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Measuring scattering distributions in scanning helium microscopy. Ultramicroscopy 2024; 260:113951. [PMID: 38471412 DOI: 10.1016/j.ultramic.2024.113951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
A scanning helium microscope typically utilises a thermal energy helium atom beam, with an energy and wavelength (¡100meV, ∼0.05 nm) particularly sensitive to surface structure. An angular detector stage for a scanning helium microscope is presented that facilitates the in-situ measurement of scattering distributions from a sample. We begin by demonstrating typical elastic and inelastic scattering from ordered surfaces. We then go on to show the role of topography in diffuse scattering from disordered surfaces, observing deviations from simple cosine scattering. In total, these studies demonstrate the wealth of information that is encoded into the scattering distributions obtained with the technique.
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An electronic medical record reminder is independently associated with improved opportunistic influenza vaccination rates for older inpatients. J R Coll Physicians Edinb 2023; 53:169-172. [PMID: 37491778 DOI: 10.1177/14782715231187763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Influenza vaccination will have added importance this winter given the possibility of further waves of the COVID-19 pandemic. This study examines the impact of an electronic medical record (EMR) reminder on influenza vaccine uptake among eligible hospital inpatients. METHODS We included a convenience sample of 750 adults (median age 77 years) who are eligible for influenza vaccination (⩾65 years and/or length of stay >30 days). A live electronic dashboard identified patients eligible for vaccination, prompting reminders sent to the clinical teams via the EMR. RESULTS The EMR reminder was associated with almost a 50% higher likelihood of vaccination after adjusting for other covariates (odds ratio 1.48 (95% confidence interval 1.00-2.20); p = 0.048). DISCUSSION Reminders sent to the clinical team via the EMR appear to be an effective means of increasing vaccine uptake and should be considered as part of this year's drive to vaccinate eligible patients in hospital.
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Black holes from a previous universe. New Sci 2023. [DOI: 10.1016/s0262-4079(23)00581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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4
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7EMF Racial Residential Segregation and Long-term Outcomes Among Medicare Beneficiaries After Out-of-Hospital Cardiac Arrest. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Electroconvulsive Therapy’s use in Idiopathic Intracranial Hypertension with Mood Disorder: caution, promise, and progress. Eur Psychiatry 2022. [PMCID: PMC9564714 DOI: 10.1192/j.eurpsy.2022.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Idiopathic Intracranial Hypertension (IIH) is a condition characterized by an increase of intracranial pressure (ICP) with no identifiable cause to date. One-half of patients who suffer from IIH have co-morbid mood disorders, such as Major Depressive Disorder (MDD), that can be refractory to pharmacologic treatment. Electroconvulsive Therapy (ECT) is a safe and effective treatment for treatment-refractory mood disorder, but possesses a relative contra-indication for IIH due to its theoretical increase in ICP. Can ECT become the gold-standard treatment modality for mood disorder from IIH? Objectives We aim to synthesize and summarize the state of the literature surrounding the intersection of ECT and IIH. We will present notable findings and propose avenues for future investigation. Methods We conducted a literature review using PubMed’s search function. Key terms that were queried are as follows: Idiopathic Intracranial Hypertension, Pseudotumor Cerebri, Benign Intracranial Hypertension, Mood Disorder, Major Depressive Disorder, ECT, Electroconvulsive Therapy. Results The prevailing theory of IIH and mood disorder centers around HPA axis dysfunction, which has been heavily theorized to be positively impacted with ECT. ECT itself may not increase the ICP, but the anesthesia might. The only two case reports in the literature presented safe and successful use of ECT’s in patients with IIH and MDD. Conclusions More data is needed to draw conclusions, as the literature surrounding ECT’s use in patients with IIH remains sparse. Further studies must explore whether ECT’s use in IIH remains effective. Through this, we may understand more about both IIH and ECT itself. Disclosure No significant relationships.
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Emerging Catatonia and Psychosis in Resolving COVID-19 Infection in an Adolescent. Eur Psychiatry 2022. [PMCID: PMC9567258 DOI: 10.1192/j.eurpsy.2022.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
COVID-19 infection may lead to encephalopathy and various neurotrophic effects which can result in neuropsychiatric complications. Here, an asymptomatic adolescent female developed acute onset catatonia and psychosis manifesting during the resolution of Covid-19 infection.
Objectives
Discuss differential diagnosis, medical workup, and initial treatment optimization for acute stabilization.
Methods
This 15-year-old female with no previous psychiatric history nor prodromal symptomatology was hospitalized secondary to Covid -19. During the immediate three-month recovery phase following resolution of Covid-19, the patient exhibited gradually increasing anxiety, paranoia, delusions, disorganized behavior, and weight loss leading to re-hospitalization secondary to catatonia. Negative workup included rapid strep test, urinalysis, chest and abdominal x-ray, EEG, and brain MRI. Lumbar puncture revealed elevated WBC of 18 but was unremarkable for NDMA receptor antibodies, CSF HSV, and encephalitis panel. IV steroids, IVIG, and Anakinra were all given without benefit. Inadequate response to olanzapine, clonidine, and lorazepam led to an Index Series of bilateral electroconvulsive therapy (ECT).
Results
The provisional diagnosis of psychotic disorder secondary to COVID-19 infection responded robustly regarding sleep, behavior, and affect by session #6, yet positive symptoms of psychosis persist. Ongoing ECT, psychopharmacology, and narrowing of the differential diagnosis continue.
Conclusions
As more COVID-19 cases evolve during the pandemic, potential post-infectious neuropsychiatric complications should be considered as potentially contributory and kept in a thoughtful differential diagnosis. Regardless of ultimate causation, the acute symptom profile responded robustly to an initial Index Series of ECT.
Disclosure
No significant relationships.
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Late 1800s Fringe Electrotherapeutic Devices: Comparative Electrical Capabilities. Eur Psychiatry 2022. [PMCID: PMC9566499 DOI: 10.1192/j.eurpsy.2022.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Desperation for cure led to 19th century invention-- electrotherapeutic devices; replete with hyperbolic claims of cure-all, perceived ineffectiveness, and potential harm rendered the modality as quackery but were used in early brain stimulation, melancholia treatment, and cortex mapping. Here, antique devices are restored, and their electrophysiological qualities ascertained. Objectives Determine the comparative capabilities of these devices in delivering electrostimulation and compare with modern standards to understand possible electrophysiological sequelae. Methods Devices known as “medical batteries” were analyzed. Power delivery utilized a “voltaic battery”, simple circuit, and a conductor wrapped around an iron core. When the circuit is energized, the core is magnetized by direct current of the battery which induces an alternating current that electrifies probes used on the body. Due to their marked age, a common 9-volt battery was exchanged for the corrosive dry cell paste batteries. Electrical parameters were then measured. ![]()
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Results
Device |
Frequency (Hz) |
Resistance (Ohms) |
Max Output (Amps) |
Min Output (Amps) |
Max Output (Volts) | Min Output (Volts) |
---|
Voltampa | 2k – 12K | 60 | 0.66 | 0.33 | 60V | 20V | J.H. Bunnell & Co.’s No. 4 D.D. | 7k-10k | 50 | 6 | 0.4 | 300V | 20V | Schall & Son
(London)b | 300-1200 | 40 | 10.5 | 2.75 | 420V | 110V |
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Conclusions Devices for electrotherapeutics ranged from anemic vibrations to dangerous tetany inducing shocks. Measuring the capabilities of these devices shows the robust yields possible if the original higher capacity batteries were utilized. The reality is, cure or not, the devices were surprisingly potent. It is interesting that, albeit unrefined, efficacious doses were available before modern electrification. Disclosure No significant relationships.
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Paradoxical Neuroethical Crisis of Agency and Identity in an Obsessive-Compulsive Disorder Deep Brain Stimulation Patient. Eur Psychiatry 2022. [PMCID: PMC9568069 DOI: 10.1192/j.eurpsy.2022.1909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Deep Brain Stimulation is an increasingly viable, well-established treatment for medication refractory obsessive-compulsive disorder. Yet, its neuromodulatory effects on the brain have led to varying and opposing neuroethical debates about its potential influence on a range of phenomena such as human agency, sense of nonauthenticity and identity. Objectives Establish the importance of maintaining the psychotherapeutic alliance in a long-term DBS patient who reported minimal device side effect and no brain-technology interface interpersonal issues; yet struggled with a paradoxical phenomenon of psychic distress surrounding issues of agency and identity, not through device implantation, but through morphology of cognitions from negativistic interpersonal dynamics and spousal victim-blaming due to the necessity for such a device. Methods Case-report of a 60+-year-old gentleman with a history of childhood-onset, treatment refractory OCD with a 15-year history of bilateral DBS lead placed via a ventral caudate/ ventral striatum trajectory through the anterior limb of the internal capsule to the nucleus accumbens. Results Years later he was only minimally improved above baseline; yet now with a few-years increasing degree of distress over a perceived atrophy of his capabilities that he felt was validated through what he described as his failure of artificial bionics. Extensive device setting re-optimization did not improve efficacy and with supportive therapy, the DBS device was weaned, and turned off. Conclusions The following year the therapeutic foci were on interpersonal identity, existential acceptance of breakthrough symptoms, and engagement of spouse into marital counseling leading to subsequent resolution of distress with improved quality of life. Disclosure No significant relationships.
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Delayed haemolysis after IV artesunate therapy for P. falciparum infection. Travel Med Infect Dis 2021; 45:102230. [PMID: 34915170 DOI: 10.1016/j.tmaid.2021.102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/23/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
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Constraints on primordial black holes. REPORTS ON PROGRESS IN PHYSICS. PHYSICAL SOCIETY (GREAT BRITAIN) 2021; 84:116902. [PMID: 34874316 DOI: 10.1088/1361-6633/ac1e31] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
We update the constraints on the fraction of the Universe that may have gone into primordial black holes (PBHs) over the mass range 10-5to 1050 g. Those smaller than ∼1015 g would have evaporated by now due to Hawking radiation, so their abundance at formation is constrained by the effects of evaporated particles on big bang nucleosynthesis, the cosmic microwave background (CMB), the Galactic and extragalacticγ-ray and cosmic ray backgrounds and the possible generation of stable Planck mass relics. PBHs larger than ∼1015 g are subject to a variety of constraints associated with gravitational lensing, dynamical effects, influence on large-scale structure, accretion and gravitational waves. We discuss the constraints on both the initial collapse fraction and the current fraction of the dark matter (DM) in PBHs at each mass scale but stress that many of the constraints are associated with observational or theoretical uncertainties. We also consider indirect constraints associated with the amplitude of the primordial density fluctuations, such as second-order tensor perturbations andμ-distortions arising from the effect of acoustic reheating on the CMB, if PBHs are created from the high-σpeaks of nearly Gaussian fluctuations. Finally we discuss how the constraints are modified if the PBHs have an extended mass function, this being relevant if PBHs provide some combination of the DM, the LIGO/Virgo coalescences and the seeds for cosmic structure. Even if PBHs make a small contribution to the DM, they could play an important cosmological role and provide a unique probe of the early Universe.
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Efficacy of color lenses in abolishing photosensitivity: Beyond the one-type-fits-all approach? Epilepsy Behav 2021; 124:108332. [PMID: 34619544 DOI: 10.1016/j.yebeh.2021.108332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Red-light filtering lenses represent an additional option to medication in photosensitive epilepsy. Blue lenses (Clarlet Z1 F133) can dramatically reduce seizure frequency, with a substantial restriction in luminance that can limit their applicability in daily life. We investigated the efficacy of 4 blue lenses with higher transmittance and reduced chromatic distortion in abolishing the photoparoxysmal EEG response (PPR) compared to the gold-standard Z1 lenses. METHODS We reviewed EEG data during photic-and pattern stimulation in 19 consecutive patients (6-39 years) with photosensitivity (PS). Stimulation was performed at baseline and while wearing Z1 and the four new lenses. Lenses were tested in the same session by asking the patient to wear them in a sequentially randomized fashion while stimulating again with the most provocative photic/pattern stimuli. The primary outcome was the change in the initial PPR observed for each lens, categorized as no change, reduction, and abolition. RESULTS Photosensitivity was detected in 17 subjects (89.5%); pattern sensitivity (PtS) was identified in 14 patients (73.7%). The highest percentages of PPR abolition/reduction were observed with Z1, for both PS and PtS. Regarding the new lenses, B1 + G1 offered the best rates, followed by B1 + G2. B1 + G3 and B1 showed lower efficacy rates, particularly for PtS. In the comparative analysis, no significant differences in PPR suppression were detected between the five lenses for PS. For PtS, the capacity of Z1 for PPR abolition was significantly higher compared with B1 + G3 and B1. CONCLUSIONS This preliminary study suggests efficacy of the new group of blue lenses with potentially greater tolerability, particularly in regions with fewer sunlight hours during winter. In line with the current trend for personalized approach to treatment, this study suggests that in some patients there might be scope in extending the testing to offer the lens with the higher transmittance effective in abolishing the PPR.
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1 Correlation Between New York City Hot Spotting Policy and Mobility to Reduce COVID-19 Spread. Ann Emerg Med 2021. [PMCID: PMC8335442 DOI: 10.1016/j.annemergmed.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term.
Purpose
To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs.
Methods
SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR.
Results
In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p<0.001), CABG (11% v 2%, p<0.001) and a diagnosis of STEMI (21% v 5%, p<0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p<0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p<0.001), statins (91% 73%, p<0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p<0.001) than non-attendees.
Conclusions
Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation
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Implant Committee Approval as a Protective Factor Against Peri-implantitis. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Does Minimally Invasive Implant Surgery Lead to Better Clinical Outcomes? A Retrospective Cohort Analysis. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Is Implant Placement in the Operating Room a Risk Factor for the Development of Peri-Implantitis? A Retrospective Cohort Analysis. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Maternal mental health and partner delivered massage: a pilot study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Mental health problems place a significant burden on the health system and are an important public health issue. Many pregnant women experience anxiety and depression, which can negatively impact health outcomes for both mother and baby. Partner-delivered massage may provide a cost effective and accessible approach to support the mental wellbeing of pregnant women.
Methods
A feasibility randomised controlled trial was conducted to compare partner-delivered relaxation massage (intervention) with a self-directed stress management program (control), for pregnant women with mild anxiety. Women attended an initial workshop at 28-32 weeks gestation, followed by the completion of either the self-directed massage or stress management program. Qualitative feasibility and acceptability data (primary outcomes) were collected via online participant diaries and post-birth interviews. Anxiety, depression and stress symptoms (secondary outcomes) were assessed using the Depression and Anxiety Stress Scale (DASS-21).
Results
14 women/partner dyads attended the partner- delivered massage group and 13 women attended the self-directed stress management group. Participants from both groups reported the programs were feasible and acceptable. Mean scores on all DASS-21 subscales significantly decreased over time in both the intervention and the control group.
Conclusions
The partner-delivered massage program was feasible and acceptable. Both programs decreased women's symptoms of anxiety, depression and stress, with no significant between-group differences identified. An adequately powered, experimental study is needed to determine the effectiveness of partner-delivered relaxation massage.
Key messages
Many women experience anxiety and depression during pregnancy and this can have a negative impact on both mother and baby. Partner-delivered relaxation massage, at least once a week in the third trimester, may help reduce women’s symptoms of anxiety, depression and stress.
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The effectiveness of massage for reducing pregnant women's anxiety and depression; systematic review and meta-analysis. Midwifery 2020; 90:102818. [PMID: 32827841 DOI: 10.1016/j.midw.2020.102818] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 08/01/2020] [Accepted: 08/14/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To critically appraise and synthesize the best available evidence on the effectiveness of massage to reduce antenatal women's anxiety and/ or depression. DESIGN Systematic review with meta-analysis PARTICIPANTS, INTERVENTIONS: Pregnant women over the age of 18 years who receive massage interventions. MEASUREMENTS AND FINDINGS Eight studies were included in the review; seven were randomized controlled trials. Data were collected via pregnant women's self-reported ratings of anxiety or depression using validated tools. Meta-analysis of four studies revealed a moderate effect of massage therapy on women's depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) (MD = -5.95, 95%CI = -8.11 to -3.80, I2 = 0%) compared with usual care. A moderate effect of massage interventions on women's anxiety were also found based on five studies using various measures (SMD = -0.59, 95%CI = -1.06 to -0.12, I2 = 75%) when compared with usual care. However, none of the trials had a low risk of bias. KEY CONCLUSIONS Non-pharmacologic treatments for mental health symptoms are an important option for women to use during pregnancy. As shown in meta-analysed data, massage therapy might be more effective in reducing pregnant women's anxiety and depression than usual care, although the current results may be prone to bias. Further high-quality research is required to fully evaluate the impact of massage therapy on pregnant women's mental health symptoms in the immediate and also longer term. IMPLICATIONS FOR PRACTICE Massage therapy may be an acceptable and feasible approach for pregnant women to employ to reduce their anxiety and depressive symptoms. More research evidence examining the safety and effectiveness of massage is required before practice recommendations can be made.
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Clinical outcomes and adverse events in patients hospitalised with COVID-19, treated with off-label hydroxychloroquine and azithromycin. Br J Clin Pharmacol 2020; 87:1150-1154. [PMID: 32687645 DOI: 10.1111/bcp.14482] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS To assess clinical outcomes and adverse drug events in patients hospitalised with COVID-19 treated with off-label hydroxychloroquine (HCQ) and azithromycin (Az). METHODS We performed a retrospective analysis of hospitalised patients who had a positive polymerase chain reaction test for SARS-CoV-2 and received HCQ plus Az or no targeted therapy. The primary end point was clinical improvement on day 7 defined as either hospital discharge or an improvement of 2 points on a 6-category ordinal scale. Secondary outcomes included mortality at day 28, intensive care admission, requirement for mechanical ventilation and incidence of adverse events. RESULTS Data from a total of 134 patients were evaluated; 82 patients received HCQ/Az and 52 patients received no targeted therapy. Clinical improvement was seen in 26.8% of patients who received HCQ/Az but this was not significant. The rates of intensive care transfer and mechanical ventilation were higher in the treatment group, but these differences were not significant. Mortality at day 28 was significantly higher in the treatment group (P = .03). Hypoglycaemia elevated liver function tests and QT prolongation were monitored in both groups. The risk of QT prolongation was significantly higher in the treatment group. Treatment was stopped early in 6 (7.3%) patients due to adverse events. CONCLUSION Although patients who received HCQ/Az were more severely ill the administration of these repurposed drugs did not result in clinical improvement and was associated with a significant increase in toxicity. This descriptive study highlights the importance of monitoring all repurposed agents for adverse events.
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186 Pediatric Readiness of Hospitals Initially Caring for Severely Ill or Injured Children. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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338 Evaluation of a new clinical pharmacy service model in a University Teaching hospital in Dublin, Ireland. Age Ageing 2019. [DOI: 10.1093/ageing/afz103.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Advances in medicines reconciliation, drug monitoring and patient counselling requirements as well as added non-clinical responsibilities at ward level have led to an increased workload on a ward-based pharmacist. There is a need to optimise the service to meet these demands.
The aim of this study was to audit the current clinical pharmacy services and to implement a New Model of Clinical Pharmacy on four wards to aid in the optimisation and prioritisation of patients during the clinical ward service.
Methods
The study was undertaken in Dublin based, University Teaching Hospital between March and June 2018. The study included the following: (1) a comprehensive literature review, (2) focus groups with key decision makers, (3) the collection and analysis of quantitative data on patients screening and interventions performed pre- and post- model implementation, (4) the final stage involved a satisfaction surveys from pharmacists involved in the study. Local ethical approval was obtained for this study.
Results
The new clinical pharmacy model increased the amount of medicines reconciliation completed (pre-model implementation 77.7% (n=192) versus post-model implementation 81.6% (n=236)), decreased time to medication reconciliation completion on Mondays and Fridays, increased discharge information cards completed and did not show statistical inferiority in the amount of interventions picked up by pharmacists (p value= 0.86; two tailed t-test). Pharmacists in the study felt the model impacted their clinical ward visit positively and aided prioritisation but did not improve on their overall job satisfaction level.
Conclusion
The study shows that a new model of clinical pharmacy can impact positively on a pharmacist’s working day by formalising the prioritisation of high-risk patients, setting clear expectations and structure without impacting negatively on other clinical duties. It is believed that the model developed will continue to support the pharmacists’ decision making and workload prioritisation post implementation of electronic prescribing.
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SNAPSHOT ACS Cohort Follow-Up – What Happens to Australian Patients in the 3 Years after Hospital Discharge: A National Data Linkage Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Elagolix Treatment in Women with Heavy Menstrual Bleeding-Associated with Uterine Fibroids: Efficacy and Safety Results from Two Double-Blind, Randomized, Placebo-Controlled Phase 3 Studies. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Plasma levonorgestrel levels in non-obese and obese women using a levonorgestrel 52 mg intrauterine system for up to 7 years. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Model of Pediatric Pulmonary Hypertension and Right Heart Failure by Chronic Pulmonary Artery Ligation With Invasive Echocardiographic Evaluation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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203 Acute Care Redesign and Alternative Payment for Emergency Medicine Within Accountable Care Organizations: A Qualitative Study. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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One dose of ibuprofen decreases levels of interleukins involved in ovulation in the follicular fluid of women undergoing minimal stimulation in-vitro fertilization. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dual trigger does not increase oocyte yield for diminished ovarian reserve patients undergoing minimal stimulation in vitro fertilization cycles. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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2. JNK Functions as a Stress-Activated and Interleukin-3 Agonist-Activated BCL2 Kinase. Cancer Control 2017. [DOI: 10.1177/107327489900600615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016. Crit Care 2016; 20:347. [PMID: 31268434 PMCID: PMC5078922 DOI: 10.1186/s13054-016-1358-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s13054-016-1208-6.].
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Interdisciplinary collaboration to promote comprehensive services for
human trafficking survivors in Ethiopia. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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32
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Establishing a NSW Cardiac Rehabilitation Minimum Dataset (CRMDS). Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract P4-02-12: Breast MRI: Enhancing pre-operative planning in women with newly diagnosed breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-02-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Hypothesis:
Preoperative breast MRIs in newly diagnosed breast cancer patients may lead to additional findings, including larger disease involvement, thus leading to a change in the operative plan. This information can led to better surgical planning and decreased rates of surgical re-excisions.
Methods:
This was a single surgeon, single institution, retrospective analysis of women with newly-diagnosed breast cancer who had surgery between December 2013 and December 2014. A total of ninety-six patients underwent preoperative breast MRI. Exclusion criteria were patient's refusal of MRI or surgery, contraindication to MRI based on implants or body habitus, and male patients.
Results:
Overall, breast MRI most closely correlated to pathological tumor size (gold standard). MRI had a 64% correlation with pathology size, whereas mammography and ultrasound correlation were 44% and 43% respectively. As breast density increased, MRI correlation to pathologic tumor size improved. For breast density between 25-50%, tumor size by MRI correlated with pathology size in 27% of patients, mammogram correlation was 33% and ultrasound was 12%. When breast density increased to 51-75%, MRI correlation improved to 92%, whereas mammogram correlation was 56% and ultrasound was 68%. The majority of patients fell within these two density categories; correlation for breast density <25% and >75% were not statistically significant. Of the breast biopsies preformed for MRI abnormalities not otherwise identified by mammography or ultrasound, 42% were positive for invasive cancer or DCIS. Thirty-eight percent of patients had a change in operative plan based on their MRI findings. Of the ninety-six patients, nine were changed from breast conserving surgery to mastectomy, and 29 underwent a larger area of resection than planned prior to MRI, due to findings of more extensive disease on MRI not otherwise appreciated by mammography or ultrasound.
Conclusion:
Pre-operative MRI played a significant role in the pre-surgical evaluation of patients with newly diagnosed breast cancer. In our series, breast MRI demonstrated better correlation with extent of disease compared to other imaging modalities. This is turn enhanced patient and surgeon decision making and led to more precise pre-operative surgical planning.
Citation Format: Carr B, Lamb LC, Zarfos K, Weigert J, Singh R. Breast MRI: Enhancing pre-operative planning in women with newly diagnosed breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-12.
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Are we meeting the calorific and protein requirement needed in the intensive care setting? Intensive Care Med Exp 2015. [PMCID: PMC4797810 DOI: 10.1186/2197-425x-3-s1-a579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Initiation of enteral and parenteral feeding and why we interrupt them in the critical care setting. Intensive Care Med Exp 2015. [PMCID: PMC4798548 DOI: 10.1186/2197-425x-3-s1-a191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Bedrock fracture systems facilitate weathering, allowing fresh mineral surfaces to interact with corrosive waters and biota from Earth's surface, while simultaneously promoting drainage of chemically equilibrated fluids. We show that topographic perturbations to regional stress fields explain bedrock fracture distributions, as revealed by seismic velocity and electrical resistivity surveys from three landscapes. The base of the fracture-rich zone mirrors surface topography where the ratio of horizontal compressive tectonic stresses to near-surface gravitational stresses is relatively large, and it parallels the surface topography where the ratio is relatively small. Three-dimensional stress calculations predict these results, suggesting that tectonic stresses interact with topography to influence bedrock disaggregation, groundwater flow, chemical weathering, and the depth of the "critical zone" in which many biogeochemical processes occur.
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Use of clomiphene citrate in minimal ovarian stimulation cycles negatively impacts endometrial thickness, independent of peak estradiol levels: an argument for a freeze-all approach. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Predictive value of postwashed total progressively motile sperm count using Casa estimates in 1524 donor and 6871 non-donor intrauterine insemination cycles. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Minimal stimulation in vitro fertilization (IVF) with a freeze-all approach gives acceptable live birth rates in an overall poor prognosis population. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Comparison of the management and in-hospital outcomes of acute coronary syndrome patients in Australia and New Zealand: results from the binational SNAPSHOT acute coronary syndrome 2012 audit. Intern Med J 2015; 45:497-509. [DOI: 10.1111/imj.12739] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/04/2015] [Indexed: 12/22/2022]
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The DEXLIFE study methods: identifying novel candidate biomarkers that predict progression to type 2 diabetes in high risk individuals. Diabetes Res Clin Pract 2014; 106:383-9. [PMID: 25125339 DOI: 10.1016/j.diabres.2014.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/20/2014] [Indexed: 11/16/2022]
Abstract
The incidence of type 2 diabetes (T2D) is rapidly increasing worldwide and T2D is likely to affect 592 million people in 2035 if the current rate of progression is continued. Today, patients are diagnosed with T2D based on elevated blood glucose, either directly or indirectly (HbA1c). However, the information on disease progression is limited. Therefore, there is a need to identify novel early markers of glucose intolerance that reflect the underlying biology and the overall physiological, metabolic and clinical characteristics of progression towards diabetes. In the DEXLIFE study, several clinical cohorts provide the basis for a series of clinical, physiological and mechanistic investigations in combination with a range of--omic technologies to construct a detailed metabolic profile of high-risk individuals across multiple cohorts. In addition, an exercise and dietary intervention study is conducted, that will assess the impact on both plasma biomarkers and specific functional tissue-based markers. The DEXLIFE study will provide novel diagnostic and predictive biomarkers which may not only effectively detect the progression towards diabetes in high risk individuals but also predict responsiveness to lifestyle interventions known to be effective in the prevention of diabetes.
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Epidemiology of unplanned intensive care admissions through inhospital referrals at a tertiary referral centre university hospital. Crit Care 2014. [PMCID: PMC4068757 DOI: 10.1186/cc13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Joint Commission Primary Stroke Center Certification Increases rt-PA Treatment (PD2.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd2.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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INVITED SESSION, SESSION 66: SREI/ASRM EXCHANGE SESSION - TREATMENT OPTIONS FOR PCOS Wednesday 6 July 2011 12:00 - 13:00. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract No. 300: Correlation of imaging outcomes following radioembolization with 90Y microspheres to tumor/normal liver uptake ratios at 99mTc macroaggregated albumin (99mTc-MAA) mapping angiography. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Smart trials: endometrial effects of the tissue selective estrogen complex (TSEC) comprised of bazedoxifene (BZA)/conjugated estrogens (CEs). Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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An Estimate of the United States Emergency Department Boarding Burden. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Gemcitabine-based transcatheter arterial chemoembolization for unresectable cholangiocarcinoma in thirty-eight patients: Single institutional experience. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14152 Background: Survival for patients with unresectable cholangiocarcinoma is reported to be 5–8 months. Systemic chemotherapy has been disappointing and not shown to significantly improve survival. Transcatheter arterial chemoembolization (TACE) has been shown to prolong survival in hepatocellular carcinoma patients but experience with cholangiocarcinoma is limited. We report our experience with the well-tolerated drug gemcitabine. Methods: Thirty-eight patients with unresectable cholangiocarcinoma were treated with one or more cycles of gemcitabine-based TACE between 2001 and 2005 at our institution. Follow-up imaging was performed on all patients after each TACE procedure. Regimens of TACE included: gemcitabine only (16), gemcitabine followed by cisplatin (2), gemcitabine followed by oxaliplatin (5), gemcitabine and cisplatin (12), and gemcitabine and cisplatin followed by oxaliplatin (3). Actual survival is reported, as 35 of 38 have died from disease (92%). Results: Patients were 57.5 years of age (range 36–87) and a median of 3 treatments (range 1–10) were administered. Median survival from time of first treatment was 10.3 months. Patients receiving gemcitabine followed by cisplatin or oxaliplatin had improved survival (mean 16.5 and 10.5 months respectively) when compared to gemcitabine alone (mean 6 months). Patients receiving gemcitabine and cisplatin as a combination had improved survival (mean 13.4 months) compared to single agent gemcitabine. Patients who progressed on gemcitabine and cisplatin and then received oxaliplatin also showed improved survival (mean 14.3 months) compared to gemcitabine only. Neutropenia, thrombocytopenia and hyperbilirubinemia were the most common toxicities observed. Three patients in the entire series exhibited grade 3 thrombocytopenia while seven patients had grade 3 and one had grade 4 bilirubin levels. Conclusions: This series provides evidence in favor of TACE rather than historically reported alternatives such as systemic chemotherapy or chemotherapy/RT. Our results suggest that gemcitabine based TACE is well tolerated and perhaps best delivered as a combination therapy for patients with unresectable cholangiocarcinoma. No significant financial relationships to disclose.
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