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White A, Pruszynski J, Williams R, Duryea EL. Transfusion and hematologic indices in cases of stillbirth due to placental abruption. Am J Obstet Gynecol 2023; 229:677.e1-677.e10. [PMID: 37364802 DOI: 10.1016/j.ajog.2023.06.042] [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: 03/08/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Stillbirth because of placental abruption is often associated with maternal hemorrhage and coagulopathy. OBJECTIVE This study aimed to describe blood product requirements, hematologic indices, and the overall clinical picture of patients experiencing abruption demise. STUDY DESIGN This retrospective cohort included patients with abruption demise at an urban hospital from 2010 to 2020. Outcome data from patients who delivered stillborn infants ≥500 g or with gestational age of ≥24 weeks were included. Abruption was a clinical diagnosis made by a multidisciplinary stillbirth review committee. The overall number and type of blood products given were analyzed. Patients with a stillbirth who required blood transfusion were compared with those that did not. In addition, the hematologic indices of these 2 populations were analyzed and compared with one another. Finally, the overall clinical characteristics of the 2 populations were analyzed. The analysis of data included chi-square, t test, and logistic and negative binomial regression models. RESULTS Of 128,252 deliveries, 615 patients (0.48%) experienced a stillbirth, with 76 cases (12%) caused by abruption. Of note, 42 patients (55.2%) required blood transfusion; all received either packed red blood cells or whole blood with a median 3.5 units (2.0-5.5) received. The total units ranged from 1 to 59, with 12 of 42 patients (29%) requiring ≥10 units. Maternal age, gestational age, and mode of delivery were not different, with most (61/76 [80%]) delivering vaginally. Hematocrit level on arrival (odds ratio, 0.80; 95% confidence interval, 0.68-0.91; P=.002) and vaginal bleeding on arrival (odds ratio, 3.73; 95% confidence interval, 1.15-13.40; P=.033) were associated with blood transfusion, as was a diagnosis of preeclampsia (odds ratio, 8.40; 95% confidence interval, 2.49-33.41; P=.001). Those that required a blood transfusion often presented with lower hematologic indices and were more likely to develop disseminated intravascular coagulation (28% vs 0%; P<.001). CONCLUSION Most patients experiencing stillbirth because of abruption required blood transfusion, with almost 1 in 3 of those patients consuming ≥10 units of blood products. Hematocrit level on arrival, vaginal bleeding, and preeclampsia were all predictors of the need for blood transfusion. Those requiring blood transfusion were more likely to develop disseminated intravascular coagulation. Blood transfusion should be prioritized when abruption demise is suspected.
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Affiliation(s)
- Alesha White
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Parkland Health System, Dallas, TX.
| | - Jessica Pruszynski
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Parkland Health System, Dallas, TX
| | - Rachel Williams
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Parkland Health System, Dallas, TX
| | - Elaine L Duryea
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Parkland Health System, Dallas, TX
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Rahn D, Richter H, Sung V, Pruszynski J. Impact of 4 versus 6 apical suspension sutures for uterosacral ligament suspension. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.12.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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Nelson DB, Martin R, Duryea EL, Lafferty AK, McIntire DD, Pruszynski J, Rochin E, Spong CY. Extending Maternal Care After Pregnancy: An Initiative to Address Health Care Disparities and Enhance Access to Care After Delivery. Jt Comm J Qual Patient Saf 2023; 49:274-279. [PMID: 36966113 DOI: 10.1016/j.jcjq.2023.02.003] [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] [Received: 11/11/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
PROBLEM DEFINITION A substantial proportion of maternal morbidity and mortality occurs after birth. However, little is known about the optimal design of programs to improve outcomes and decrease disparities during this period. CONTEXT Parkland Health is a tax-supported health system in Dallas that delivers more than 11,000 patients annually. A community needs assessment identified substantial health disparities in this community. The proportion of women in this region with diabetes mellitus (DM) and chronic hypertension (CHTN) during pregnancy is higher than surrounding regions, but access to care in the area is difficult because of the limited availability of ambulatory care. INITIAL APPROACH The authors created extending Maternal Care After Pregnancy (eMCAP), a community-based program, to address health care disparities and enhance access to care for the 12 months after birth. The team also evaluated the ability of Z codes (ICD-10 codes for social determinants of health) to identify patients with health-related social needs. KEY INSIGHTS AND SURPRISES The eMCAP program demonstrated improvement in attendance and quality of postpartum care for women living in underserved areas with CHTN and DM. For both CHTN and DM, eMCAP patients were matched 1:2 to controls outside of the eMCAP target region with similar comorbidities for maternal age ± 4 years, Black race, and delivery date ± 45 days. Compared to matched controls who were provided standard referrals, follow-up postpartum attendance for eMCAP women with CHTN was significantly better at 2 weeks and 1, 3, 6, 9, and 12 months (all p < 0.001). Similarly, eMCAP women with DM had significantly better follow-up at 2 weeks (p = 0.04), 1 month (p = 0.002), and 3 months (p = 0.049), resulting in HbA1c values for DM being significantly lower (p < 0.05) throughout the postpartum period. Despite the health system leading in reporting of Z codes, nearly 99% of applicable Z codes were not recorded, underscoring a public health opportunity. Through the eMCAP program, this initiative has demonstrated improved clinical performance for health care outcomes relevant to postpartum patients that can be deployed elsewhere to improve maternal health in underserved communities.
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Liu CR, Heid CA, Hauptmann E, Ali M, Pruszynski J, Pillai A, Banga A, Wait MA, Huffman LC, Peltz M, Hackmann AE, Jessen ME, Ring WS, Murala JS. Donor substance use and lung transplantation: A single center experience. Transplantation Reports 2022. [DOI: 10.1016/j.tpr.2022.100124] [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: 11/23/2022] Open
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Thiele L, Thompson J, Pruszynski J, Spong C. Gaps in evidence-based medicine: underrepresented populations still excluded from research trials following 2018 recommendations from the Health and Human Services Task Force on Research Specific to Pregnant Women and Lactating Women. Am J Obstet Gynecol 2022; 227:908-909. [PMID: 35835261 PMCID: PMC9364817 DOI: 10.1016/j.ajog.2022.07.009] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 01/27/2023]
Affiliation(s)
| | | | - Jessica Pruszynski
- University of Texas Southwestern Medical Center Department of Obstetrics and Gynecology
| | - Catherine Spong
- University of Texas Southwestern Medical Center Department of Obstetrics and Gynecology; Parkland Health and Hospital System
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Schell RC, Macias DA, Garner WH, White AM, McIntire DD, Pruszynski J, Adhikari EH. Examining the impact of trimester of diagnosis on COVID-19 disease progression in pregnancy. Am J Obstet Gynecol MFM 2022; 4:100728. [PMID: 35995369 PMCID: PMC9391234 DOI: 10.1016/j.ajogmf.2022.100728] [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: 07/05/2022] [Revised: 08/02/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND COVID-19 infection is associated with increased morbidity in pregnancy and adverse maternal and neonatal outcomes. Little is currently known about how the timing of infection during pregnancy affects these outcomes. OBJECTIVE This study aimed to evaluate the effect of trimester of COVID-19 infection on disease progression and severity in pregnant patients. STUDY DESIGN This was a prospective cohort study of pregnant patients diagnosed with COVID-19 infection who delivered at a single urban hospital. Universal testing for SARS-CoV-2 was performed at hospital admission and for symptomatic patients in inpatient, emergency department, and outpatient settings. Disease severity was defined as asymptomatic, mild, moderate, severe, or critical on the basis of National Institutes of Health criteria. We evaluated disease progression from asymptomatic to symptomatic infection and from asymptomatic or mild infection to moderate, severe, or critical illness, and stratified by trimester of COVID-19 diagnosis. Primary outcomes included progression of COVID-19 disease severity and a composite obstetrical outcome, which included delivery at <37 weeks, preeclampsia with severe features, abruption, excess blood loss at delivery (>500 mL for vaginal or >1000 mL for cesarean delivery), and stillbirth. RESULTS From March 18, 2020 to September 30, 2021, 1326 pregnant patients were diagnosed with COVID-19 and delivered at our institution, including 103 (8%) first-, 355 (27%) second-, and 868 (65%) third-trimester patients. First-trimester patients were older and had more medical comorbidities; 86% of patients in all trimesters were Hispanic. Among patients admitted within 14 days of a positive test, 3 of 18 (17%) first-trimester, 20 of 47 (43%) second-trimester, and 34 of 574 (6%) third-trimester patients were admitted for the indication of COVID-19 illness. Across all trimesters, 1195 (90%) of 1326 COVID-19 infections were asymptomatic or mild, and 45 (10%) of 436 initially asymptomatic patients developed symptoms. Of patients with asymptomatic or mild symptoms at diagnosis, 4 (4%) of 93 first-, 18 (5%) of 337 second-, and 49 (6%) of 836 third-trimester patients developed moderate, severe, or critical illness (P=.80). There was no significant difference in composite obstetrical outcome with respect to trimester of COVID-19 diagnosis (24% first-trimester, 28% second-trimester, 28% third-trimester patients; P=.69). CONCLUSION Moderate, severe, or critical illness develops in almost 10% of pregnant patients. The frequency of COVID-19 disease progression in pregnancy does not differ by trimester of diagnosis.
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Affiliation(s)
- Rachel C Schell
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX (Drs Schell, Macias, White, McIntire, Pruszynski, and Adhikari); Parkland Health, Dallas, TX (Drs Schell, Macias, White, and Adhikari).
| | - Devin A Macias
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX (Drs Schell, Macias, White, McIntire, Pruszynski, and Adhikari); Parkland Health, Dallas, TX (Drs Schell, Macias, White, and Adhikari)
| | - W Holt Garner
- School of Medicine, The University of Texas Southwestern Medical Center, Dallas, TX (Mr Garner)
| | - Alesha M White
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX (Drs Schell, Macias, White, McIntire, Pruszynski, and Adhikari); Parkland Health, Dallas, TX (Drs Schell, Macias, White, and Adhikari)
| | - Donald D McIntire
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX (Drs Schell, Macias, White, McIntire, Pruszynski, and Adhikari)
| | - Jessica Pruszynski
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX (Drs Schell, Macias, White, McIntire, Pruszynski, and Adhikari)
| | - Emily H Adhikari
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX (Drs Schell, Macias, White, McIntire, Pruszynski, and Adhikari); Parkland Health, Dallas, TX (Drs Schell, Macias, White, and Adhikari)
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Sendukas E, Muir T, Negrete Vasquez O, Pruszynski J, Chao L. 8553 The Effect of Obesity on the Accuracy of Uterine Weight Estimation and Impact on Hysterectomy Outcomes. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.432] [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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8
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Adhikari EH, MacDonald L, SoRelle JA, Morse J, Pruszynski J, Spong CY. COVID-19 Cases and Disease Severity in Pregnancy and Neonatal Positivity Associated With Delta (B.1.617.2) and Omicron (B.1.1.529) Variant Predominance. JAMA 2022; 327:1500-1502. [PMID: 35325015 PMCID: PMC8949750 DOI: 10.1001/jama.2022.4356] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study examines infections, illness severity, vaccinations, and early neonatal infections among obstetric patients during the pre-Delta, Delta, and Omicron periods of the COVID-19 pandemic.
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Affiliation(s)
- Emily H. Adhikari
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | | | - Jeffrey A. SoRelle
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas
| | - Jessica Morse
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Jessica Pruszynski
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | - Catherine Y. Spong
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
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Akam-Venkata J, Ikemba CM, Martinez J, Pruszynski J, Heistein L, Pirolli TJ, Forbess JM. Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta. Pediatr Cardiol 2022; 43:1645-1652. [PMID: 35637360 PMCID: PMC9150633 DOI: 10.1007/s00246-022-02895-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/24/2022] [Indexed: 01/28/2023]
Abstract
Surgical options for coarctation of aorta (CoA) with atrioventricular septal defect (AVSD) include single-stage repair vs. staged approach with neonatal CoA repair and delayed AVSD repair. The durability of left atrioventricular valve (LAVV) function after neonatal repair is questioned, and the optimal approach remains controversial. Eighteen CoA-AVSD patients who underwent single-stage repair 2005-2015 by a single surgeon were retrospectively analyzed. Fifteen patients had complete and three had partial AVSD. Birth weight was 3.19 kg (2.17-4.08). Age at surgery was 16 days (6-127). One- and ten-year survival were 80% and 69%. Freedom from reintervention was 60% and 40% at one and ten-year respectively. Reinterventions included relief of left ventricular outflow tract obstruction (LVOTO) (n = 4), repair of cleft LAVV (n = 3), and LAVV and aortic valve replacement (n = 1). Freedom from LAVV reintervention was 85.6% and 66% at 1 and 10 years respectively. There were four deaths: two post-operative and two following hospital discharge. Mortality was due to sepsis in three patients, and heart failure related to LVOTO and LAVV insufficiency in one. At 68-month (0.6-144) follow-up the majority had mild or less LAVV regurgitation, and all had normal LV dimension and systolic function. There was no recurrent arch obstruction. Single-stage surgical repair of CoA-AVSD is feasible and reasonable. Survival and freedom from reintervention in our cohort approximate those outcomes of two-stage repair with durable left AV valve function and no recurrent arch obstruction. These patients are frequently syndromic and demonstrate mortality risk from non-cardiac causes. Consideration of a single-staged approach is warranted for appropriate patients with CoA-AVSD.
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Affiliation(s)
- Jyothsna Akam-Venkata
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Division of Pediatric Cardiology, Department of Pediatrics, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS, 39216, USA.
| | - Catherine M. Ikemba
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Joseph Martinez
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Jessica Pruszynski
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Lisa Heistein
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Timothy J. Pirolli
- Department of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Joseph M. Forbess
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, USA
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Vela RJ, Pruszynski J, Mone T, Niles P, Peltz M. Differences in Organ Donation and Transplantation in States Within the United States and in European Countries: Is There a Benefit to Opting Out? Transplant Proc 2021; 53:2801-2806. [PMID: 34802724 DOI: 10.1016/j.transproceed.2021.09.029] [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] [Received: 07/22/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Organ donation in the United States currently requires explicit consent by an "opt-in" approach. Some European countries have reported an increase in donation rates with an "opt-out" strategy. We hypothesized that regional differences in decision making affect organ donation rates in different countries and suggest no single approach will reliably increase organ donation rates. METHODS Donation and transplantation rates in European countries and states within the United States with populations of >10 million and a minimum organ donation rate of 10 donors per million were compared. 2016 International Registry in Organ Donation and Transplantation data and the 2016 Scientific Registry of Transplant Recipients annual report were used for European countries and US states, respectively. Comparisons by region and donation model were made. RESULTS Deceased organ donor rates and transplants did not differ between opt-in and opt-out models. Living donation was increased in all opt-in entities. When comparing European countries, there was a trend toward higher organ donation rates in opt-out countries than in opt-in countries. Donation and transplantation rates of US states were higher than both European opt-in and opt-out countries. CONCLUSION There were no differences in deceased donor organ donation when considering the donation consent model. These data do not support that an opt-out approach will increase the number of transplants in the United States.
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Affiliation(s)
- Ryan J Vela
- Department of Cardiovascular & Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States.
| | - Jessica Pruszynski
- Department of Cardiovascular & Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Tom Mone
- OneLegacy, Los Angeles, California, United States
| | - Patricia Niles
- Southwest Transplant Alliance, Dallas, Texas 75231, United States
| | - Matthias Peltz
- Department of Cardiovascular & Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Heid CA, Chandra R, Liu C, Pruszynski J, Khoury MK, Vela R, Zeng X, Maaraoui K, Kalsbeek A, Ring WS, Amin A, Murala J, Peltz M. Cardiac transplantation in adults with congenital heart disease: A single center case series. Clin Transplant 2021; 35:e14430. [PMID: 34288107 DOI: 10.1111/ctr.14430] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adult congenital heart disease (CHD) transplant recipients historically experienced worse survival early after transplantation. We aim to review updated trends in adult CHD transplantation. METHODS We performed a single center case series of adult cardiac transplants from January 2013 through July 2020. Outcomes of patients with CHD were compared to non-CHD. The primary outcome was overall survival. Secondary outcomes included a variety of post-operative complications. RESULTS 18/262 (7%) transplants were CHD recipients. CHD patients were younger with median age 41 (32-47) versus 58 (48-65) (P < .001). Fontan circulation for single ventricle physiology was present in 4/18 (22%) of CHD recipients, while 16/18 (89%) had systemic right ventricles. CHD recipients had higher rates of previous cardiovascular operations (94% vs. 51%, P < .001). 9/18 (50%) of CHD patients required reconstructive procedures at the time of transplant. Operative and cardiopulmonary bypass times were longer for the CHD cohort (7.5 h [6.6-8.5] vs. 5.6 h [4.6-7] P < .001) and (197 min [158-240] vs. 130 [105-167] P < .001), respectively. There were no differences in operative complications or survival between CHD and non-CHD recipients. CONCLUSIONS These data highlight the added technical challenges of performing adult CHD transplants. However, similar outcomes can be achieved as for non-CHD recipients. SUMMARY Modern advances in palliation of congenital heart defects (CHD) has led to increased survival into adulthood. Many of these patients require heart transplantation as adults. There are limited data on adult CHD transplantation. Historically, these patients have had worse perioperative outcomes with improved long-term survival. We retrospectively analyzed 262 heart transplants at a single center, 18 of which were for adult CHD. Here, we report our series of 18 CHD recipients. We detail the palliative history of all CHD patients and highlight the added technical challenges for each of the 18 patients at transplant. In our analysis, CHD patients had more prior cardiovascular surgeries as well as longer transplant operative and bypass times. Despite this, there were no differences in perioperative and long-term outcomes. We have added patient and institution specific data for transplanting patients with adult CHD. We hope that our experience will add to the growing body of literature on adult CHD transplantation.
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Affiliation(s)
- Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Raghav Chandra
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Charles Liu
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica Pruszynski
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mitri K Khoury
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ryan Vela
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xue Zeng
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kayla Maaraoui
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anya Kalsbeek
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - W Steves Ring
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alpesh Amin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John Murala
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Onifade A, Lemon-Riggs D, Smith A, Pak T, Pruszynski J, Reznik S, Moon TS. Comparing the rate of fiberoptic bronchoscopy use with a video double lumen tube versus a conventional double lumen tube-a randomized controlled trial. J Thorac Dis 2020; 12:6533-6541. [PMID: 33282355 PMCID: PMC7711371 DOI: 10.21037/jtd-20-1595] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Double lumen endotracheal tubes (DLT) are commonly used to provide single lung ventilation during thoracic surgery. A fiberoptic bronchoscope (FOB) is typically used to confirm accurate DLT placement. Accounting for initial purchase, maintenance, repair and cleaning, the use of an FOB can cost as much as $312 per procedure. The VivaSight DLT (VS-DLT) incorporates a built-in camera, which is aimed at reducing FOB use and its associated costs. In this study, we compared the rate of FOB use when intubating using either a VS-DLT or a conventional DLT (c-DLT). Methods This is a randomized controlled comparative study performed at a public county teaching hospital. A total of 50 patients were enrolled and randomly assigned to either a c-DLT (n=25) or a VS-DLT (n=25). The primary outcome was the rate of FOB use. Secondary outcomes included time to correct tube placement and incidence of malposition during surgery. Results Use of the VS-DLT required significantly less FOB use (28%) compared to use of the c-DLT (100%). While there was no difference in the ease of intubation, the time to correct tube placement was significantly faster using a VS-DLT (54 vs. 156 s, P<0.001). Additionally, the incidence of tube malposition was significantly reduced in the VS-DLT group. Conclusions This study demonstrated a significantly lower rate of FOB use when using a VS-DLT compared to a c-DLT. Placement of the VS-DLT was significantly quicker and malposition during surgery occurred significantly less than with the c-DLT. While intubating with a VS-DLT provides clinical benefits, it may not result in significant cost reductions when compared to a c-DLT.
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Affiliation(s)
- Akinjide Onifade
- Department of Anesthesia and Pain Management, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Dlorean Lemon-Riggs
- Department of Anesthesia and Pain Management, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Aaron Smith
- Department of Anesthesia and Pain Management, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Taylor Pak
- Department of Anesthesia and Pain Management, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Jessica Pruszynski
- Department of Cardiothoracic Surgery, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Scott Reznik
- Department of Cardiothoracic Surgery, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Tiffany S Moon
- Department of Anesthesia and Pain Management, University of Texas at Southwestern Medical Center, Dallas, TX, USA
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13
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Moon TS, Reznik S, Pak T, Jan K, Pruszynski J, Kim A, Smith KM, Lu R, Chen J, Gasanova I, Fox PE, Ogunnaike B. Sugammadex versus neostigmine for reversal of rocuronium-induced neuromuscular blockade: A randomized, double-blinded study of thoracic surgical patients evaluating hypoxic episodes in the early postoperative period. J Clin Anesth 2020; 64:109804. [PMID: 32353805 DOI: 10.1016/j.jclinane.2020.109804] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 01/20/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVE This objective of this study was to determine if reversal of rocuronium-induced neuromuscular blockade with sugammadex versus neostigmine results in a decreased number of hypoxic episodes in the early postoperative period in patients undergoing thoracic surgery with single lung ventilation. DESIGN Single-center, randomized, double-blind, two-arm clinical trial. SETTING Operating room and postanesthesia care unit. PATIENTS 92 subjects aged ≥18, American Society of Anesthesiologists physical status II-IV, and undergoing a thoracic operation necessitating single lung ventilation. INTERVENTIONS Subjects received either 2 mg/kg sugammadex or 50 μg/kg neostigmine with 8 μg/kg glycopyrrolate for reversal of moderate neuromuscular blockade. MEASUREMENTS For the first 90 min postoperatively, all episodes of hypoxia were recorded. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch® SX) and the train of four (TOF) was recorded at 2, 5, 10, and 15 min after administration of the neuromuscular reversal agent. MAIN RESULTS Subjects who received neostigmine had a median of 1 episode (interquartile range IQR: 0-2.2) of hypoxia versus subjects who received sugammadex who had a median of 0 episodes (IQR: 0-1) (p = 0.009). The mean time to recovery of TOF ≥ 0.9 was significantly faster with sugammadex at 10 min (95% confidence interval CI: 5-15) compared with neostigmine at 40 min (95% CI: 15-53) (p < 0.001). CONCLUSIONS In thoracic surgical patients necessitating single lung ventilation, sugammadex provides faster reversal of moderate neuromuscular blockade and results in a decreased number of postoperative hypoxic episodes compared with neostigmine.
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Affiliation(s)
- Tiffany S Moon
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Scott Reznik
- University of Texas Southwestern Medical Center, Department of Cardiovascular and Thoracic Surgery, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Taylor Pak
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Kathryn Jan
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Jessica Pruszynski
- University of Texas Southwestern Medical Center, Department of Cardiovascular and Thoracic Surgery, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Agnes Kim
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Katelynn M Smith
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Rachael Lu
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Joy Chen
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Irina Gasanova
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Pamela E Fox
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Babatunde Ogunnaike
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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Heid C, Khoury M, Vela R, Liu C, Maaraoui K, Pruszynski J, Walsh L, Ring W, Peltz M, Wait M, Huffman L. Pulse Dose Steroids are Not Associated with Wound Dehiscence Following Lung Transplant. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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15
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Geoffrion TR, Pirolli TJ, Pruszynski J, Dyer AK, Davies RR, Forbess JM, Guleserian KJ. Mitral Valve Surgery in the First Year of Life. Pediatr Cardiol 2020; 41:334-340. [PMID: 31865441 DOI: 10.1007/s00246-019-02262-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/05/2019] [Indexed: 11/30/2022]
Abstract
Data are limited on outcomes associated with mitral valve surgery in infants. Prior studies report high mortality and increased risk for late cardiac failure particularly for those with mitral stenosis. We sought to evaluate outcomes in patients with mitral stenosis (MS) or regurgitation (MR) who had mitral valvuloplasty or replacement in the first year of life. A retrospective analysis of all patients in a single institution who underwent mitral valvuloplasty or replacement in their first year of life from 2004 to 2016 (n = 25), excluding patients with single ventricle pathology or those undergoing surgery for atrioventricular canal defect, was carried out. Median age and weight at surgery were 76.5 days (range 2-329) and 4.5 kg (range 3.0-10.1), respectively. The primary mitral pathology was MR in 16 and MS in 9 patients. Median follow-up among living patients was 4 years (range 106 days-12.3 years). Overall survival was 96% at 30 days and 87.8% at 1, 5, and 10 years. There were three early deaths (12%), all within 6 weeks of surgery. There were no late deaths. Three patients required valve replacement, 1 of which had a primary mitral valve replacement and died within 30 days of surgery. Re-intervention-free survival (surgical and catheter based) was 83.8%, 73.3%, and 48.9% at 1, 5, and 10 years per Kaplan-Meier estimates. There was no difference in re-intervention-free survival between patients with MR versus MS. No risk factors for death or re-intervention were identified. Mitral valvuloplasty and replacement can be performed in infants under 1 year of age with acceptable survival and need for re-intervention.
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Affiliation(s)
- Tracy R Geoffrion
- The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Timothy J Pirolli
- University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
| | | | | | - Ryan R Davies
- University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
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16
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Vela R, Pruszynski J, Amin A, Drazner M, Huffman L, Peltz M. Influence of Device Type on Stroke Risk in Women Undergoing LVAD Implantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Goraya N, Simoni J, Sager LN, Pruszynski J, Wesson DE. Acid retention in chronic kidney disease is inversely related to GFR. Am J Physiol Renal Physiol 2018; 314:F985-F991. [PMID: 29357423 DOI: 10.1152/ajprenal.00463.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Greater H+ retention in animal models of chronic kidney disease (CKD) mediates faster glomerular filtration rate (GFR) decline and dietary H+ reduction slows eGFR decline in CKD patients with reduced eGFR and H+ retention due to the high acid (H+) diets of developed societies. We examined if H+ retention in CKD is inversely associated with estimated GFR (eGFR) using cross-sectional and longitudinal analysis of individuals with CKD stage 1 (>90 ml·min- 1·1.73 m-2), CKD stage 2 (60-89 ml/min per 1.73 m2), and CKD stage 3 (30-59 ml·min- 1·1.73 m-2) eGFR. H+ retention was assessed using the difference between observed and expected plasma total CO2 2 h after 0.5 meq/kg body wt oral NaHCO3. H+ retention was higher in CKD 2 vs. CKD 1 ( P < 0.01) and in CKD 3 vs. CKD 2 ( P < 0.02) at baseline and 5 yr, and was higher in CKD 2 vs. CKD 1 ( P < 0.01) at 10 yr. All groups had lower eGFR at subsequent time points ( P < 0.01) but H+ retention was not different among the three time points for CKD 1. By contrast, eGFR decrease was associated with higher H+ retention in CKD 2 at 5 yr ( P = 0.04) and 10 yr ( P < 0.01) and with higher H+ retention in CKD 3 at 5 yr ( P < 0.01). Yearly eGFR decline rate was faster in CKD 2 vs. CKD 1 ( P < 0.01) and in CKD 3 vs. CKD 2 ( P < 0.01). The data show that H+ retention is inversely associated with eGFR, with faster eGFR decline, and support the need for greater dietary H+ reduction therapy for CKD individuals with lower eGFR.
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Affiliation(s)
- Nimrit Goraya
- Department of Internal Medicine, Texas A&M College of Medicine, Temple, Texas.,Department of Internal Medicine, Baylor Scott & White Health, Temple, Texas
| | - Jan Simoni
- Department of Surgery, Texas Tech University Health Sciences Center , Lubbock, Texas
| | - Lauren N Sager
- Department of Biostatistics, Baylor Scott & White Health, Temple, Texas
| | - Jessica Pruszynski
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern , Dallas, Texas
| | - Donald E Wesson
- Department of Internal Medicine, Texas A&M Health Sciences Center College of Medicine , Dallas, Texas.,Baylor Scott & White Health and Wellness Center, Dallas, Texas
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18
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Wu E, Langsjoen J, Pruszynski J, Kuehl TJ, Larsen WI. Variation in Use of Prophylactic Antibiotics in Gynecologic Procedures Before and After an Educational Intervention. South Med J 2017; 110:782-784. [PMID: 29197313 DOI: 10.14423/smj.0000000000000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Guidelines for use of prophylactic antibiotics in gynecologic procedures are outlined by the American Congress of Obstetricians and Gynecologists. There remains, however, a high rate of unindicated administration of antibiotics for surgeries. A retrospective study performed at our institution in 2012-2013 demonstrated that unindicated prophylactic antibiotics were administered over half the time. This study aimed to examine variations in the use of prophylactic antibiotics in patients undergoing gynecologic surgery at Scott and White Memorial Hospital and determine whether an educational intervention to gynecology physicians was associated with a significant decrease in unindicated prophylactic antibiotics. METHODS A retrospective chart review was performed for all women undergoing gynecologic surgery at Scott and White Memorial Hospital in Temple, Texas for 1 year. An educational intervention regarding prophylactic antibiotic usage was held for obstetricians and gynecologists in the middle of that year. Subjects were included if they had procedures with a Current Procedural Terminology code corresponding to a procedure that does not require prophylactic antibiotics. Subjects were excluded if they had concurrent procedures for which antibiotics are recommended. RESULTS A total of 500 subjects met inclusion and exclusion criteria, with 243 before the educational intervention and 257 after the intervention. In our study, a significant decrease (P < 0.0001) in unindicated prophylactic antibiotic use was demonstrated: from 45.7% (111/243) preintervention to 24.9% (64/257) postintervention. Before the educational intervention, both the gynecology oncology and reproductive endocrinology and infertility divisions had the highest rates of unindicated antibiotic use-91.7% (44/48) and 91.7% (33/36), respectively. The generalist and urogynecology divisions had the lowest rates for specialists before the intervention: 20.6% (30/146) and 30.8% (4/13), respectively. After the intervention, all of the divisions demonstrated an improvement in their rates of unindicated prophylactic antibiotic use. The urogynecology division demonstrated an improvement that can be considered clinically significant while not meeting statistical significance. The adverse event rates were not different between subjects who received preoperative prophylactic antibiotics (2.9%) and subjects who did not (2.8%). CONCLUSIONS A simple educational intervention was associated with a significant decrease in unindicated prophylactic antibiotics in gynecologic procedures.
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Affiliation(s)
- Emily Wu
- From the Department of Obstetrics and Gynecology, Scott and White Memorial Hospital, and the Office of Biostatistics, Baylor Scott and White Health, Temple, Texas
| | - Jessica Langsjoen
- From the Department of Obstetrics and Gynecology, Scott and White Memorial Hospital, and the Office of Biostatistics, Baylor Scott and White Health, Temple, Texas
| | - Jessica Pruszynski
- From the Department of Obstetrics and Gynecology, Scott and White Memorial Hospital, and the Office of Biostatistics, Baylor Scott and White Health, Temple, Texas
| | - Thomas J Kuehl
- From the Department of Obstetrics and Gynecology, Scott and White Memorial Hospital, and the Office of Biostatistics, Baylor Scott and White Health, Temple, Texas
| | - Wilma I Larsen
- From the Department of Obstetrics and Gynecology, Scott and White Memorial Hospital, and the Office of Biostatistics, Baylor Scott and White Health, Temple, Texas
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Abstract
Background To treat erectile dysfunction (ED), phosphodiesterase type 5 inhibitors (PDE5i) are commonly used. However, to date, only a few studies exist evaluate a possible effect on the incidence of prostate cancer. One such study completed by the authors’ institution suggested men who use PDE5i for ED may have a lower incidence of prostate cancer. This study was meant to address some of the shortcomings of the former study and further characterize the link between prostate cancer and PDE5i use. Methods A retrospective, match-paired analysis was undertaken: 5,717 patients were identified between 2000 and 2011; a 1:2 match pair analysis ultimately identified 394 cases with cancer and 788 controls without cancer. Pairs were matched based on age, ethnicity, and PSA value. Results No correlation existed between PDE5i use and prostate cancer [OR 1.02, 95% confidence interval (CI): 0.78–1.35, P=0.8842] or diabetes mellitus and prostate cancer (OR 1.12, 95% CI: 0.84–1.48, P=0.4499). A statistically significant correlation was demonstrated with PSA and prostate cancer (OR 1.48, 95% CI: 1.38–1.58, P<0.0001). Conclusions The data suggest that there is essentially no association with PDE5i use and prostate cancer.
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Affiliation(s)
- G Luke Machen
- Department of Surgery, Division of Urology; Baylor Scott & White Health/The Texas A&M Health Science Center College of Medicine; Temple, Texas, USA
| | - M Hasan Rajab
- Department of Surgery, Division of Urology; Baylor Scott & White Health/The Texas A&M Health Science Center College of Medicine; Temple, Texas, USA
| | - Jessica Pruszynski
- Department of Surgery, Division of Urology; Baylor Scott & White Health/The Texas A&M Health Science Center College of Medicine; Temple, Texas, USA
| | - K Scott Coffield
- Department of Surgery, Division of Urology; Baylor Scott & White Health/The Texas A&M Health Science Center College of Medicine; Temple, Texas, USA
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20
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Roehm B, Simoni J, Pruszynski J, Wesson DE. Cigarette Smoking Attenuates Kidney Protection by Angiotensin-Converting Enzyme Inhibition in Nondiabetic Chronic Kidney Disease. Am J Nephrol 2017; 46:260-267. [PMID: 28930715 DOI: 10.1159/000481206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cigarette smoking exacerbates the estimated glomerular filtration rate (eGFR) decline in nondiabetic chronic kidney disease (CKD) despite the kidney protection that is achieved by angiotensin converting enzyme inhibition (ACEI). Whether smoking cessation restores ACEI-related kidney protection is not known. METHODS This 5-year, prospective, prevention trial recruited 108 smokers and 108 nonsmokers with stage-2 nondiabetic CKD with primary hypertension and urine albumin-to-creatinine ratio (Ualb) >200 mg/g. All smokers underwent smoking cessation intervention programs. Blood pressure was reduced in all participants toward achieving a goal of <130 mm Hg with regimens including ACEI. The primary outcome was eGFR change, and secondary outcomes included Ualb and urine levels of angiotensinogen (UATG), a surrogate for kidney angiotensin II (AII) levels, and isoprostane 8-isoprostaglandin F2α (U8-iso), an indicator of oxidative stress. RESULTS One-year Ualb was lower than baseline in nonsmokers but not in either smoking group, supporting greater ACEI-related kidney protection in nonsmokers than smokers. Higher Ualb at 1 year in continued smokers was associated with higher UATG and higher U8-iso, consistent with smoking-induced AII and increased oxidative stress contributing to less ACEI-related kidney protection in smokers. Baseline eGFR was not different among groups (p = 0.92), but 5-year eGFR was higher in quitters than in continued smokers (62.0 ± 5.4 vs. 52.9 ± 5.6 mL/min/1.73 m2, p < 0.001); this value was lower in quitters than in nonsmokers (64.7 ± 5.6 mL/min/1.73 m2, p = 0.02). CONCLUSIONS Smoking cessation compared with continued smoking ameliorates eGFR decline in nondiabetic CKD treated with ACEI, possibly by restoring kidney-protective effects of ACEI through reductions in kidney AII and oxidative stress.
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Affiliation(s)
- Bethany Roehm
- Department of Internal Medicine, Tufts University School of Medicine, Boston, MA, USA
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21
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Jhavar S, Swanson G, Pruszynski J. Risk factors for locoregional relapse after radical nephrectomy. Asia Pac J Clin Oncol 2017; 14:192-197. [PMID: 28488392 DOI: 10.1111/ajco.12684] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/17/2017] [Indexed: 11/30/2022]
Abstract
AIM To identify risk factors for locoregional relapse after radical nephrectomy for renal cell carcinoma. METHODS We retrospectively reviewed the charts of 259 patients who underwent radical nephrectomy for sporadic clinically localized unilateral renal cell carcinoma between 1998 and 2012. Relapse patterns (locoregional and/or distant) were identified. Relapse-free survival was calculated using Kaplan-Meier method. Factors associated with decreased relapse-free survival were identified using univariate and multivariate Cox proportional hazards regression model analysis. Locoregional relapse estimates were calculated for individual factors and combination of factors. RESULTS At a median follow-up of 68 months (interquartile range: 75 months), 24% patients relapsed. Of these, 54% had locoregional relapse. High-grade, positive margin, large tumor size and stage III/IV were associated with worse relapse-free survival on multivariate analysis. Locoregional relapse occurred among patients with tumor size >7-</ = 10 cm (22%), >10 cm (35%), stage III/IV (31%), grade III/IV (26%), renal vein invasion (22%), perinephric fat invasion (30%), </ = 7 cm plus grade III/IV (15%), >7 cm plus grade I/II (21%), >7 cm plus grade III/IV (48%), stage III/IV plus grade I/II (24%) and stage III/IV plus grade III/IV (45%). CONCLUSION We were able to discern risk factors (individual or in combination) associated with increased risk of locoregional relapse after radical nephrectomy for renal cell carcinoma. This could help distinguish patients who may benefit from adjuvant locoregionally directed therapy.
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Affiliation(s)
- Sameer Jhavar
- Department of Radiation Oncology, Scott and White Medical Center, Temple, Texas, USA
| | - Gregory Swanson
- Department of Radiation Oncology, Scott and White Medical Center, Temple, Texas, USA
| | - Jessica Pruszynski
- Department of Biostatistics, Scott and White Medical Center, Temple, Texas, USA
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Jhavar S, Pruszynski J, Gowan A, Boyle T, Deb N, Patel M. Intensity modulated radiation therapy after extra-pleural pneumonectomy for malignant pleural mesothelioma is feasible without fatal pulmonary toxicity and provides good survival. Asia Pac J Clin Oncol 2017; 14:e88-e94. [PMID: 28371288 DOI: 10.1111/ajco.12680] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/02/2017] [Indexed: 11/30/2022]
Abstract
AIM To analyze patterns of failure, toxicity, relapse-free survival (RFS), and overall survival (OS) in malignant pleural mesothelioma (MPM) patients treated with intensity-modulated radiation therapy following extrapleural pneumonectomy (EPP). METHODS We reviewed 18 charts of patients with MPM from 2005 to 2014 who underwent EPP followed by hemithoracic intensity-modulated radiation therapy. Intensity-modulated radiation therapy dose delivery adhered to published lung dose constraints. Kaplan-Meier curves were used to assess the RFS and OS. Median survival times are reported for both RFS and OS. RESULTS Median age was 65 years (range: 40-76 years). Chemotherapy was administered in four neo-adjuvant and seven adjuvant patients. Pathological American Joint Committee on Cancer stages II, III, IV, surgical margin, lympho-vascular space, pericardium, and chest wall involvement were seen in 3, 12, 3, 9, 7, 12 and 3 patients, respectively. The majority of the patients received 45 Gy in 25 fractions. The mean lung dose was 7.14 Gy (range: 5 Gy-9.3 Gy). The mean V20 was 2.23%. At a median follow-up of 3 years, eight patients were alive (44%); 10 experienced relapse (56%). Median RFS and OS were 24.4 months (95% CI: >16.3 months) and 38.2 months (95% CI: 17.4-78.1 months), respectively. Acute toxicities were fatigue, dermatitis, nausea, esophagitis/dysphagia, cough, and dyspnea on exertion. No grade III, IV, or fatal pulmonary toxicities were observed. CONCLUSION Intensity-modulated radiation therapy following EPP for MPM resulted in RFS and OS comparable to the published literature without significant toxicity.
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Affiliation(s)
- Sameer Jhavar
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, Texas, USA
| | | | - Alan Gowan
- Hematology and Oncology, Baylor Scott and White Health, Temple, Texas, USA
| | - Teresa Boyle
- Radiation Oncology, Austin Cancer Centers, Texas, USA
| | - Niloyjyoti Deb
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, Texas, USA
| | - Mehul Patel
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, Texas, USA
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Wesson DE, Pruszynski J, Cai W, Simoni J. Acid retention with reduced glomerular filtration rate increases urine biomarkers of kidney and bone injury. Kidney Int 2016; 91:914-927. [PMID: 27988208 DOI: 10.1016/j.kint.2016.10.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 02/26/2016] [Revised: 10/09/2016] [Accepted: 10/13/2016] [Indexed: 11/18/2022]
Abstract
Diets high in acid of developed societies that do not cause metabolic acidosis in patients with chronic kidney disease nevertheless appear to cause acid retention with associated morbidity, particularly in those with reduced glomerular filtration rate. Here we used a rat 2/3 nephrectomy model of chronic kidney disease to study induction and maintenance of acid retention and its consequences on indicators of kidney and bone injury. Dietary acid was increased in animals eating base-producing soy protein with acid-producing casein and in casein-eating animals with added ammonium chloride. Using microdialysis to measure the kidney cortical acid content, we found that nephrectomized animals had greater acid retention than sham-operated animals when both ate the soy diet. Each increment in dietary acid further increased acid retention more in nephrectomized than in sham rats. Nephrectomized and sham animals achieved similar steady-state daily urine net acid excretion in response to increments in dietary acid but nephrectomized animals took longer to do so, contributing to greater acid retention that was maintained until the increased dietary acid was stopped. Acid retention was associated with increased urine excretion of both N-acetyl-β-D-glucosaminidase and deoxypyridinoline, greater in nephrectomized than control rats, consistent with kidney tubulointerstitial and bone matrix injury, respectively. Greater acid retention in nephrectomized than control animals was induced by a slower increase in urinary net acid excretion rate in response to the increment in dietary acid and also maintained until the dietary acid increment was stopped. Thus, acid retention increased biomarkers of kidney and bone injury in the urine, supporting untoward consequences to these two tissues.
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Affiliation(s)
- Donald E Wesson
- Baylor Scott and White Health, Dallas, TX, USA; Department of Medicine, Texas A&M College of Medicine, Temple, TX, USA.
| | - Jessica Pruszynski
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Wendy Cai
- Department of Biostatistics, Baylor Scott and White Health, Temple, TX, USA
| | - Jan Simoni
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Gaglani M, Murthy K, Pruszynski J, Robertson A, Nangrani A, Clipper L. Risk Factors of Influenza Vaccine Failure in 2012–13, 2013–14 and 2014–15 at Baylor Scott & White Health (BSWH) in Central Texas. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Manjusha Gaglani
- Pediatrics, Baylor Scott & White Health, Texas A&M HSC COM, Temple, Texas
| | - Kempapura Murthy
- Academic Operations Research Development, Baylor Scott & White Health, Temple, Texas
| | | | | | | | - Lydia Clipper
- Academic Operations, Baylor Scott & White Health, Temple, Texas
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Cantey J, Kaligiri R, Carder T, Pruszynski J, Mallett L. What Is the Cost of Coagulase-Negative Staphylococcal Sepsis in the Neonatal Intensive Care Unit (NICU)? Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.539] [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)
- Joseph Cantey
- Pediatrics, Texas A&M Health Science Center, Temple, Texas
| | | | | | | | - Lea Mallett
- Pediatrics, Texas A&M Health Science Center, Temple, Texas
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Jahoor A, Delmas T, Giri B, Male E, Pruszynski J, Murdoch L, Arroliga A, Ghamande S. Fluid Resuscitation of at Least 1 Liter in Septic Patients Decreases the Need for Renal Replacement Therapy Without Increasing the Risk of Acute Congestive Heart Failure or Acute Respiratory Failure. Chest 2016. [DOI: 10.1016/j.chest.2016.08.362] [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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Olek D, Deb N, Pruszynski J, Mutyala S. Retrospective Analysis of Surface Brachytherapy for Nonmelanoma Skin Cancer on the Nose and Ear. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2398] [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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Gestaut M, Pruszynski J, Swanson G. Prostate Cancer in Patients With High Prostate-Specific Antigen But Otherwise Very Low-Risk Disease Behaves Like Prostate Cancer in High-Risk Patients. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1337] [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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Goraya N, Simoni J, Pruszynski J, Xiang P, Wesson D. Abstract P265: Blood Pressure Control is Better and Less Expensive in Chronic Kidney Disease When Associated Metabolic Acidosis is Treated with Fruits and Vegetables Rather Than Sodium Bicarbonate. Hypertension 2016. [DOI: 10.1161/hyp.68.suppl_1.p265] [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
Background:
Both sodium bicarbonate (NaHCO
3
) and base-producing fruits and vegetables (F+V) improve metabolic acidosis in chronic kidney disease (CKD) and appear to provide similar levels of kidney protection. Because F+V themselves reduce blood pressure, we examined if treatment of metabolic acidosis in CKD with F+V was associated with improved blood pressure control, using fewer anti-hypertensive drugs, and thereby with lower cost of hypertension management.
Methods:
We randomized 108 subjects with CKD stage 3 eGFR (30-59 ml/min) and metabolic acidosis as follows: F+V (n=36) added to reduce dietary potential renal acid load (PRAL) 50%, oral NaHCO
3
(HCO
3
, n=36) to reduce PRAL 50%, or no alkali (Usual Care, n=36). All were treated toward systolic blood pressure (SBP) <130 mmHg with regimens including ACE inhibition and followed 5 years.
Results:
Entry SBP and initial doses of 5 formulary anti-hypertensive drugs most commonly used for blood pressure control in CKD were not different among the 3 groups. At 5 years, SBP was lower in F+V (125±5 mm Hg) than both HCO
3
and Usual Care (135±5 and 134±5 mm Hg, respectively, p<0.01 vs. F+V for each). Daily doses for the following drugs at year 5 were lower in F+V than HCO
3
and Usual Care: Enalapril (8.3±2.4 vs. 11.1±3.6 and 11.7±4.8, mg/day, respectively, p<0.01), Diltiazem (1.7±7.0 vs. 145.8±36.0 and 153.3±35.7, mg/day, p<0.01), Clonidine (0.14±0.20 vs. 0.65±0.15 and 0.63±0.16, mg/day, p<0.01), Atenolol (0 vs. 6.25±15.1 and 6.25±15.1 mg/day, p<0.02) but there was no difference among groups in the year 5 dose of hydrochlorthiazide (16.1±9.9 vs. 21.9±16.2 and 21.5±16.3 mg/day, p=0.27). Five-year drug cost of hypertension management was less in F+V ($79,760) than both HCO
3
($155,372) and Usual Care ($152,305).
Conclusions:
Treating metabolic acidosis in CKD patients with F+V but not NaHCO
3
was associated with lower SBP, use of fewer and lower doses of anti-hypertensive drugs, and lower group cost of hypertension management. The data support that clinicians consider these adjunctive benefits of F+V on hypertension management when recommending treatment strategies for metabolic acidosis in CKD.
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Affiliation(s)
| | - Jan Simoni
- Texas Tech Univ Health Sciences Cntr, Lubbock, TX
| | | | - Pin Xiang
- Baylor Scott and White Health, Temple, TX
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Wang F, Shen X, Pruszynski J, Huang J, Kirmani B, Wu E, Fonkem E. Abstract 465: CD44 as a potential therapeutic target and prognosis marker for glioblastoma. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-465] [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
Glioblastoma (GBM) is a common and very aggressive primary brain tumor with no cure. The current diagnosis relying on magnetic resonance imagining, computed tomography, and biopsy is a very expensive and aggressive process. More effective therapeutic strategies such as target therapies and simplified early diagnosis tools are urgently needed for GBM management and prognosis. As recent reports suggest that GBM expresses CD44, a type-I transmembrane glycoprotein, is a marker of cancer stem cell and therapy resistance, with a goal of identifying a therapeutic target and a prognosis maker for GBM, we analyzed several data sets previously detected by microarrays using an online R2 Genomics analysis and visualization platform (http://r2.amc.nl). Through examining of the expression levels of CD44 in the tissues of normal cerebellum (without brain tumor) and in GBM tissues, we find that the expression level of CD44 in GBM is higher than that in non-brain tumor tissues. Comparing the expression levels of CD44 in Primary and recurrent GBMs, GBM cell lines, neuron stem cell lines, and normal cortex tissues, we observe that the expression levels of CD44 in recurrent GBMs are higher than primary GBMs; the CD44 levels in GBM cell lines are similar to neuron stem cell lines which are significantly higher than that in the normal cortex tissues. We further evaluated the correlation of CD44 levels with patients’ overall survival in 4 available complete data sets in the R2 database, including 2 from The Cancer Genome Atlas (TCGA) database. We show that an elevated level of CD44 in GBM is associated with a short overall survival time although variations exist from cohort to cohort. In addition, we studied the effect of p53 status on CD44 expression, we reveal that CD44 level is higher in the GBMs carrying p53 mutation compared to those with wild-type p53. Taken together, these results indicate that CD44 could be a potential therapeutic target of GBM and the expression level of CD44 in the GBM may be an indicator of poor outcome for patients with GBM.
Citation Format: Fengfei Wang, Xin Shen, Jessica Pruszynski, Jason Huang, Batool Kirmani, Erxi Wu, Ekokobe Fonkem. CD44 as a potential therapeutic target and prognosis marker for glioblastoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 465.
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Affiliation(s)
| | - Xin Shen
- Baylor Scott & White Health, Temple, TX
| | | | | | | | - Erxi Wu
- Baylor Scott & White Health, Temple, TX
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Seago S, Hayek A, Pruszynski J, Newman MG. Change in prescription habits after federal rescheduling of hydrocodone combination products. Proc (Bayl Univ Med Cent) 2016; 29:268-70. [PMID: 27365868 DOI: 10.1080/08998280.2016.11929431] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Nationally, health care providers wrote 259 million prescriptions for narcotic analgesics in 2012, or roughly one bottle of narcotics per US adult (1). In an effort to combat this ever-growing problem, the Drug Enforcement Administration changed the schedule of hydrocodone combination products from schedule III to schedule II on October 6, 2014. Fourteen Baylor Scott & White pharmacies encompassing a 200-mile radius in Central Texas were queried for prescription information on hydrocodone/acetaminophen, morphine, codeine/acetaminophen, and tramadol before and after the rescheduling to evaluate trends in prescription drug usage. While the rescheduling of hydrocodone combination products resulted in a reduced number of prescriptions and the total quantity dispensed of both the hydrocodone/acetaminophen 5/325 mg (Norco 5/325) and 10/325 mg (Norco 10/325) formulations, this was offset by a dramatic increase in alternative narcotic analgesics such as tramadol, codeine/acetaminophen 30/300 mg (Tylenol #3), and codeine/acetaminophen 60/300 mg (Tylenol #4), which do not have schedule II requirements. Additionally, there was no significant reduction in total pain medication prescribed after converting all agents to morphine equivalents.
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Affiliation(s)
- Susan Seago
- Departments of Medicine (Seago, Newman), Pulmonary and Critical Care (Hayek), and Biostatistics (Pruszynski), Scott & White Memorial Hospital, Baylor Scott & White Health, Temple, Texas; and Texas A&M Health Sciences Center College of Medicine, Temple, Texas (Newman)
| | - Adam Hayek
- Departments of Medicine (Seago, Newman), Pulmonary and Critical Care (Hayek), and Biostatistics (Pruszynski), Scott & White Memorial Hospital, Baylor Scott & White Health, Temple, Texas; and Texas A&M Health Sciences Center College of Medicine, Temple, Texas (Newman)
| | - Jessica Pruszynski
- Departments of Medicine (Seago, Newman), Pulmonary and Critical Care (Hayek), and Biostatistics (Pruszynski), Scott & White Memorial Hospital, Baylor Scott & White Health, Temple, Texas; and Texas A&M Health Sciences Center College of Medicine, Temple, Texas (Newman)
| | - Megan Greene Newman
- Departments of Medicine (Seago, Newman), Pulmonary and Critical Care (Hayek), and Biostatistics (Pruszynski), Scott & White Memorial Hospital, Baylor Scott & White Health, Temple, Texas; and Texas A&M Health Sciences Center College of Medicine, Temple, Texas (Newman)
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32
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Hasan S, Arora D, Male E, Pruszynski J, Ord C, Bhat A, Rao A, Niloyjyoti D. Is axillary node dissection needed after mastectomy with positive sentinel nodes? J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.531] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Celine Ord
- University of Arizona College of Medicine, Phoenix, AZ
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Gaglani M, Pruszynski J, Murthy K, Clipper L, Robertson A, Reis M, Chung JR, Piedra PA, Avadhanula V, Nowalk MP, Zimmerman RK, Jackson ML, Jackson LA, Petrie JG, Ohmit SE, Monto AS, McLean HQ, Belongia EA, Fry AM, Flannery B. Influenza Vaccine Effectiveness Against 2009 Pandemic Influenza A(H1N1) Virus Differed by Vaccine Type During 2013-2014 in the United States. J Infect Dis 2016; 213:1546-56. [PMID: 26743842 DOI: 10.1093/infdis/jiv577] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/13/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The predominant strain during the 2013-2014 influenza season was 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09). This vaccine-component has remained unchanged from 2009. METHODS The US Flu Vaccine Effectiveness Network enrolled subjects aged ≥6 months with medically attended acute respiratory illness (MAARI), including cough, with illness onset ≤7 days before enrollment. Influenza was confirmed by reverse-transcription polymerase chain reaction (RT-PCR). We determined the effectiveness of trivalent or quadrivalent inactivated influenza vaccine (IIV) among subjects ages ≥6 months and the effectiveness of quadrivalent live attenuated influenza vaccine (LAIV4) among children aged 2-17 years, using a test-negative design. The effect of prior receipt of any A(H1N1)pdm09-containing vaccine since 2009 on the effectiveness of current-season vaccine was assessed. RESULTS We enrolled 5999 subjects; 5637 (94%) were analyzed; 18% had RT-PCR-confirmed A(H1N1)pdm09-related MAARI. Overall, the effectiveness of vaccine against A(H1N1)pdm09-related MAARI was 54% (95% confidence interval [CI], 46%-61%). Among fully vaccinated children aged 2-17 years, the effectiveness of LAIV4 was 17% (95% CI, -39% to 51%) and the effectiveness of IIV was 60% (95% CI, 36%-74%). Subjects aged ≥9 years showed significant residual protection of any prior A(H1N1)pdm09-containing vaccine dose(s) received since 2009, as did children <9 years old considered fully vaccinated by prior season. CONCLUSIONS During 2013-2014, IIV was significantly effective against A(H1N1)pdm09. Lack of LAIV4 effectiveness in children highlights the importance of continued annual monitoring of effectiveness of influenza vaccines in the United States.
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Affiliation(s)
- Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple
| | - Jessica Pruszynski
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple
| | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple
| | - Lydia Clipper
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple
| | - Anne Robertson
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple
| | - Michael Reis
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple
| | - Jessie R Chung
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | - Joshua G Petrie
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Suzanne E Ohmit
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | | | | | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia
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34
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Jhavar S, Pruszynski J, Fang-Hollingsworth Y, Vyas S, Arora D, Gestaut M, Olek D, Axelrud G, Hasan S, Ord C, Mutyala S, Deb N, Swanson G. Identifying Patients at High Risk for Local Relapse After Radical Nephrectomy for Nonmetastatic Renal Cell Carcinoma. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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35
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Arora D, Hasan S, Male E, Pruszynski J, Ord C, Rao A. Prognostic Factors Affecting Outcomes in Triple Negative Breast Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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36
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Jahoor A, Delmas T, Giri B, Murdoch L, Pruszynski J, Spradley C, Arroliga A, Ghamande S. Impact of Emergency Department Wait Time on Mortality in Severe Sepsis. Chest 2015. [DOI: 10.1378/chest.2271123] [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: 11/01/2022] Open
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37
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Dixon JL, Papaconstantinou HT, Pruszynski J, Rascoe PA, Reznik SI. Methicillin-Resistant Staphylococcus aureus Colonization and Empyema: Does it Matter? Surg Infect (Larchmt) 2015; 16:583-7. [DOI: 10.1089/sur.2014.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jennifer L. Dixon
- Department of Surgery, Scott and White Memorial Hospital, Temple, Texas
| | | | | | - Philip A. Rascoe
- Department of Surgery, Scott and White Memorial Hospital, Temple, Texas
| | - Scott I. Reznik
- Department of Surgery, Scott and White Memorial Hospital, Temple, Texas
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38
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DuMontier C, Rindfleisch K, Pruszynski J, Frey JJ. A multi-method intervention to reduce no-shows in an urban residency clinic. Fam Med 2013; 45:634-641. [PMID: 24136694] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Missed appointments can create financial, capacity, and continuity issues in primary care. An urban family medicine residency teaching clinic with a large culturally diverse population of low-income patients struggled for decades with a persistent no-show rate of 15%--17% despite multiple attempts to remind patients or otherwise address the problem. This study sought to measure the effects of a multi-method approach to decreasing the overall clinic no-show rate over time. METHODS A team of clinicians and staff undertook a systematic review of the literature to identify an approach to decreasing the number of no-show appointments while maintaining a commitment to the population and quality of care. The team implemented a three-stage process: an interview with the cohort of patients with the highest number of repeated no-show appointments, a double booking process for patients with a history of frequent missed appointments, and a change in the entire schedule to a modified advanced access schedule. RESULTS A cohort of 141 patients (2% of the practice population) accounted for almost 17% of the total missed appointments. The cohort differed from the overall clinic, being largely African American women on Medicaid with a large burden of medical comorbidities and a high prevalence of mental health issues. After the intervention, the rate of no-show appointments in the cohort fell from 33.3% to 17.7%, and the overall clinic rate fell from 10% to 7%; this decrease persisted for the 33-month observation period after the intervention and has been maintained to this date. The largest improvement in appointment keeping came after a modified advanced access schedule was implemented clinic-wide. CONCLUSIONS Indentifying a large at-risk population for no-shows and using a multi-method approach to addressing the issue can show persistent improvement and could be used in other residency training and community clinic settings.
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Bradley TG, Berzins DW, Valeri N, Pruszynski J, Eliades T, Katsaros C. An investigation into the mechanical and aesthetic properties of new generation coated nickel-titanium wires in the as-received state and after clinical use. Eur J Orthod 2013; 36:290-6. [PMID: 23873791 DOI: 10.1093/ejo/cjt048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND/OBJECTIVES The purpose of this study was to compare the mechanical, structural, and aesthetic properties of two types of aesthetic coated nickel-titanium (NiTi) wires compared with comparable regular NiTi wires in the as-received state and after clinical use. MATERIALS/METHODS Sixty one subjects were randomly assigned to four groups (N = 61), two groups of coated wires and two groups of comparable, non-coated controls (n = 15/group). The period in the mouth ranged from 4 to 12 weeks after insertion. In total, 121 wires (61 retrieved and 60 as-received) were used in the study. The percentages of coating retention and loss were extrapolated from scans. A brief survey of five questions with three choices was given to all patients. Differential scanning calorimetry (DSC) and three-point bending tests were done on as-received and used wires. RESULTS The surface characterization by the percentage of resin remaining indicated that most wires in both test groups lost a significant amount of coating. A patient survey indicated that this was a noticeable feature for patients. DSC analysis of the wires indicated that the metallurgical properties of the coated wires were not similar to the uncoated wires in the as-received condition. Three-point bending results indicate a wide variation in test results with large standard deviations among all the groups. LIMITATIONS The extent of coating loss requires investigating, as do the biological properties of the detached coating. CONCLUSIONS Both wires lost a significant amount of aesthetic coating after varying periods in the mouth. The metallurgical testing of these findings may indicate that these wires perform differently in the mouth.
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Affiliation(s)
- T Gerard Bradley
- *Department of Developmental Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA,
| | - David W Berzins
- *Department of Developmental Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA
| | - Nicholas Valeri
- *Department of Developmental Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA
| | - Jessica Pruszynski
- **Division of Biostatistics, Medical College of Wisconsin, Milwaukee, USA
| | - Theodore Eliades
- ***Department of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - Christos Katsaros
- ****Department of Orthodontics and Dentofacial Orthopedics, Medical School, University of Bern, Switzerland
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Belknap RA, Haglund K, Felzer H, Pruszynski J, Schneider J. A theater intervention to prevent teen dating violence for Mexican-American middle school students. J Adolesc Health 2013; 53:62-7. [PMID: 23583507 DOI: 10.1016/j.jadohealth.2013.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 02/03/2013] [Accepted: 02/04/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To test a theater intervention designed to raise awareness of the dynamics and consequences of teen dating violence (TDV) and to facilitate creation of nonviolent responses to TDV among Latino and Latina adolescents. The intervention was based on Theater of the Oppressed, which advocates the use of theater methods to explore social issues and to allow audiences to experiment with problem-solving, thereby promoting change. METHODS This study used a pretest-posttest, no control group, mixed-measures design to study 66 Mexican-American adolescents (mean age, 13.4 ± 5 years). Two plays containing subtle and overt signs of control and abuse were written and performed. Scripts were based on data from prior studies of TDV among Latino and Latina adolescents. At baseline, we measured sociodemographics, personal safety, and ethnic identity. Pre-post instruments measured acceptance of TDV, confidence to resolve conflicts nonviolently, and intentions to use nonviolent strategies to resolve conflict. We collected qualitative data via essay. RESULTS At posttest, participants had less acceptance of TDV (t = -2.08; p < .05), increased confidence to resolve conflicts nonviolently (t = 3.82; p < .001), and higher intentions to use nonviolent strategies (t = 3.35; p = .001). We analyzed 20 essays. Qualitative results provided context for understanding participants' changes in attitude, confidence, and nonviolent behavioral intentions. CONCLUSIONS This adaptation of Theater of the Oppressed was an effective way to interact with Latino adolescents. In a safe setting, participants vicariously experienced TDV, which facilitated self-reflection and cognitive rehearsal strategies to respond nonviolently to TDV.
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Affiliation(s)
- Ruth Ann Belknap
- College of Nursing, Marquette University, Milwaukee, WI 53201-1881, USA
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41
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Mollov N, Bosio JA, Pruszynski J, Wirtz T. Intra- and inter-examiner reliability of direct facial soft tissue measurements using digital calipers. J World Fed Orthod 2012. [DOI: 10.1016/j.ejwf.2012.10.002] [Citation(s) in RCA: 2] [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: 10/27/2022]
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42
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Bratt MM, Baernholdt M, Pruszynski J. Are rural and urban newly licensed nurses different? A longitudinal study of a nurse residency programme. J Nurs Manag 2012; 22:779-91. [PMID: 25208945 DOI: 10.1111/j.1365-2834.2012.01483.x] [Citation(s) in RCA: 28] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2012] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to compare rural and urban nurse residency programme participants' personal and job characteristics and perceptions of decision-making, job satisfaction, job stress, nursing performance and organisational commitment over time. BACKGROUND Nurse residency programmes are an evolving strategy to foster transition to practice for new nurses. However, there are limited data available for programme outcomes particularly for rural nurses. METHOD A longitudinal design sampled 382 urban and 86 rural newly licensed hospital nurses during a 12-month nurse residency programme. Data were collected at the start of the programme, at 6 months and the end of the programme. RESULTS At the end of the programme, rural nurses had significantly higher job satisfaction and lower job stress compared with urban nurses. Across all time-periods rural nurses had significantly lower levels of stress caused by the physical work environment and at the end of the programme had less stress related to staffing compared with urban nurses. Perceptions of their organisational commitment and competency to make decisions and perform role elements were similar. CONCLUSIONS Differences in these outcomes may be result from unique characteristics of rural vs. urban nursing practice that need further exploration. IMPLICATIONS FOR NURSING MANAGEMENT Providing a nurse residency programme in rural and urban hospitals can be a useful recruitment and retention strategy.
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Edwards LM, Haglund K, Fehring RJ, Pruszynski J. Religiosity and Sexual Risk Behaviors Among Latina Adolescents: Trends from 1995 to 2008. J Womens Health (Larchmt) 2011; 20:871-7. [DOI: 10.1089/jwh.2010.1949] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [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)
- Lisa M. Edwards
- Department of Counselor Education and Counseling Psychology, Marquette University, Milwaukee, Wisconsin
| | - Kristin Haglund
- College of Nursing, Marquette University, Milwaukee, Wisconsin
| | | | - Jessica Pruszynski
- College of Nursing, Marquette University, Milwaukee, Wisconsin
- Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
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