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Morgan S, Reid I, Bendon C, Ishaq M, Shayan R, Pope B, Park D, Karnezis T. A Family-Based Study of Inherited Genetic Risk in Lipedema. Lymphat Res Biol 2024; 22:106-111. [PMID: 38407896 PMCID: PMC11044871 DOI: 10.1089/lrb.2023.0065] [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] [Indexed: 02/27/2024] Open
Abstract
Background: Lipedema is a progressive condition involving excessive deposition of subcutaneous adipose tissue, predominantly in the lower limbs, which severely compromises quality of life. Despite the impact of lipedema, its molecular and genetic bases are poorly understood, making diagnosis and treatment difficult. Historical evaluation of individuals with lipedema indicates a positive family history in 60%-80% of cases; however, genetic investigation of larger family cohorts is required. Here, we report the largest family-based sequencing study to date, aimed at identifying genetic changes that contribute to lipedema. Methods and Results: DNA samples from 31 individuals from 9 lipedema families were analyzed to reveal genetic variants predicted to alter protein function, yielding candidate variants in 469 genes. We did not identify any individual genes that contained likely disease-causing variants across all participating families. However, gene ontology analysis highlighted vasopressin receptor activity, microfibril binding, and patched binding as statistically significantly overrepresented categories for the set of candidate variants. Conclusions: Our study suggests that lipedema is not caused by a single exomic genetic factor, providing support for the hypothesis of genetic heterogeneity in the etiology of lipedema. As the largest study of its kind in the lipedema field, the results advance our understanding of the disease and provide a roadmap for future research aimed at improving the lives of those affected by lipedema.
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Affiliation(s)
- Steven Morgan
- Lymphatic, Adipose and Regenerative Medicine Group, Department of O'Brien Institute, St Vincent's Institute of Medical Research, Fitzroy, Australia
| | - Isabella Reid
- Lymphatic, Adipose and Regenerative Medicine Group, Department of O'Brien Institute, St Vincent's Institute of Medical Research, Fitzroy, Australia
| | - Charlotte Bendon
- Department of Plastic and Reconstructive Surgery, West Wing, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom
| | - Musarat Ishaq
- Lymphatic, Adipose and Regenerative Medicine Group, Department of O'Brien Institute, St Vincent's Institute of Medical Research, Fitzroy, Australia
| | - Ramin Shayan
- Lymphatic, Adipose and Regenerative Medicine Group, Department of O'Brien Institute, St Vincent's Institute of Medical Research, Fitzroy, Australia
- Department of Medicine, St Vincent's Hospital, Fitzroy, Australia
| | - Bernard Pope
- Melbourne Bioinformatics, The University of Melbourne, Parkville, Australia
- Department of Surgery (Royal Melbourne Hospital), The University of Melbourne, Parkville, Australia
- Department of Clinical Pathology, The University of Melbourne, Parkville, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Daniel Park
- Melbourne Bioinformatics, The University of Melbourne, Parkville, Australia
- Department of Biochemistry and Pharmacology, The University of Melbourne, Parkville, Australia
| | - Tara Karnezis
- Lymphatic, Adipose and Regenerative Medicine Group, Department of O'Brien Institute, St Vincent's Institute of Medical Research, Fitzroy, Australia
- Department of Medicine, St Vincent's Hospital, Fitzroy, Australia
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Morgan S, Jarvis S, Conti A, Staudinger K, Reynolds C, Bar-Or D. Displaced Geriatric Femoral Neck Fractures: A Retrospective Comparison of Total Hip Arthroplasties Versus Hemiarthroplasty. Geriatr Orthop Surg Rehabil 2023; 14:21514593231198949. [PMID: 38023061 PMCID: PMC10655670 DOI: 10.1177/21514593231198949] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Controversary exists around the best surgical management for traumatic geriatric displaced femoral neck fractures. The study objective was to compare outcomes among those managed with a total hip arthroplasty (THA) to those managed with a hemiarthroplasty (HA). Methods This retrospective matched cohort study included geriatric hip fractures (≥65 y/o) admitted 7/1/16-3/31/20. Patients were matched on having an advanced directive, pre-existing dementia, and age. Outcomes included: time to surgery, length of stay (LOS), blood loss volume, and discharge destination. THAs were compared to HAs; an alpha of <.05 indicated statistical significance. Results There were 191 patients: 86% were treated with HA and 14% with THA. Most (40%) were 80-89 years old, 66% were female, and 92% were white. After matching, the groups were well balanced on demographics and baseline characteristics with 27 patients/arm. The median time to surgery was 23 hours for both arms, P = .38. The LOS was significantly longer for those managed with a HA when compared to those managed with a THA, 5.6 vs 4.0 days, P = .001. The median blood loss volume was significantly lower for HAs than for THAs, but the difference was small, 100 vs 120 mL, P = .02. Patients managed with a HA were less likely to be discharged home than those managed with a THA, 22% vs 70%, P = .005. Conclusions While patients managed with a THA had significantly more blood loss than those managed with a HA, the difference in blood loss was small and not clinically relevant. Those managed with a THA experienced a significantly shorter LOS and were more likely to be discharged home than patients managed with a HA. Among a healthier, younger geriatric population, THA may lead to shortened LOS and improved discharge destinations when compared to HA for treatment of femoral neck fractures.
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Affiliation(s)
- Steven Morgan
- Trauma Department, Swedish Medical Center, Englewood, CO, USA
| | - Stephanie Jarvis
- Trauma Department, Injury Outcomes Network (ION) Research, Englewood, CO, USA
| | - Alexander Conti
- Trauma Department, Swedish Medical Center, Englewood, CO, USA
| | | | | | - David Bar-Or
- Trauma Department, Swedish Medical Center, Englewood, CO, USA
- Trauma Department, Injury Outcomes Network (ION) Research, Englewood, CO, USA
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Meinig R, Jarvis S, Salottolo K, Nwafo N, McNair P, Harrison P, Morgan S, Duane T, Woods B, Nentwig M, Kelly M, Cornutt D, Bar-Or D. Propensity matched analysis examining the effect of passive reversal of direct oral anticoagulants on blood loss and the need for transfusions among traumatic geriatric hip fractures. Eur J Med Res 2023; 28:241. [PMID: 37475008 PMCID: PMC10360353 DOI: 10.1186/s40001-023-01053-2] [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: 02/01/2022] [Accepted: 02/08/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Reversal of direct oral anticoagulants (DOACs) is currently recommended prior to emergent surgery, such as surgical intervention for traumatic geriatric hip fractures. However, reversal methods are expensive and timely, often delaying surgical intervention, which is a predictor of outcomes. The study objective was to examine the effect of DOAC reversal on blood loss and transfusions among geriatric patients with hip fractures. METHODS This retrospective propensity-matched study across six level I trauma centers included geriatric patients on DOACs with isolated fragility hip fractures requiring surgical intervention (2014-2017). Outcomes included: intraoperative blood loss, intraoperative pRBCs, and hospital length of stay (HLOS). RESULTS After matching there were 62 patients (31 reversed, 31 not reversed), 29 patients were not matched. The only reversal method utilized was passive reversal (waiting ≥ 24 hours for elimination). Passively reversed patients had a longer time to surgery (mean, 43 vs. 18 hours, p < 0.01). Most patients (92%) had blood loss (90% passively reversed, 94% not reversed); the median volume of blood loss was 100 mL for both those groups, p = 0.97. Thirteen percent had pRBCs transfused (13% passively reversed and 13% not reversed); the median volume of pRBCs transfused was 525 mL for those passively reversed and 314 mL for those not reversed, p = 0.52. The mean HLOS was significantly longer for those passively reversed (7 vs. 5 days, p = 0.001). CONCLUSIONS Passive DOAC reversal for geriatric patients with isolated hip fracture requiring surgery may be contributing to delayed surgery and an increased HLOS without having a significant effect on blood loss or transfusions. These data suggest that passive DOAC reversal may not be necessary prior to surgical repair of isolated hip fracture.
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Affiliation(s)
- Richard Meinig
- Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO, 80907, USA
| | - Stephanie Jarvis
- Injury Outcomes Network (ION) Research, 501 East Hampden Ave, Englewood, CO, 80113, USA
| | - Kristin Salottolo
- Injury Outcomes Network (ION) Research, 501 East Hampden Ave, Englewood, CO, 80113, USA
| | - Nnamdi Nwafo
- Swedish Medical Center, 501 East Hampden Ave, Englewood, CO, 80113, USA
| | - Patrick McNair
- St. Anthony Hospital, 11600 W 2nd Plaza, Lakewood, CO, 80228, USA
| | - Paul Harrison
- Wesley Medical Center, 550 North Hillside St. Wichita, Wichita, KS, 67214, USA
| | - Steven Morgan
- Swedish Medical Center, 501 East Hampden Ave, Englewood, CO, 80113, USA
| | - Therese Duane
- Medical City Plano, 3901 West 15th Street, Plano, TX, 75075, USA
| | - Bradley Woods
- Research Medical Center, 2316 East Meyer Blvd, Kansas City, MO, 64132, USA
| | - Michelle Nentwig
- Wesley Medical Center, 550 North Hillside St. Wichita, Wichita, KS, 67214, USA
| | - Michael Kelly
- Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO, 80907, USA
| | - David Cornutt
- Regional West Medical Center, 4021 Ave B, Scottsbluff, NE, 69361, USA
| | - David Bar-Or
- Injury Outcomes Network (ION) Research, 501 East Hampden Ave, Englewood, CO, 80113, USA.
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Pillay V, Shukla L, Herle P, Maciburko S, Bandara N, Reid I, Morgan S, Yuan Y, Luu J, Cowley KJ, Ramm S, Simpson KJ, Achen MG, Stacker SA, Shayan R, Karnezis T. Radiation therapy attenuates lymphatic vessel repair by reducing VEGFR-3 signalling. Front Pharmacol 2023; 14:1152314. [PMID: 37188266 PMCID: PMC10176020 DOI: 10.3389/fphar.2023.1152314] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction: Surgery and radiotherapy are key cancer treatments and the leading causes of damage to the lymphatics, a vascular network critical to fluid homeostasis and immunity. The clinical manifestation of this damage constitutes a devastating side-effect of cancer treatment, known as lymphoedema. Lymphoedema is a chronic condition evolving from the accumulation of interstitial fluid due to impaired drainage via the lymphatics and is recognised to contribute significant morbidity to patients who survive their cancer. Nevertheless, the molecular mechanisms underlying the damage inflicted on lymphatic vessels, and particularly the lymphatic endothelial cells (LEC) that constitute them, by these treatment modalities, remain poorly understood. Methods: We used a combination of cell based assays, biochemistry and animal models of lymphatic injury to examine the molecular mechanisms behind LEC injury and the subsequent effects on lymphatic vessels, particularly the role of the VEGF-C/VEGF-D/VEGFR-3 lymphangiogenic signalling pathway, in lymphatic injury underpinning the development of lymphoedema. Results: We demonstrate that radiotherapy selectively impairs key LEC functions needed for new lymphatic vessel growth (lymphangiogenesis). This effect is mediated by attenuation of VEGFR-3 signalling and downstream signalling cascades. VEGFR-3 protein levels were downregulated in LEC that were exposed to radiation, and LEC were therefore selectively less responsive to VEGF-C and VEGF-D. These findings were validated in our animal models of radiation and surgical injury. Discussion: Our data provide mechanistic insight into injury sustained by LEC and lymphatics during surgical and radiotherapy cancer treatments and underscore the need for alternative non-VEGF-C/VEGFR-3-based therapies to treat lymphoedema.
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Affiliation(s)
- Vinochani Pillay
- O’Brien Institute Department, St Vincent’s Institute for Medical Research, Fitzroy, VIC, Australia
| | - Lipi Shukla
- O’Brien Institute Department, St Vincent’s Institute for Medical Research, Fitzroy, VIC, Australia
- Department of Plastic Surgery, St. Vincent’s Hospital, Fitzroy, VIC, Australia
- Faculty of Health Sciences, ACU, AORTEC; Australian Catholic University, Fitzroy, VIC, Australia
- Department of Plastic Surgery, Alfred Health, Melbourne, VIC, Australia
| | - Prad Herle
- O’Brien Institute Department, St Vincent’s Institute for Medical Research, Fitzroy, VIC, Australia
| | - Simon Maciburko
- O’Brien Institute Department, St Vincent’s Institute for Medical Research, Fitzroy, VIC, Australia
| | - Nadeeka Bandara
- O’Brien Institute Department, St Vincent’s Institute for Medical Research, Fitzroy, VIC, Australia
| | - Isabella Reid
- O’Brien Institute Department, St Vincent’s Institute for Medical Research, Fitzroy, VIC, Australia
| | - Steven Morgan
- O’Brien Institute Department, St Vincent’s Institute for Medical Research, Fitzroy, VIC, Australia
| | - Yinan Yuan
- O’Brien Institute Department, St Vincent’s Institute for Medical Research, Fitzroy, VIC, Australia
| | - Jennii Luu
- Victorian Centre for Functional Genomics, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karla J. Cowley
- Victorian Centre for Functional Genomics, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Susanne Ramm
- Victorian Centre for Functional Genomics, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Biochemistry and Pharmacology, University of Melbourne, Parkville, VIC, Australia
| | - Kaylene J. Simpson
- Victorian Centre for Functional Genomics, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Biochemistry and Pharmacology, University of Melbourne, Parkville, VIC, Australia
- Department of Medicine, University of Melbourne, St. Vincent’s Hospital, Fitzroy, VIC, Australia
| | - Marc G. Achen
- O’Brien Institute Department, St Vincent’s Institute for Medical Research, Fitzroy, VIC, Australia
| | - Steven A. Stacker
- Tumour Angiogenesis and Microenvironment Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Ramin Shayan
- O’Brien Institute Department, St Vincent’s Institute for Medical Research, Fitzroy, VIC, Australia
- Department of Plastic Surgery, St. Vincent’s Hospital, Fitzroy, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Department of Plastic Surgery, Alfred Health, Melbourne, VIC, Australia
| | - Tara Karnezis
- O’Brien Institute Department, St Vincent’s Institute for Medical Research, Fitzroy, VIC, Australia
- Department of Medicine, University of Melbourne, St. Vincent’s Hospital, Fitzroy, VIC, Australia
- *Correspondence: Tara Karnezis,
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Morgan R, Clamp A, Barnes B, Schlecht H, Yarram-Smith L, Wallis Y, Morgan S, Valganon M, Hudson E, McKenna S, Sundar S, Nicum S, Brenton J, Kristeleit R, Banerjee S, McNeish I, Ledermann J, Taylor S, Evans G, Jayson G. 575P Homologous recombination deficiency in newly diagnosed FIGO stage III/IV high-grade serous or endometrioid ovarian cancer: A multi-national observational study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.703] [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] Open
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Topless R, Green R, Morgan S, Robinson P, Merriman T, Gaffo A. POS1222 FOLIC ACID AND METHOTREXATE USE AND THEIR ASSOCIATION WITH COVID-19 DIAGNOSIS AND MORTALITY: AN ANALYSIS FROM THE UK BIOBANK. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFolate metabolism is implicated in SARS-CoV-2 infectivity (Ref).ObjectivesTo determine if methotrexate (an antifolate) or folic acid prescription were associated with a lowered and increased risk, respectively, for COVID-19 diagnosis or mortality in a large population-based cohort (UK Biobank).MethodsData from 380,380 UK Biobank participants with general practice prescription data were used. Criteria for COVID-19 diagnosis were 1) a positive SARS-CoV-2 test and / or 2) ICD-10 code for confirmed COVID-19 (U07.1) or probable COVID-19 (U07.2) in hospital records, or death records. This definition identified 26,003 individuals diagnosed with COVID-19 of whom 820 were known to have died from COVID-19. Logistic regression statistical models were adjusted for age group (4 categories), sex, ethnicity, Townsend deprivation index, BMI, smoking status, presence of rheumatoid arthritis, sickle cell disease, use of anticonvulsants, statins and iron supplements.ResultsCompared with people prescribed neither folic acid nor methotrexate, people prescribed folic acid supplementation had increased risk of diagnosis of COVID-19 (OR 1.51 [1.42; 1.61]). The prescription of methotrexate with or without folic acid was not associated with COVID-19 diagnosis (P≥0.18). Compared with people prescribed neither folic acid nor methotrexate, people prescribed folic acid supplementation had an increased risk of death after a diagnosis of COVID-19 (OR 2.64 [2.15; 3.24]) in a fully adjusted model. The prescription of methotrexate in combination with folic acid was not associated with an increased risk for death after a diagnosis of COVID-19 (1.07 [0.57; 1.98]). (Table 1)Table 1.COVID-19 diagnosis and associated death in people prescribed methotrexate and / or folic acid in the UKBB, compared to people not prescribed methotrexate or folic acid. Model 1 adjusted for age group, sex, ethnicity, Townsend deprivation index, BMI, smoking status Model 2 is model 1 plus adjustment by the presence of rheumatoid arthritis, sickle cell disease, use of statins, anticonvulsants and iron supplementation.UnadjustedModel 1Model 2OR[95% CI]POR[95% CI]POR[95% CI]PNeither Folic acid nor Methotrexate1.0-1.0-1.0-COVID-19 diagnosisFolic acid only1.58[1.49; 1.68]<0.0011.60[1.50; 1.70]<0.0011.51[1.42; 1.61]<0.001Methotrexate and Folic acid1.09[0.96; 1.23]0.181.15[1.02; 1.30]0.0211.09[0.96; 1.23]0.18COVID-19 associated deathFolic acid only5.14 [4.23; 6.24]<0.0012.91 [2.38; 3.55]<0.0012.64[2.15; 3.24]<0.001Methotrexate and folic acid1.47 [0.81; 2.67]0.211.26 [0.70; 2.30]0.441.07 [0.57; 1.98]0.84ConclusionWe report increased risk for COVID-19 diagnosis and COVID-19-related death for people prescribed folic acid supplementation. The prescription and use of supplemental folic acid may confer risk of infection with the SARS-CoV-2 virus as well as the risk of death resulting from COVID-19. Our results also suggest that methotrexate might attenuate an increased risk for COVID-19 diagnosis and death conferred by folic acid.References[1]Zhang Y, Guo R, Kim SH, et al. SARS-CoV-2 hijacks folate and one-carbon metabolism for viral replication. Nature Communications 2021;12(1):1676. doi: 10.1038/s41467-021-21903-zDisclosure of InterestsRuth Topless: None declared, Ralph Green: None declared, Sarah Morgan: None declared, Philip Robinson Consultant of: Abbvie, Atom Biosciences, Eli Lilly, Gilead, Janssen, Novartis, UCB, Roche, Pfizer, Grant/research support from: Janssen, Novartis, Pfizer and UCB Pharma, Tony Merriman: None declared, Angelo Gaffo Consultant of: SOBI, Selecta
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Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
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Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
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Cochrane A, Booth A, Walker I, Morgan S, Mitchell A, Barlow-Pay M, Hewitt C, Taylor B, Chapman C, Raftery J, Fleming J, Torgerson D, Parkes J. Examining the effectiveness of Gateway-an out-of-court community-based intervention to reduce recidivism and improve the health and well-being of young adults committing low-level offences: study protocol for a randomised controlled trial. Trials 2021; 22:939. [PMID: 34923999 PMCID: PMC8684788 DOI: 10.1186/s13063-021-05905-2] [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: 10/26/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young adult offenders represent a third of the UK prison population and are at risk of poor health outcomes including drug and alcohol misuse, self-harm and suicide. Court diversion interventions aim to reduce the negative consequences of formal criminal justice sanctions and focus resources on addressing the root causes of offending. Although diversions are widely used, evidence of their effectiveness has not yet been established. Hampshire Constabulary, working together with local charities, have developed the Gateway programme, an out-of-court intervention aimed at improving the life chances of young adults. Issued as a conditional caution, participants undertake a health and social care needs assessment, attend workshops encouraging analysis of own behaviour and its consequences and agree not to re-offend during the 16-week caution. METHODS This is a pragmatic, multi-site, parallel-group, superiority randomised controlled trial with a target sample size of 334. Participants are aged 18-24, reside in Hampshire and Isle of Wight and are being questioned for an eligible low-level offence. Police investigators offer potential participants a chance to receive the Gateway caution, and those interested are also invited to take part in the study. Police officers obtain Stage 1 consent and carry out an eligibility check, after which participants are randomised on a 1:1 basis either to receive Gateway or follow the usual process, such as court appearance or a different conditional caution. Researchers subsequently obtain Stage 2 consent and collect data at weeks 4 and 16, and 1 year post-randomisation. The primary outcome is the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Secondary outcomes include health status, alcohol and drug use, recidivism and resource use. The primary analysis will compare the WEMWBS score between the two groups at 12 months. DISCUSSION This pioneering trial aims to address the evidence gap surrounding diversion in 18-24-year-olds. The findings will inform law enforcement agencies, third sector organisations, policymakers and commissioners, as well as researchers working in related fields and with vulnerable target populations. TRIAL REGISTRATION International Standard Randomised Controlled Trial Register ( ISRCTN 11888938 ).
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Affiliation(s)
- A Cochrane
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - A Booth
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - I Walker
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - S Morgan
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - A Mitchell
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - M Barlow-Pay
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - C Hewitt
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - B Taylor
- Hampshire Constabulary, Southampton Central Police Station, Southampton, SO15 1AN, UK
| | - C Chapman
- Hampshire Constabulary, Southampton Central Police Station, Southampton, SO15 1AN, UK
| | - J Raftery
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - J Fleming
- Department of Sociology, Social Policy and Criminology, University of Southampton, Southampton, SO17 1BJ, UK
| | - D Torgerson
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - J Parkes
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
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Ishaq M, Bandara N, Morgan S, Nowell C, Mehdi AM, Lyu R, McCarthy D, Anderson D, Creek DJ, Achen MG, Shayan R, Karnezis T. Key signaling networks are dysregulated in patients with the adipose tissue disorder, lipedema. Int J Obes (Lond) 2021; 46:502-514. [PMID: 34764426 PMCID: PMC8873020 DOI: 10.1038/s41366-021-01002-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 01/04/2023]
Abstract
Objectives Lipedema, a poorly understood chronic disease of adipose hyper-deposition, is often mistaken for obesity and causes significant impairment to mobility and quality-of-life. To identify molecular mechanisms underpinning lipedema, we employed comprehensive omics-based comparative analyses of whole tissue, adipocyte precursors (adipose-derived stem cells (ADSCs)), and adipocytes from patients with or without lipedema. Methods We compared whole-tissues, ADSCs, and adipocytes from body mass index–matched lipedema (n = 14) and unaffected (n = 10) patients using comprehensive global lipidomic and metabolomic analyses, transcriptional profiling, and functional assays. Results Transcriptional profiling revealed >4400 significant differences in lipedema tissue, with altered levels of mRNAs involved in critical signaling and cell function-regulating pathways (e.g., lipid metabolism and cell-cycle/proliferation). Functional assays showed accelerated ADSC proliferation and differentiation in lipedema. Profiling lipedema adipocytes revealed >900 changes in lipid composition and >600 differentially altered metabolites. Transcriptional profiling of lipedema ADSCs and non-lipedema ADSCs revealed significant differential expression of >3400 genes including some involved in extracellular matrix and cell-cycle/proliferation signaling pathways. One upregulated gene in lipedema ADSCs, Bub1, encodes a cell-cycle regulator, central to the kinetochore complex, which regulates several histone proteins involved in cell proliferation. Downstream signaling analysis of lipedema ADSCs demonstrated enhanced activation of histone H2A, a key cell proliferation driver and Bub1 target. Critically, hyperproliferation exhibited by lipedema ADSCs was inhibited by the small molecule Bub1 inhibitor 2OH-BNPP1 and by CRISPR/Cas9-mediated Bub1 gene depletion. Conclusion We found significant differences in gene expression, and lipid and metabolite profiles, in tissue, ADSCs, and adipocytes from lipedema patients compared to non-affected controls. Functional assays demonstrated that dysregulated Bub1 signaling drives increased proliferation of lipedema ADSCs, suggesting a potential mechanism for enhanced adipogenesis in lipedema. Importantly, our characterization of signaling networks driving lipedema identifies potential molecular targets, including Bub1, for novel lipedema therapeutics.
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Affiliation(s)
- Musarat Ishaq
- Lymphatic, Adipose and Regenerative Medicine Laboratory, O'Brien Institute Department, St Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia. .,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, 3065, Australia.
| | - Nadeeka Bandara
- Lymphatic, Adipose and Regenerative Medicine Laboratory, O'Brien Institute Department, St Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia
| | - Steven Morgan
- Lymphatic, Adipose and Regenerative Medicine Laboratory, O'Brien Institute Department, St Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia
| | - Cameron Nowell
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Ahmad M Mehdi
- Diamantia Institute, Faculty of Medicine, The University of Queensland, St Lucia, QLD, 4067, Australia
| | - Ruqian Lyu
- Bioinformatics and Cellular Genomics, St. Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia
| | - Davis McCarthy
- Bioinformatics and Cellular Genomics, St. Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia
| | - Dovile Anderson
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Darren J Creek
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Marc G Achen
- Lymphatic, Adipose and Regenerative Medicine Laboratory, O'Brien Institute Department, St Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia.,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, 3065, Australia
| | - Ramin Shayan
- Lymphatic, Adipose and Regenerative Medicine Laboratory, O'Brien Institute Department, St Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia.,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, 3065, Australia
| | - Tara Karnezis
- Lymphatic, Adipose and Regenerative Medicine Laboratory, O'Brien Institute Department, St Vincent's Institute of Medical Research, Fitzroy, VIC, 3065, Australia. .,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, 3065, Australia.
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Morgan S, Vo A, Ni W, Radey M, McGeer K, Rowe S, Jorth P, Singh S, Nichols D, Singh P. 429: Effects of elexacaftor/tezacaftor/ivacaftor on the CF sputum microbiome: Preliminary analysis from the Promise study. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01853-1] [Citation(s) in RCA: 1] [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: 11/30/2022]
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13
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Frugtniet B, Morgan S, Murray A, Palmer-Smith S, White R, Jones R, Hanna L, Fuller C, Hudson E, Mullard A, Quinton AE. The detection of germline and somatic BRCA1/2 genetic variants through parallel testing of patients with high-grade serous ovarian cancer: a national retrospective audit. BJOG 2021; 129:433-442. [PMID: 34657373 PMCID: PMC9298909 DOI: 10.1111/1471-0528.16975] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/22/2021] [Revised: 08/11/2021] [Accepted: 09/12/2021] [Indexed: 12/05/2022]
Abstract
Objective To determine the frequency of germline and somatic pathogenic BRCA1 and BRCA2 variants in patients with high‐grade serous ovarian cancer tested by next‐generation sequencing (NGS), with the aim of defining the best strategy to be implemented in future routine testing. Design National retrospective audit. Setting The All Wales Medical Genomics Service (AWMGS). Population Patients with high‐grade serous ovarian/fallopian tube/peritoneal cancer referred by oncologists to the AWMGS between February 2015 and February 2021 for germline and/or tumour testing of the BRCA1 and BRCA2 genes by NGS. Methods Analysis of NGS data from germline and/or tumour testing. Main outcome measures Frequency of BRCA1 and BRCA2 pathogenic variants. Results The overall observed germline/somatic pathogenic variant detection rate was 11.6% in the 844 patients included in this study, with a 9.2% (73/791) germline pathogenic variant detection rate. Parallel tumour and germline testing was carried out for 169 patients and the overall pathogenic variant detection rate for this cohort was 14.8%, with 6.5% (11/169) shown to have a somatic pathogenic variant. Two BRCA1 dosage variants were found during germline screens, representing 2.0% (2/98) of patients with a pathogenic variant that would have been missed through tumour testing alone. Conclusions Parallel germline and tumour BRCA1 and BRCA2 testing maximises the detection of pathogenic variants in patients with high‐grade serous ovarian cancer. Tweetable abstract Parallel germline and tumour testing maximises BRCA pathogenic variant detection in ovarian cancer. Parallel germline and tumour testing maximises BRCA pathogenic variant detection in ovarian cancer. Linked article This article is commented on by C Gourley, p. 443 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16978.
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Affiliation(s)
- B Frugtniet
- All Wales Medical Genomics Laboratory, University Hospital of Wales, Cardiff, UK
| | - S Morgan
- All Wales Medical Genomics Laboratory, University Hospital of Wales, Cardiff, UK
| | - A Murray
- All Wales Medical Genomics Service, University Hospital of Wales, Cardiff, UK
| | - S Palmer-Smith
- All Wales Medical Genomics Laboratory, University Hospital of Wales, Cardiff, UK
| | - R White
- All Wales Medical Genomics Laboratory, University Hospital of Wales, Cardiff, UK
| | - R Jones
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - L Hanna
- Velindre Cancer Centre, Velindre University NHS Trust, Cardiff, UK
| | - C Fuller
- Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board, Bangor, UK
| | - E Hudson
- Velindre Cancer Centre, Velindre University NHS Trust, Cardiff, UK
| | - A Mullard
- Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board, Bangor, UK
| | - A E Quinton
- Velindre Cancer Centre, Velindre University NHS Trust, Cardiff, UK
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Wood S, McCluskey L, Ellwood-Thompson R, Files C, Medway C, White R, Roberts H, Morgan S. 364P Implementation of a comprehensive streamlined next generation sequencing (NGS) test for glioma including detection of the 1p/19q codeletion. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.028] [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
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Dinneen E, Grierson J, Haider A, Allen C, Heffernan-Ho D, Clow R, Freeman A, Briggs T, Nathan S, Brew-Graves C, Mallett S, Williams N, Persad R, Aning J, Oxley J, Oakley N, Morgan S, Tahir F, Ahmad I, Dutto L, Salmond J, Marzena R, Ben-Salha I, Kelly J, Shaw G. NeuroSAFE PROOF. Update on a multi-centre, pragmatic, RCT for men undergoing robot-assisted radical prostatectomy: Trial in progress. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01245-8] [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]
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Lijfrock V, Morgan S, Hwang S, Efimova E, Lawrence K, Hawser S, Morrissey I. 1613. Global 2018 Surveillance of Eravacycline Against Gram-negative Pathogens, Including Multi-drug Resistant Isolates. Open Forum Infect Dis 2020. [PMCID: PMC7777381 DOI: 10.1093/ofid/ofaa439.1793] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Eravacycline (ERV) is a fully-synthetic, fluorocycline antibacterial approved by the FDA and EMA for treatment of complicated intra-abdominal infections (cIAI) in patients ≥18 years of age. The purpose of this study was to describe the in vitro activity of ERV against Gram-negative pathogens, including multi-drug resistant (MDR) isolates, collected in 2018. Methods Isolates were collected during 2018 from various body sites. Minimum inhibitory concentrations (MICs) were determined by CLSI broth microdilution. Antibiotic susceptibility was determined using the most updated CLSI breakpoints, except for ERV and tigecycline (TGC) where FDA breakpoints established in 2018 and 2005 respectively, were used. MDR was defined as resistance to ≥3 antibiotics from aztreonam, a carbapenem (meropenem or ertapenem [ETP]), cefepime/cefotaxime/ceftazidime/ceftriaxone (any one), gentamicin, levofloxacin, piperacillin-tazobactam TZP, tetracycline or TGC. Results Summary MIC data for ERV and select comparators are shown in the Table. ERV MIC90 for all-Enterobacteriaceae was 0.5 μg/ml and for MDR-Enterobacteriaceae was 1μg/ml. The susceptibilities for all-Enterobacteriaceae were 93%, 95%, 93% and 82% for ERV, TGC, ETP and TZP, respectively. ERV further demonstrated higher rates of susceptibility than ETP and TZP against MDR-Enterobateriaceae, 81% vs 71% vs 38%. ERV MIC50/90 for carbapenem-resistant Acinetobacter baumannii (CRAB) were 4-fold lower than TGC. Table ![]()
Conclusion ERV in vitro activity was demonstrated and comparable susceptibility rates were observed for clinically important Gram-negative pathogens, including resistant isolates. Overall, ERV MIC90 values were 2- to 8- fold lower than TGC. this study further highlights the in vitro activity of ERV against Gram-negative pathogens identified in patients with cIAI. Disclosures Virgil Lijfrock, PharMD, Tetraphase (Employee) Steven Morgan, PharMD, Tetraphase Pharmaceuticals (Employee) Sara Hwang, PharMD, Tetraphase Pharmaceuticals (Employee) Ekaterina Efimova, PharMD, Tetraphase Pharmaceuticals (Employee) Kenneth Lawrence, PharmD, Tetraphase Pharmaceuticals (Employee) Stephen Hawser, PhD, Tetraphase Pharmaceuticals (Scientific Research Study Investigator) Ian Morrissey, PhD, Tetraphase Pharmaceuticals (Scientific Research Study Investigator)
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Affiliation(s)
| | | | - Sara Hwang
- Tetraphase Pharmaceuticals, Miami Shores, Florida
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Morgan S, Hwang S, Efimova E, Hawser S, Morrissey I, Lijfrock V. 915. Global 2018 Surveillance of Eravacycline Against Gram-positive Pathogens, Including Resistant Isolates. Open Forum Infect Dis 2020. [PMCID: PMC7776539 DOI: 10.1093/ofid/ofaa439.1103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Eravacycline (ERV) is a fully-synthetic, fluorocycline antibacterial approved by the FDA and EMA for the treatment of complicated intra-abdominal infections (cIAI) in patients ≥18 years of age. The purpose of this study was to further monitor the in vitro activity of ERV against Gram-positive pathogens, such as Staphylococcus aureus (including methicillin-resistant S. aureus, MRSA), Enterococcus spp. (including vancomycin-resistant Enterococcus, VRE) and Streptococcus spp.
Methods
Isolates were collected globally during 2018 from various body sites. Minimum inhibitory concentrations (MICs) were determined by CLSI broth microdilution. Antibiotic susceptibility was determined using the most recent CLSI breakpoints (30th ed CLSI M100 document), except for ERV and tigecycline (TGC) where FDA breakpoints from 2018 and 2005, respectively, were applied.
Results
Summary MIC data for ERV and select comparators are shown in the Table. ERV MIC50/90 for Enterococcus spp were 0.06/0.12 μg/mL and were not affected by the presence of vancomycin resistant mechanisms. The MIC90 of ERV against VRE was 2-fold lower than TGC, at a value of 0.12 μg/mL. ERV MIC90 values for methicillin-susceptible S. aureus (MSSA) was 0.12 μg/mL and for MRSA was 0.25 μg/mL. Generally, for all pathogens, ERV MIC90 values were 2- to 4-fold lower than TGC.
Table
Conclusion
ERV in vitro activity was demonstrated for clinically important Gram-positive pathogens, including resistant isolates. Overall, ERV demonstrated lower MIC90 values than comparators for all organisms. This 2018 global surveillance highlights ERV’s utility against Gram-positive organisms and further underscores its role in cIAI, where these pathogens play a causative role.
Disclosures
Steven Morgan, PharMD, Tetraphase Pharmaceuticals (Employee) Sara Hwang, PharMD, Tetraphase Pharmaceuticals (Employee) Ekaterina Efimova, PharMD, Tetraphase Pharmaceuticals (Employee) Stephen Hawser, PhD, Tetraphase Pharmaceuticals (Scientific Research Study Investigator) Virgil Lijfrock, PharMD, Tetraphase (Employee)
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Affiliation(s)
| | - Sara Hwang
- Tetraphase Pharmaceuticals, Villanova, Pennsylvania
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18
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Meinig R, Cornutt D, Jarvis S, Salottolo K, Kelly M, Harrison P, Nentwig M, Morgan S, Nwafo N, McNair P, Banerjee R, Woods B, Bar-Or D. Partial warfarin reversal prior to hip fracture surgical intervention in geriatric trauma patients effects on blood loss and transfusions. J Clin Orthop Trauma 2020; 14:45-51. [PMID: 33717896 PMCID: PMC7920139 DOI: 10.1016/j.jcot.2020.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Warfarin reversal is typically sought prior to surgery for geriatric hip fractures; however, patients often proceed to surgery with partial warfarin reversal. The effect of partial reversal (defined as having an international normalized ratio [INR] > 1.5) remains unclear. METHODS This was a retrospective cohort study. Geriatric patients (≥65 y/o) admitted to six level I trauma centers from 01/2014-01/2018 with isolated hip fractures requiring surgery who were taking warfarin pre-injury were included. Warfarin reversal methods included: vitamin K, factor VIIa, (a)PCC, fresh frozen plasma (FFP), and the "wait and watch" method. An INR of ≤ 1.5 defined complete reversal. The primary outcome was the volume of blood loss during surgery; other outcomes included packed red blood cell (pRBC) and FFP transfusions, and time to surgery. RESULTS There were 135 patients, 44% partially reversed and 56% completely reversed. The median volume of blood loss was 100 mL for both those completely and partially reversed, p = 0.72. There was no difference in the proportion of patients with blood loss by study arm, 95% vs. 95%, p > 0.99. Twenty-five percent of those completely reversed and 39% of those partially reversed had pRBCs transfused, p = 0.08. Of those completely reversed 5% received an FFP transfusion compared to 14% of those partially reversed, p = 0.09. There were no statistically significant differences observed for the volume of pRBC or FFP transfused, or for time to surgery. CONCLUSIONS Partial reversal may be safe for blood loss and blood product transfusions for geriatric patients with isolated hip fractures. Complete warfarin reversal may not be necessary prior to hip fracture surgery, especially for mildly elevated INRs.
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Key Words
- AAOS, American Academy of Orthopedic Surgeons
- ANOVA, analysis of variance
- CVA, cerebrovascular accident
- DOAC, direct oral anticoagulants
- DVT, deep vein thrombosis
- FFP, fresh frozen plasma
- Geriatric
- HIPAA, health insurance accountability and assurance act
- HLOS, hospital length of stay
- Hip fracture
- ICD, international classification of diseases
- ICU LOS, intensive care unit length of stay
- INR, international normalized ratio
- ION, Injury Outcomes Network
- IQR, interquartile range
- IV, intravenous
- MI, myocardial infarction
- PCC, prothrombin complex concentrates
- PE, pulmonary embolism
- Reversal
- SD, standard deviation
- TQIP, Trauma Quality Improvement Program
- Trauma
- Warfarin
- aPCC, activated prothrombin complex concentrates
- mL, milliliters
- pRBC, packed red blood cells
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Affiliation(s)
- Richard Meinig
- Orthopedic Surgery and Trauma, Penrose Hospital, 1263 Lake Plaza Dr, Colorado Springs, CO, 80906, USA
| | - David Cornutt
- Emergency Medicine, Regional West Medical Center, 4021 Avenue B, Scottsbluff, NE, 69361, USA
| | - Stephanie Jarvis
- Injury Outcomes Network (ION) Research, 501 E. Hampden Ave, Englewood, CO, 80113, USA
| | - Kristin Salottolo
- Injury Outcomes Network (ION) Research, 501 E. Hampden Ave, Englewood, CO, 80113, USA
| | - Michael Kelly
- Orthopedic Surgery and Trauma, Penrose Hospital, 1263 Lake Plaza Dr, Colorado Springs, CO, 80906, USA
| | - Paul Harrison
- General, Trauma, & Orthopedic Surgery, Wesley Medical Center, 3242 E. Murdock Street, Wichita, KS, 67208, USA
| | - Michelle Nentwig
- General, Trauma, & Orthopedic Surgery, Wesley Medical Center, 3242 E. Murdock Street, Wichita, KS, 67208, USA
| | - Steven Morgan
- Orthopedic Surgery, Internal Medicine, Swedish Medical Center, 501 E Hampden Ave, Englewood, CO, 80113, USA
| | - Nnamdi Nwafo
- Orthopedic Surgery, Internal Medicine, Swedish Medical Center, 501 E Hampden Ave, Englewood, CO, 80113, USA
| | - Patrick McNair
- Orthopedic Sports Medicine and Trauma, St. Anthony Hospital, 11600 West 2nd Plaza, Lakewood, CO, 80228, USA
| | - Rahul Banerjee
- Orthopaedic Trauma, Medical City Plano, 1600 Coit Rd Suite 104, Plano, TX, 75075, USA
| | - Bradley Woods
- General Surgery, Research Medical Center, 2316 East Meyer Boulevard, Kansas City, MO, 64132, USA
| | - David Bar-Or
- Injury Outcomes Network (ION) Research, 501 E. Hampden Ave, Englewood, CO, 80113, USA
- Corresponding author. Injury Outcomes Network (ION) Research, 501 E Hampden Ave, Englewood, CO, 80113, USA.
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19
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Niazi T, Williams S, Davis I, Stockler M, Martin A, Bracken K, Roncolato F, McJannett M, Horvath L, Sengupta S, Hughes S, McDermott R, Catto J, Kelly P, Vapiwala N, Parulekar W, Morgan S, Rendon R, Sweeney C. 694TiP DASL-HiCaP: Darolutamide augments standard therapy for localised very high-risk cancer of the prostate (ANZUP1801). A randomised phase III double-blind, placebo-controlled trial of adding darolutamide to androgen deprivation therapy and definitive or salvage radiation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2088] [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: 11/16/2022] Open
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20
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Patel N, Maher J, Lie X, Gwaltney C, Morgan S, Meyers O, Workman C, Negro A, Cohen G. P-170 Understanding patient experience in hepatocellular carcinoma: A qualitative patient interview study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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21
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Weir DL, Motulsky A, Abrahamowicz M, Lee TC, Morgan S, Buckeridge DL, Tamblyn R. Failure to follow medication changes made at hospital discharge is associated with adverse events in 30 days. Health Serv Res 2020; 55:512-523. [PMID: 32434274 PMCID: PMC7376001 DOI: 10.1111/1475-6773.13292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/20/2019] [Revised: 03/02/2020] [Accepted: 04/04/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the hypothesis that nonadherence to medication changes made at hospital discharge is associated with an increased risk of adverse events in the 30 days postdischarge. STUDY SETTING Patients admitted to hospitals in Montreal, Quebec, between 2014 and 2016. STUDY DESIGN Prospective cohort study. DATA COLLECTION Nonadherence to medication changes was measured by comparing medications dispensed in the community with those prescribed at hospital discharge. Patient, health system, and drug regimen-level covariates were measured using medical services and pharmacy claims data as well as data abstracted from the patient's hospital chart. Multivariable Cox models were used to determine the association between nonadherence to medication changes and the risk of adverse events. PRINCIPAL FINDINGS Among 2655 patients who met our inclusion criteria, mean age was 69.5 years (SD 14.7) and 1581 (60%) were males. Almost half of patients (n = 1161, 44%) were nonadherent to at least one medication change, and 860 (32%) were readmitted to hospital, visited the emergency department, or died in the 30 days postdischarge. Patients who were not adherent to any of their medication changes had a 35% higher risk of adverse events compared to those who were adherent to all medication changes (1.41 vs 1.27 events/100 person-days, adjusted hazard ratio: 1.35, 95% CI: 1.06-1.71). CONCLUSIONS Almost half of all patients were not adherent to some or all changes made to their medications at hospital discharge. Nonadherence to all changes was associated with an increased risk of adverse events. Interventions addressing barriers to adherence should be considered moving forward.
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Affiliation(s)
- Daniala L Weir
- Department of Epidemiology and Biostatistics, Department of Medicine,, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, Department of Medicine,, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Todd C Lee
- Department of Epidemiology and Biostatistics, Department of Medicine,, McGill University, Montreal, Quebec, Canada.,Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Steven Morgan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David L Buckeridge
- Department of Epidemiology and Biostatistics, Department of Medicine,, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, Department of Medicine,, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
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22
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Dutcher L, Yeager A, Gitelman Y, Morgan S, Laude JD, Binkley S, Binkley A, Cimino C, McDonnell L, Saw S, Cluzet V, Lautenbach E, Hamilton KW. Assessing an intervention to improve the safety of automatic stop orders for inpatient antimicrobials. Infect Prev Pract 2020; 2:100062. [PMID: 34368705 PMCID: PMC8336312 DOI: 10.1016/j.infpip.2020.100062] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/15/2020] [Indexed: 12/03/2022] Open
Abstract
Background Automatic stop orders (ASOs) for antimicrobials have been recommended as a component of antimicrobial stewardship programs, but may result in unintentional treatment interruption due to failure of providers to re-order an antimicrobial medication. We examined the impact of a multifaceted intervention designed to reduce the potential harms of interrupting antimicrobial treatment due to ASOs. Methods An intervention was implemented that included pharmacist review of expiring antimicrobials as well as provider education to encourage use of a long-term antimicrobial order set for commonly used prophylactic antimicrobials. Pharmacist interventions and antimicrobial re-ordering was recorded. Percent of missed doses of a commonly used prophylactic antimicrobial, single strength co-trimoxazole, was compared pre- and post-intervention using a chi-squared test. Results From November 1, 2015 to November 30, 2016, there were 401 individual pharmacist interventions for antimicrobial ASOs, resulting in 295 instances of antimicrobial re-ordering. The total percent of presumed missed single strength co-trimoxazole doses was reduced from 8.4% to 6.2% post-intervention (P<0.001). Conclusions This study found that a targeted intervention was associated with a reduction in unintended antimicrobial treatment interruption related to ASOs.
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Affiliation(s)
- Lauren Dutcher
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alyssa Yeager
- Department of Medicine, Yale New Haven Medical Center, New Haven, CT, USA
| | - Yevgeniy Gitelman
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Shawn Binkley
- Pharmacy Department, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda Binkley
- Pharmacy Department, Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - Christo Cimino
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Stephen Saw
- Pharmacy Department, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Valerie Cluzet
- Division of Infectious Diseases, Health Quest, Poughkeepsie, NY, USA
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Keith W Hamilton
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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23
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Hoke M, Omar NB, Amburgy JW, Self DM, Schnell A, Morgan S, Larios EA, Chambers MR. Impact of exercise on bone mineral density, fall prevention, and vertebral fragility fractures in postmenopausal osteoporotic women. J Clin Neurosci 2020; 76:261-263. [PMID: 32305276 DOI: 10.1016/j.jocn.2020.04.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/04/2020] [Indexed: 12/01/2022]
Abstract
Osteoporosis is the most prevalent bone disease worldwide and predisposes affected individuals to fragility fractures. Exercise has been shown to have multiple health benefits in post-menopausal osteoporotic women, but often recommendations regarding the benefits of specific exercise types are vague. Improving bone mineral density (BMD) is an essential component in any program to prevent osteoporotic vertebral fractures. The objective of this report is to briefly review the current understanding on the impact of exercise on BMD in postmenopausal women as it pertains to fragility fractures. Broad categories of exercises include aerobic, resistance, stretching, and balance. Tai Chi, Yoga, and Pilates are a heterogeneous group of specific exercise modalities that can span multiple categories. Current literature suggests that only resistance type exercises have a convincing impact on BMD. Core-strengthening exercises and attention to posture/balance can help mitigate falls. A number of barriers affect patient compliance and accessibility to exercise. In summary, exercise should be included in any multi-modality osteoporosis treatment plan with the goal of sustained exercise throughout life. If possible, osteoporotic women should be on a resistance-based regimen incorporating weight-bearing exercises, and also target posture and balance. Healthcare providers and educators should have resources readily available for patients.
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Affiliation(s)
- M Hoke
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - N B Omar
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, AL, United States.
| | - J W Amburgy
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - D M Self
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - A Schnell
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - S Morgan
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Emerson A Larios
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - M R Chambers
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, AL, United States
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24
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Weir DL, Lee TC, McDonald EG, Motulsky A, Abrahamowicz M, Morgan S, Buckeridge D, Tamblyn R. Both New and Chronic Potentially Inappropriate Medications Continued at Hospital Discharge Are Associated With Increased Risk of Adverse Events. J Am Geriatr Soc 2020; 68:1184-1192. [PMID: 32232988 PMCID: PMC7687123 DOI: 10.1111/jgs.16413] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 09/19/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Admission to hospital provides the opportunity to review patient medications; however, the extent to which the safety of drug regimens changes after hospitalization is unclear. OBJECTIVE To estimate the number of potentially inappropriate medications (PIMs) prescribed to patients at hospital discharge and their association with the risk of adverse events 30 days after discharge. DESIGN Prospective cohort study. SETTING Tertiary care hospitals within the McGill University Health Centre Network in Montreal, Quebec, Canada. PARTICIPANTS Patients from internal medicine, cardiac, and thoracic surgery, aged 65 years and older, admitted between October 2014 and November 2016. MEASURES Abstracted chart data were linked to provincial health databases. PIMs were identified using AGS (American Geriatrics Society) Beers Criteria®, STOPP, and Choosing Wisely statements. Multivariable logistic regression and Cox models were used to assess the association between PIMs and adverse events. RESULTS Of 2,402 included patients, 1,381 (57%) were male; median age was 76 years (interquartile range [IQR] = 70‐82 years); and eight discharge medications were prescribed (IQR = 2‐8). A total of 1,576 (66%) patients were prescribed at least one PIM at discharge; 1,176 (49%) continued a PIM from prior to admission, and 755 (31%) were prescribed at least one new PIM. In the 30 days after discharge, 218 (9%) experienced an adverse drug event (ADE) and 862 (36%) visited the emergency department (ED), were rehospitalized, or died. After adjustment, each additional new PIM and continued community PIM were respectively associated with a 21% (odds ratio [OR] = 1.21; 95% confidence interval [CI] = 1.01‐1.45) and a 10% (OR = 1.10; 95% CI = 1.01‐1.21) increased odds of ADEs. They were also respectively associated with a 13% (hazard ratio [HR] = 1.13; 95% CI = 1.03‐1.26) and a 5% (HR = 1.05; 95% CI = 1.00‐1.10) increased risk of ED visits, rehospitalization, and death. CONCLUSIONS Two in three hospitalized patients were prescribed a PIM at discharge, and increasing numbers of PIMs were associated with an increased risk of ADEs and all‐cause adverse events. Improving hospital prescribing practices may reduce the frequency of PIMs and associated adverse events. J Am Geriatr Soc 68:1184–1192, 2020. See related editorial by Donna M. Fick in this issue.
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Affiliation(s)
- Daniala L Weir
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Todd C Lee
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Emily G McDonald
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Aude Motulsky
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Steven Morgan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Buckeridge
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
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25
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Fitzgerald E, Foley D, McNamara R, Barrett E, Boylan C, Butler J, Morgan S, Okafor I. Trends in Mental Health Presentations to a Paediatric Emergency Department. Ir Med J 2020; 113:20. [PMID: 32401083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Aims This study aimed to analyse trends in mental health presentations to the Emergency Department (ED), which anecdotally had increased over the past decade. Methods The ED's electronic 'Symphony' system was used to identify the annual number of presentations categorised as having a mental health complaint from 2006-2017. A detailed analysis was performed on presentations over a one-year period. Results The number of presentations increased from 69 in 2006 to a peak of 432 in 2016 (526% increase). The overall admission rate was 33.3%(n=99), while 52.5%(n=156) of presentations occurred outside of standard working hours. Similar increases were documented by other ED's worldwide, and the WHO estimate that neuropsychiatric disorders will become one of the top five causes of morbidity, mortality and disability among children by 2020. Conclusion With the number of mental health presentations dramatically increasing, carefully designed and integrated strategies are required to pro-actively tackle this growing epidemic.
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Affiliation(s)
- E Fitzgerald
- Emergency Department, Children's University Hospital, Temple Street, Dublin
| | - D Foley
- Emergency Department, Children's University Hospital, Temple Street, Dublin
| | - R McNamara
- Emergency Department, Children's University Hospital, Temple Street, Dublin
| | - E Barrett
- Department of Psychiatry, Children's University Hospital, Temple Street, Dublin
| | - C Boylan
- Department of Psychiatry, Children's University Hospital, Temple Street, Dublin
| | - J Butler
- Department of Psychiatry, Children's University Hospital, Temple Street, Dublin
| | - S Morgan
- St. Patrick's University Hospital, Dublin
| | - I Okafor
- Emergency Department, Children's University Hospital, Temple Street, Dublin
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26
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Roberts H, Wood S, McNeil E, White R, Morgan S. Validation and implementation of a bespoke pan-cancer NGS panel for FFPE solid tumour analysis within an NHS setting. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.089] [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: 11/13/2022] Open
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27
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Weir DL, Motulsky A, Abrahamowicz M, Lee TC, Morgan S, Buckeridge DL, Tamblyn R. Challenges at Care Transitions: Failure to Follow Medication Changes Made at Hospital Discharge. Am J Med 2019; 132:1216-1224.e5. [PMID: 31145881 DOI: 10.1016/j.amjmed.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND In-hospital medication reconciliation has not demonstrated reductions in adverse health outcomes, possibly because patients do not follow the changes made to their preadmission medications. Our objective was to determine the incidence of and variables associated with failure to follow newly prescribed therapies, discontinued medications, and dose changes. METHODS A prospective cohort study of patients admitted to hospitals in Montreal, Quebec between 2014 and 2016 was conducted. Failure to follow medication changes 30 days post discharge was measured by comparing prescribed and dispensed medications. Multivariable logistic regression was used to determine characteristics associated with failure to follow changes. RESULTS Among 2655 patients, mean age was 69.5 years (SD 14.7), and 1581 (60%) were males. There were 10,068 medication changes made at hospital discharge and 24% were not followed in the 30 days post discharge. Thirty percent of dose modifications were filled at the incorrect dose, 27% of new medications were not filled, and 12% of discontinued medications were filled. A number of factors increased the risk of failure to follow medication changes, including increasing out-of-pocket medication costs (adjusted odds ratio [aOR] 1.12; 95% confidence interval [CI], 1.07-1.18), discharge to long-term care facility (aOR 2.29; 95% CI, 1.63-3.08), and not having medications dispensed prior to admission (aOR 4.67; 95% CI, 3.75-5.90). CONCLUSION One in 4 hospital medication changes was not followed post discharge. Health policy aimed at eliminating out-of-pocket medication costs and investigation of factors influencing failure to follow changes for those not dispensed medications prior to admission and for long-term care residents are important next steps to address this issue.
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Affiliation(s)
- Daniala L Weir
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Que, Canada.
| | - Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Que, Canada; Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Que, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Research Institute of the McGill University Health Centre, Montreal, Que, Canada
| | - Todd C Lee
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Department of Medicine, McGill University, Montreal, Que, Canada
| | - Steven Morgan
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - David L Buckeridge
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Que, Canada
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Que, Canada
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Lea S, Martins A, Bassett M, Cable M, Doig G, Fern L, Morgan S, Soanes L, Smith S, Whelan M, Taylor R. Young people’s experiences when active cancer treatment ends. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz275.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Knox J, Cheng A, Cleary S, Galle P, Kokudo N, Lencioni R, Park J, Zhou J, Mann H, Morgan S, Liu X, Chin S, Vlahovic G, Fan J. A phase 3 study of durvalumab with or without bevacizumab as adjuvant therapy in patients with hepatocellular carcinoma at high risk of recurrence after curative hepatic resection or ablation: EMERALD-2. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Knox J, Cheng A, Cleary S, Galle P, Kokudo N, Lencioni R, Park J, Zhou J, Mann H, Morgan S, Liu X, Chin S, Vlahovic G, Fan J. A phase 3 study of durvalumab with or without bevacizumab as adjuvant therapy in patients with hepatocellular carcinoma (HCC) who are at high risk of recurrence after curative hepatic resection. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Qiang B, Abdalla A, Morgan S, Hashemi P, Peña E. Estimating Concentration Response Function and Change-Point using Time-Course and Calibration Data. Biostat Biom Open Access J 2019; 9:57-68. [PMID: 34113792 PMCID: PMC8189314] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this paper the problem of determining the functional relationship between time and the concentration of a chemical substance is studied. An intervention drug is administered on the experimental unit from which the chemical substance (specimen) is measured. This drug is hypothesized to cause a change in the concentration level of the chemical substance a certain lag-time after the intervention. However, the concentration value could not be directly measured, but rather a surrogate response can be measured. In the time-course study, this surrogate response is measured using different electrodes which possess varied behaviors. To utilize these surrogate measurements arising from the different electrodes (sensors), a calibration study is undertaken which measures the surrogate response for the different electrodes at known concentration levels. Based on the time-course and calibration data sets, a statistical procedure to estimate the signal function and the lag-time is proposed. Simulation studies indicate that the proposed procedure is able to reasonably recover the signal function and the lag-time. The procedure is then applied to the real data sets obtained during an analytical chemistry experiment.
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Affiliation(s)
- B Qiang
- Department of Math and Stats, Southern Illinois University Edwardsville, USA,Corresponding author: B Qiang, Department of Math and Stats, Southern Illinois University Edwardsville, Edwardsville, USA
| | - A Abdalla
- Department of Chemistry and Biochemistry, USC, Columbia, SC 29208
| | - S Morgan
- Department of Chemistry and Biochemistry, USC, Columbia, SC 29208
| | - P Hashemi
- Department of Chemistry and Biochemistry, USC, Columbia, SC 29208
| | - E Peña
- Department of Statistics, USC, USA
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Lee T, White M, Overly S, Mehta J, Binkley S, Morgan S, Saw S, Hamilton K. 1814. External Validation of Precision Antibiotic Therapy for Enterococcal Bloodstream Infections. Open Forum Infect Dis 2018. [PMCID: PMC6254180 DOI: 10.1093/ofid/ofy210.1470] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background ILÚM Heath Solutions, an infectious diseases software platform, developed precision antibiotic therapy (PAT) software to guide selection of therapy using data science, patient-specific factors, as well as historical patient, pharmacy, and microbiologic data. PAT reports percentages reflecting likelihood of susceptibility across a panel of antibiotics, identifying patients at high risk for resistant organisms. PAT has previously demonstrated high accuracy for predicting susceptibility of Enterobacteriaceae in bloodstream infections (BSIs) and risk for multi-drug resistance. The objective of this study was to validate PAT predictive capabilities in enterococcal BSIs and to assess accuracy in risk-stratifying patients for vancomycin-resistant Enterococcus spp. (VRE). Methods This retrospective cohort study included patients with an index enterococcal BSI from January 2016 through December 2016. The primary outcome was the performance characteristics of PAT in accurately predicting the risk of VRE, elaborated with sensitivity and specificity rates across varying PAT thresholds. Receiver operating characteristics (ROC) curve analyses were performed to identify an acceptable PAT threshold to define high risk for VRE. Brier score calculations were used to compare accuracy of PAT predictions to that of the institutional antibiogram. Results ROC curve analysis (Figure 1) demonstrated an area under the curve of 0.94, indicating excellent discrimination. The Brier scores for the institutional antibiogram and PAT software were 0.067 and 0.075, respectively, representing a similar degree in accuracy. Species-level Brier scores for the institutional antibiogram and PAT were 0.043 and 0.065, respectively, for E. faecalis and 0.093 and 0.073, respectively, for E. faecium. Conclusion PAT software was able to discriminate enterococcal BSIs resistant and susceptible to vancomycin. Similar to previous results seen with Enterobacteriaceae, PAT may be useful to accurately predict susceptibilities for Enterococcus spp., particularly for E. faecium. Disclosures S. Overly, ILÚM Health Solutions: Consultant, Salary. J. Mehta, ILUM Health Solutions: Consultant, Salary.
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Affiliation(s)
- Tiffany Lee
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melissa White
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Shawn Binkley
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven Morgan
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Saw
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith Hamilton
- Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Morley J, Anderson V, Beattie V, Clayton K, Denby D, Eaton M, Glover S, Griffiths A, Maddock N, Mcadam J, Morgan S, Perkins T, Phillips S, Pugh B, Rees P, Roberts J, Robinson W, Rose P. P3.07-05 Can Improving Working Partnerships with Primary Care Prevent Avoidable Emergency Admissions for Patients with Lung Cancer? J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1741] [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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Downing K, Leegant A, Morgan S, Dolan S, Boutis G. 95: Detecting plasma desmosine as a marker for elastic fiber degradation in pelvic floor connective tissue during the postpartum period. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.114] [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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Morgan S, Krueger D, Burroughs L, Binkley N. Impact of Very Dense Artifacts on Hologic and GE Lunar Densitometers. J Clin Densitom 2018. [DOI: 10.1016/j.jocd.2017.10.039] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yang J., Fang J, Shu Y, Chang J, Chen G, He J, Li W, Liu X, Yang N, Zhou C, Huang J, Yang L, Handzel A, Frigault M, Ahmed G, Egile C, Morgan S, Wu Y. OA 09.06 A Phase Ib Trial of Savolitinib plus Gefitinib for Chinese Patients with EGFR-Mutant MET-Amplified Advanced NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Malone S, Eapen L, C.E., Kendal W, Craig J, Macrae R, Perry G, Bowen J, Morgan S, Holmes O, Grimes S. Durable prostate cancer control in a randomized trial of optimal timing of dose escalated (76 Gy) radiation and 6 months ADT in prostate cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx370.045] [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: 11/13/2022] Open
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Tannenbaum C, Morgan S, Farrell B, Trimble J, Currie J, Shaw J, Silvius J. ENABLING KNOWLEDGE TRANSLATION THROUGH THE CANADIAN DEPRESCRIBING NETWORK. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2476] [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: 11/14/2022] Open
Affiliation(s)
| | - S. Morgan
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - B. Farrell
- Bruyere Research Institute, Ottawa, Ontario, Canada,
| | - J. Trimble
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - J. Currie
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - J. Shaw
- Women’s College Hospital, Toronto, Ontario, Canada
| | - J. Silvius
- Alberta Health Services, Calgery, Alberta, Canada,
- University of Calgery, Calgery, Alberta, Canada,
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Hasanovic M, Morgan S, Oakley S, Richman S, Šabanović Š, Habibović S, Pajević I. EMDR training's for Bosnia and Herzegovina mental health workers resulted with seven European accredited EMDR psychotherapists and one European accredited EMDR consultant. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IntroductionBosnia-Herzegovina (BH) citizens, affected by 1992–1995 war, developed serious mental health posttraumatic consequences. Their needs for EMDR (eye movement desensitisation and reprocessing) treatment increased. The Humanitarian Assistance Programmes UK & Ireland (HAP) work in partnership with mental health professionals in Bosnia-Herzegovina (BH) from 2010.ObjectivesWe aim to build a body of qualified and experienced professionals who can establish and sustain their own EMDR training.MethodAuthors described educational process considering the history of idea and its realization through training levels and process of supervision which was provided from the Humanitarian Assistance Program (HAP) of UK &Ireland with non profit, humanitarian approach in sharing skills of EMDR to mental health therapists in BH.ResultsThe trainers from HAP UK & Ireland completed five EMDR trainings in BH (two in Tuzla and three in Sarajevo) for 100 recruited trainees from different BH health institutions from different cities and entities in BH. To be accredited EMDR therapists all trainees are obliged to practice EMDR therapy with clients under the supervision process of HAP UK&Ireland supervisors. Supervision is organized via Skype Internet technology. Up today seven trainees completed their supervision successfully and became European Accredited EMDR Psychotherapists, one of them became European Accredited EMDR Consultant.ConclusionFive training of Bosnia-Herzegovina mental health workers to effectively use EMDR with enthusiastic help of EMDR trainers from HAP UK&Ireland resulted with seven European accredited EMDR psychotherapists, and one of them became European accredited EMDR consultant. This will increase psychotherapy capacities in postwar BH.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Leiman DA, Riff BP, Morgan S, Metz DC, Falk GW, French B, Umscheid CA, Lewis J. Alginate therapy is effective treatment for GERD symptoms: a systematic review and meta-analysis. Dis Esophagus 2017; 30:1-9. [PMID: 28375448 PMCID: PMC6036656 DOI: 10.1093/dote/dow020] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 11/15/2016] [Indexed: 12/11/2022]
Abstract
In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some patients, especially those with nonerosive reflux disease or atypical GERD symptoms, acid-suppressive therapy with PPIs is not as successful. Alginates are medications that work through an alternative mechanism by displacing the postprandial gastric acid pocket. This study performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of patients with symptoms of GERD. PubMed/MEDLINE, Embase, and the Cochrane library electronic databases were searched through October 2015 for randomized controlled trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists (H2RAs), or PPIs for the treatment of GERD symptoms. Additional studies were identified through a bibliography review. Non-English studies and those with pediatric patients were excluded. Meta-analyses were performed using random-effect models to calculate odds ratios (OR). Heterogeneity between studies was estimated using the I2 statistic. Analyses were stratified by type of comparator. The search strategy yielded 665 studies and 15 (2.3%) met inclusion criteria. Fourteen were included in the meta-analysis (N = 2095 subjects). Alginate-based therapies increased the odds of resolution of GERD symptoms when compared to placebo or antacids (OR: 4.42; 95% CI 2.45-7.97) with a moderate degree of heterogeneity between studies (I2 = 71%, P = .001). Compared to PPIs or H2RAs, alginates appear less effective but the pooled estimate was not statistically significant (OR: 0.58; 95% CI 0.27-1.22). Alginates are more effective than placebo or antacids for treating GERD symptoms.
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Affiliation(s)
- D. A. Leiman
- Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina
| | - B. P. Riff
- Division of Gastroenterology, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | | | | | | | - B. French
- Center for Evidence-based Practice,Department of Biostatistics and Epidemiology,Leonard Davis Institute of Health Economics,Center for Clinical Epidemiology and Biostatistics
| | - C. A. Umscheid
- Center for Evidence-based Practice,Department of Biostatistics and Epidemiology,Leonard Davis Institute of Health Economics,Center for Clinical Epidemiology and Biostatistics,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J. D. Lewis
- Division of Gastroenterology,Department of Biostatistics and Epidemiology,Leonard Davis Institute of Health Economics,Center for Clinical Epidemiology and Biostatistics
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Dunbar M, Onuora C, Morgan S, Stone FE, Huckaba TM, Davenport IR. Follicle cell processes: a shark thing? J Fish Biol 2017; 90:1031-1036. [PMID: 27781275 PMCID: PMC6434947 DOI: 10.1111/jfb.13196] [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] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 09/26/2016] [Indexed: 06/06/2023]
Abstract
Follicle cell processes (FCP) are identified in two species of carcharhinid shark (Selachii) but are absent in the little skate Leucoraja erinacea (Batoidea). This suggests that FCPs are either a unique structure that evolved in selachians or were lost by the batoids after their divergence, some 280 mya. The presence of FCPs in the selachians would be consistent with the evolution of large oocytes in this group of animals.
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Affiliation(s)
| | | | | | | | | | - I. R. Davenport
- Author to whom correspondence should be addressed. Tel.: +1 504 520 7594;
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Hamilton E, Patel M, Armstrong A, Baird R, Jhaveri K, Hoch M, Morgan S, Dowdall T, Schiavon G, Klinowska T, Weir H, Bujac S, Nash T, Im SA. Abstract P6-12-03: A phase I study of AZD9496, a novel oral, selective estrogen receptor degrader (SERD) in women with estrogen receptor positive, HER-2 negative advanced breast cancer (ABC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-12-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background AZD9496 is a potent orally bioavailable ER antagonist and degrader that has shown antitumor efficacy in a range of preclinical xenograft models including ESR1wild-type tamoxifen-resistant and long term estrogen deprived models and an ESR1 mutant model.
Methods This is a phase I, open label global multicenter study in women with ER+ HER2–ve BC either metastatic or locoregionally recurrent, not amenable to treatment with curative intent. Patients are post-menopausal, or pre-menopausal women receiving LHRH agonist therapy, with disease progression after ≥6 months endocrine therapy for ER+ BC (no limit on number of prior endocrine therapies; ≤2 prior chemotherapies in advanced setting). The primary objective is to determine the safety and tolerability of AZD9496. Cohorts of 3-6 patients received daily oral therapy and dose limiting toxicities (DLTs) occurring in cycle 1 (28 days) were assessed. Patients are dosed until MTD (defined as ≤1/6 patients with a DLT) or maximum feasible dose (MFD) is reached. Key secondary objectives include determination of single and multiple dose pharmacokinetics (PK), and preliminary antitumor efficacy. ER target modulation by protein and gene expression is evaluated in circulating tumor cells and paired tumor biopsies.
In addition to the dose escalation phase, expansion cohort(s) in patients with or without ESR1 mutations can be enrolled to examine the safety, tolerability, PK and biological activity of AZD9496 further.
Results Preliminary data as of 30th April 2016: 45 patients (median age 62 (range 41-83); 38 post-menopausal, 7 pre/perimenopausal; visceral metastases 76%, prior fulvestrant 25/45) received AZD9496 in 7 dose escalation cohorts: 20mg QD n=4, 40mg BID n=6, 80mg BID n=5, 150mg BID n=6, 250mg BID n=6, 400mg BID n=6, 600mg BID n=6 and also a 250mg BID expansion cohort n=6. The majority of adverse events (AEs) were grade 1 or 2; the most common treatment-related AEs (≥10%) have been diarrhoea (33%), fatigue (27%), nausea (22%), upper abdominal pain (13%) and increased liver function tests (13%). Six patients had treatment-related grade 3 AEs, 5 of which were manageable with dose interruption +/- dose reduction. Specifically, three had DLTs: grade 3 increased AST/ALT/GGT-150mg BID, serious adverse reaction (SAR) leading to withdrawal; grade 3 diarrhoea and grade 3 increased AST/ALT/GGT-400mg BID, SAR, manageable with dose reductions; grade 3 diarrhoea 600mg BID, manageable with dose reduction. The MTD/MFD has not been reached.
Following the first dose up to 400mg the AZD9496 exposure increased in reasonable proportion to increasing dose. At 600mg a more than dose-proportional increase in exposure was observed. Evidence of reduced ER and Ki67 has been observed in on-study biopsies at 150mg BID and above. 10 subjects received treatment for >3-<6 months (5 ongoing, 5 discontinued),4 subjects >6-<12 months (3 ongoing, 1 discontinued), 3 subjects ≥1 year (2 ongoing, 1 discontinued).
Conclusions AZD9496 has a tolerable safety profile, evidence of PD biomarker modulation and prolonged stabilisation of disease in women with heavily pre-treated ER+ve ABC.
Citation Format: Hamilton E, Patel M, Armstrong A, Baird R, Jhaveri K, Hoch M, Morgan S, Dowdall T, Schiavon G, Klinowska T, Weir H, Bujac S, Nash T, Im S-A. A phase I study of AZD9496, a novel oral, selective estrogen receptor degrader (SERD) in women with estrogen receptor positive, HER-2 negative advanced breast cancer (ABC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-12-03.
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Affiliation(s)
- E Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - M Patel
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - A Armstrong
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - R Baird
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - K Jhaveri
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - M Hoch
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - S Morgan
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - T Dowdall
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - G Schiavon
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - T Klinowska
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - H Weir
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - S Bujac
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - T Nash
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
| | - S-A Im
- Sarah Cannon Research Institute/Tennessee Oncology; Sarah Cannon Research Institute/Florida Cancer Specialists; The Christie NHS Foundation Trust and the University of Manchester, United Kingdom; Cambridge Cancer Centre, United Kingdom; Memorial Sloan Kettering Cancer Center, New York; AstraZeneca, Cambridge, United Kingdom; Seoul National University Hospital, Korea
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Früh-Green G, Orcutt B, Green S, Cotterill C, Morgan S, Akizawa N, Bayrakci G, Behrmann JH, Boschi C, Brazleton W, Cannat M, Dunkel K, Escartin J, Harris M, Herrero-Bervera E, Hesse K, John B, Lang S, Lilley M, Liu HQ, Mayhew L, McCaig A, Menez B, Morono Y, Quéméneur M, Rouméjon S, Sandaruwan Ratnayake A, Schrenk M, Schwarzenbach E, Twing K, Weis D, Whattham S, Williams M, Zhao R. Expedition 357 methods. Proceedings of the International Ocean Discovery Program 2017. [DOI: 10.14379/iodp.proc.357.102.2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Früh-Green G, Orcutt B, Green S, Cotterill C, Morgan S, Akizawa N, Bayrakci G, Behrmann JH, Boschi C, Brazleton W, Cannat M, Dunkel K, Escartin J, Harris M, Herrero-Bervera E, Hesse K, John B, Lang S, Lilley M, Liu HQ, Mayhew L, McCaig A, Menez B, Morono Y, Quéméneur M, Rouméjon S, Sandaruwan Ratnayake A, Schrenk M, Schwarzenbach E, Twing K, Weis D, Whattham S, Williams M, Zhao R. Western sites. Proceedings of the International Ocean Discovery Program 2017. [DOI: 10.14379/iodp.proc.357.105.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Früh-Green G, Orcutt B, Green S, Cotterill C, Morgan S, Akizawa N, Bayrakci G, Behrmann JH, Boschi C, Brazleton W, Cannat M, Dunkel K, Escartin J, Harris M, Herrero-Bervera E, Hesse K, John B, Lang S, Lilley M, Liu HQ, Mayhew L, McCaig A, Menez B, Morono Y, Quéméneur M, Rouméjon S, Sandaruwan Ratnayake A, Schrenk M, Schwarzenbach E, Twing K, Weis D, Whattham S, Williams M, Zhao R. Eastern sites. ACTA ACUST UNITED AC 2017. [DOI: 10.14379/iodp.proc.357.103.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
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Früh-Green G, Orcutt B, Green S, Cotterill C, Morgan S, Akizawa N, Bayrakci G, Behrmann JH, Boschi C, Brazleton W, Cannat M, Dunkel K, Escartin J, Harris M, Herrero-Bervera E, Hesse K, John B, Lang S, Lilley M, Liu HQ, Mayhew L, McCaig A, Menez B, Morono Y, Quéméneur M, Rouméjon S, Sandaruwan Ratnayake A, Schrenk M, Schwarzenbach E, Twing K, Weis D, Whattham S, Williams M, Zhao R. Central sites. Proceedings of the International Ocean Discovery Program 2017. [DOI: 10.14379/iodp.proc.357.104.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Früh-Green G, Orcutt B, Green S, Cotterill C, Morgan S, Akizawa N, Bayrakci G, Behrmann JH, Boschi C, Brazleton W, Cannat M, Dunkel K, Escartin J, Harris M, Herrero-Bervera E, Hesse K, John B, Lang S, Lilley M, Liu HQ, Mayhew L, McCaig A, Menez B, Morono Y, Quéméneur M, Rouméjon S, Sandaruwan Ratnayake A, Schrenk M, Schwarzenbach E, Twing K, Weis D, Whattham S, Williams M, Zhao R. Northern sites. ACTA ACUST UNITED AC 2017. [DOI: 10.14379/iodp.proc.357.106.2017] [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: 03/15/2023]
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Leiman DA, Riff BP, Morgan S, Metz DC, Falk GW, French B, Umscheid CA, Lewis JD. Alginate therapy is effective treatment for gastroesophageal reflux disease symptoms: a systematic review and meta-analysis. Dis Esophagus 2017; 30:1-8. [PMID: 27671545 DOI: 10.1111/dote.12535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some patients, especially those with non-erosive reflux disease or atypical GERD symptoms, acid suppressive therapy with PPIs is not as successful. Alginates are medications that work through an alternative mechanism by displacing the post-prandial gastric acid pocket. We performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of patients with symptoms of GERD.PubMed/MEDLINE, Embase and the Cochrane library electronic databases were searched through October 2015 for randomized controlled trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists (H2RAs) or PPIs for the treatment of GERD symptoms. Additional studies were identified through bibliography review. Non-English studies and those with pediatric patients were excluded. Meta-analyses were performed using random-effects models to calculate odds ratios (OR). Heterogeneity between studies was estimated using the I2 statistic. Analyses were stratified by type of comparator. The search strategy yielded 665 studies and 15 (2.3%) met inclusion criteria. Fourteen were included in the meta-analysis (N = 2095 subjects). Alginate-based therapies increased the odds of resolution of GERD symptoms when compared to placebo or antacids (OR: 4.42; 95% CI 2.45-7.97) with a moderate degree of heterogeneity between studies (I2 = 71%, P = .001). Compared to PPIs or H2RAs, alginates appear less effective but the pooled estimate was not statistically significant (OR: 0.58; 95% CI 0.27-1.22). Alginates are more effective than placebo or antacids for treating GERD symptoms.
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Affiliation(s)
- D A Leiman
- Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA
| | - B P Riff
- Division of Gastroenterology, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - S Morgan
- Center for Evidence-based Practice, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - D C Metz
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - G W Falk
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - B French
- Center for Evidence-based Practice, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Department of Biostatistics and Epidemiology, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Leonard Davis Institute of Health Economics, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - C A Umscheid
- Center for Evidence-based Practice, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Department of Biostatistics and Epidemiology, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Leonard Davis Institute of Health Economics, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J D Lewis
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biostatistics and Epidemiology, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Leonard Davis Institute of Health Economics, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, niversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Yeager A, Gitelman Y, Morgan S, Dougherty J, Timko D, Binkley S, Hamilton K. Intervention to Improve Performance of Antimicrobial Automatic Stop Orders. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.692] [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)
- Alyssa Yeager
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Yevgeniy Gitelman
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Steven Morgan
- Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jillian Dougherty
- Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel Timko
- Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shawn Binkley
- Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith Hamilton
- Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Morgan S, Matthews P, Papas M, Davis B, Megargel R. 126 An Observational Study of Albuterol Administration by Basic Life Support Providers. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.138] [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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