graft Failure: A Single-Centre Observational Study. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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38
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Aroney N, Murdoch D, Markham R, Grisanti C, Savage M, Poon K, Raffel C, Zhang M, Walters D. The Guideliner Catheter: Upfront Versus Escalation Strategy. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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39
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Hyasat K, Markham R, Savage M, Raffel C, Poon K, Walters D. Outcomes of Transcatheter Aortic Valve Replacement in Low, Intermediate and High-Risk Patients: The Prince Charles Hospital Experience. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.956] [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]
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40
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Grisanti C, Savage M, Lam K, Gaikwad N, Walters D. Representation Rates Following Negative Fractional Flow Reserve: Real-World Experience. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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41
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Wainberg Z, Jalal S, Muro K, Yoon H, Garrido M, Golan T, Doi T, Catenacci D, Geva R, Ku G, Bleeker J, Bang YJ, Hara H, Chung H, Savage M, Wang J, Koshiji M, Dalal R, Fuchs C. KEYNOTE-059 Update: Efficacy and safety of pembrolizumab alone or in combination with chemotherapy in patients with advanced gastric or gastroesophageal (G/GEJ) cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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42
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Olson C, Rochau G, Slutz S, Morrow C, Olson R, Cuneo M, Hanson D, Bennett G, Sanford T, Bailey J, Stygar W, Vesey R, Mehlhorn T, Struve K, Mazarakis M, Savage M, Pointon T, Kiefer M, Rosenthal S, Cochrane K, Schneider L, Glover S, Reed K, Schroen D, Farnum C, Modesto M, Oscar D, Chhabildas L, Boyes J, Vigil V, Keith R, Turgeon M, Cipiti M, Lindgren E, Dandini V, Tran H, Smith D, McDaniel D, Quintenz J, Matzen MK, VanDevender JP, Gauster W, Shephard L, Walck M, Renk T, Tanaka T, Ulrickson M, Meier W, Latkowski J, Moir R, Schmitt R, Reyes S, Abbott R, Peterson R, Pollock G, Ottinger P, Schumer J, Peterson P, Kammer D, Kulcinski G, El-Guebaly L, Moses G, Sviatoslavsky I, Sawan M, Anderson M, Bonazza R, Oakley J, Meekunasombat P, De Groot J, Jensen N, Abdou M, Ying A, Calderoni P, Morley N, Abdel-Khalik S, Dillon C, Lascar C, Sadowski D, Curry R, McDonald K, Barkey M, Szaroletta W, Gallix R, Alexander N, Rickman W, Charman C, Shatoff H, Welch D, Rose D, Panchuk P, Louie D, Dean S, Kim A, Nedoseev S, Grabovsky E, Kingsep A, Smirnov V. Development Path for Z-Pinch IFE. Fusion Science and Technology 2017. [DOI: 10.13182/fst05-a757] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- C. Olson
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - G. Rochau
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - S. Slutz
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - C. Morrow
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - R. Olson
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - M. Cuneo
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - D. Hanson
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - G. Bennett
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - T. Sanford
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - J. Bailey
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - W. Stygar
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - R. Vesey
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - T. Mehlhorn
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - K. Struve
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - M. Mazarakis
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - M. Savage
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - T. Pointon
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - M. Kiefer
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - S. Rosenthal
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - K. Cochrane
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - L. Schneider
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - S. Glover
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - K. Reed
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - D. Schroen
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - C. Farnum
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - M. Modesto
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - D. Oscar
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - L. Chhabildas
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - J. Boyes
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - V. Vigil
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - R. Keith
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - M. Turgeon
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - M. Cipiti
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - E. Lindgren
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - V. Dandini
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - H. Tran
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - D. Smith
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - D. McDaniel
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - J. Quintenz
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - M. K. Matzen
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | | | - W. Gauster
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - L. Shephard
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - M. Walck
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - T. Renk
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - T. Tanaka
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - M. Ulrickson
- Sandia National Laboratories, Albuquerque, NM 87107 USA
| | - W. Meier
- Lawrence Livermore National Laboratory, Livermore, CA 94551, USA
| | - J. Latkowski
- Lawrence Livermore National Laboratory, Livermore, CA 94551, USA
| | - R. Moir
- Lawrence Livermore National Laboratory, Livermore, CA 94551, USA
| | - R. Schmitt
- Lawrence Livermore National Laboratory, Livermore, CA 94551, USA
| | - S. Reyes
- Lawrence Livermore National Laboratory, Livermore, CA 94551, USA
| | - R. Abbott
- Lawrence Livermore National Laboratory, Livermore, CA 94551, USA
| | - R. Peterson
- Los Alamos National Laboratories, Los Alamos, NM 87545, USA
| | - G. Pollock
- Los Alamos National Laboratories, Los Alamos, NM 87545, USA
| | - P. Ottinger
- Naval Research Laboratory, Washington, DC 20375, USA
| | - J. Schumer
- Naval Research Laboratory, Washington, DC 20375, USA
| | - P. Peterson
- University of California, Berkeley, CA 94720, USA
| | - D. Kammer
- University of Wisconsin, Madison, WI 53706, USA
| | | | | | - G. Moses
- University of Wisconsin, Madison, WI 53706, USA
| | | | - M. Sawan
- University of Wisconsin, Madison, WI 53706, USA
| | - M. Anderson
- University of Wisconsin, Madison, WI 53706, USA
| | - R. Bonazza
- University of Wisconsin, Madison, WI 53706, USA
| | - J. Oakley
- University of Wisconsin, Madison, WI 53706, USA
| | | | - J. De Groot
- University of California, Davis, Davis, CA 95616, USA
| | - N. Jensen
- University of California, Davis, Davis, CA 95616, USA
| | - M. Abdou
- University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - A. Ying
- University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - P. Calderoni
- University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - N. Morley
- University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - S. Abdel-Khalik
- Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - C. Dillon
- Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - C. Lascar
- Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - D. Sadowski
- Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - R. Curry
- University of Missouri-Columbia, Columbia, MO 65211, USA
| | - K. McDonald
- University of Missouri-Columbia, Columbia, MO 65211, USA
| | - M. Barkey
- University of Alabama, Tuscaloosa, AL 35487, USA
| | - W. Szaroletta
- University of New Mexico, Albuquerque, NM 87106, USA
| | - R. Gallix
- General Atomics, San Diego, CA 92121, USA
| | | | - W. Rickman
- General Atomics, San Diego, CA 92121, USA
| | - C. Charman
- General Atomics, San Diego, CA 92121, USA
| | - H. Shatoff
- General Atomics, San Diego, CA 92121, USA
| | - D. Welch
- ATK Mission Research, Albuquerque, NM 87110, USA
| | - D. Rose
- ATK Mission Research, Albuquerque, NM 87110, USA
| | | | - D. Louie
- Omicron, Albuquerque, NM 87110, USA
| | - S. Dean
- Fusion Power Associates, Gaithersburg, MD 20879, USA
| | - A. Kim
- Institute of High Current Electronics, Tomsk, Russia
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Powles T, Bellmunt J, Castellano D, O’Donnell P, Grivas P, Vuky J, Plimack E, Hahn N, Balar A, Pang L, Savage M, Perini R, Keefe S, Bajorin D, De Wit R. Pembrolizumab produces clinically meaningful responses as first-line therapy in cisplatin-ineligible advanced urothelial cancer: Results from subgroup analyses of KEYNOTE-052. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/s1569-9056(17)30236-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zarpak R, Savage M, Raffle C, Poon K. Haemodynamic Evaluation of Long-term TAVR Durability: A Single Centre Experience. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.378] [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]
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Mengel C, Tatavarty S, Savage M, Walters D. 10 Years of Takotsubo: A Single Centre Experience. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.135] [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]
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Kahrom A, Markham R, Mandala A, Gaikwad N, Kyranis S, Murdoch D, Savage M, Crowhurst J, Rusli S, Tan X, Kahrom N, Shaw E, Hyasat K, Challa A, Walters D, He C. J-CTO Score in Predicting Procedural Success and Outcomes at 12 Months: A Single Centre Registry. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.422] [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: 10/21/2022]
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Gluer R, Incani A, Murdoch D, Robinson B, Savage M, Raffel O. Right Atrial Pressure Measurement During Fractional Flow Reserve. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gaikwad N, Khaled B, Kyranis S, Savage M, Shaw E, Robinson B, Crowhurst J, Murdoch D, Raffel C, Poon K, Clarke A, Tessar P, Walters D. TAVI in the Younger Population: A Comparison Between <75 Year and >75 Year Cohorts. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.470] [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: 10/21/2022]
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Lam K, Savage M, Murdoch D, Raffel C, Walters D, Paitry S. Real World Comparison of Fractional Flow Reserve (FFR) and Instantaneous Wave-Free Ration (iFR) in a Single Centre. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.609] [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: 10/21/2022]
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Markham R, Challa A, Hlaing S, Kyranis S, Murdoch D, Savage M, Shaw E, Gaikwad N, Hyasat K, Hanna J, Latona J, Mandala A, Kahrom A, Walters D, He C. Comparative Outcomes of Balloon, Mechanical and Self-expanding Devices in Transcatheter Aortic Valve Replacement. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.396] [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: 10/21/2022]
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