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Makkar S, Béguin M, Dissertori G, Flock J, Fuentes C, Gajewski J, Hrbacek J, McNamara K, Ritzer C, Rucinski A, Weber D, Lomax A, Winterhalter C. PO-1602 Image reconstruction using the PETITION PET scanner aimed at biologically guided proton therapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03566-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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2
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Ingemann D, McNamara K. 273: Hope for the future: Optimism among patients using elexacaftor/tezacaftor/ivacaftor treatment of cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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3
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Tishberg M, Yeates S, McNamara K, Hayes S. CP01.04 Biomarker Testing Among Users of Online Lung Cancer Resources - Can Online Communities Make a Clinical Impact? J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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4
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Boland L, Brosseau L, Caspar S, Graham ID, Hutchinson AM, Kothari A, McNamara K, McInnes E, Angel M, Stacey D. Reporting health research translation and impact in the curriculum vitae: a survey. Implement Sci Commun 2020; 1:20. [PMID: 32885181 PMCID: PMC7427883 DOI: 10.1186/s43058-020-00021-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/10/2020] [Indexed: 11/12/2022] Open
Abstract
Background Increasingly, health researchers must demonstrate the impact and real-life applications of their research. We investigated how health researchers with expertise in knowledge translation report research translation activities and impact on their curriculum vitae (CV). Methods We conducted a cross-sectional survey of health researchers with expertise in knowledge translation as we anticipated best practices in CV reporting from this specialized group. Our survey asked participants about their reporting of research translation and impact activities on their CVs, intention to report, and barriers and facilitators to reporting such activities on their CVs. We calculated univariate descriptive statistics for all quantitative data. Linear regression models determined predictors of researchers’ intention to report research translation and impact activities on their CVs. We analyzed open-ended qualitative responses using content analysis. Results One hundred and fifty-three health researchers responded to the survey (response rate = 29%). Most respondents were Canadian, were female, and had a doctoral degree. Eighty-two percent indicated they reported at least one research translation and/or impact indicator on their CVs. Of those, health researchers commonly reported the following: advisory/regulatory committee membership related to research program (83%), research translation award(s) (61%), and academic performance assessments (59%). Researchers least commonly indicated the following: citation metric scores (31%), summaries of impact (21%), and requests to use research materials and/or products (19%). Fewer than half of the health researchers intended to report knowledge translation (43%) and impact (33%) on their CVs. Strong beliefs about capabilities and consequences of reporting research translation and/or impact were significant predictors of intention. Main barriers were as follows: CV templates do not include research translation and impact activities, participants perceived employers do not value research translation and impact activities, and lack of metrics to evaluate research translation and impact. Ninety-six percent were unaware of a CV template formatted to include research translation and/or impact reporting. Conclusions Knowledge translation and impact indicators on the CV are inconsistently reported by our sample of health researchers. Modifiable barriers should be addressed to support more consistent reporting of such activities, including providing a CV template that includes research translation and impact as well as clear metrics to quantify them.
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Affiliation(s)
- L Boland
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada.,School of Health Studies, Western University, 1151 Richmond Street, London, ON N6A 3K7 Canada
| | - L Brosseau
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8M5 Canada
| | - S Caspar
- Faculty of Health Sciences-Therapeutic Recreation Program, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4 Canada
| | - I D Graham
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health Faculty of Medicine, University of Ottawa, 307D-600 Peter Morand Cresent, Ottawa, ON K1G 5Z3 Canada.,School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - A M Hutchinson
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC Australia.,Monash Health, Clayton, VIC Australia
| | - A Kothari
- School of Health Studies, Western University, 1151 Richmond Street, London, ON N6A 3K7 Canada
| | - K McNamara
- School of Medicine, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - E McInnes
- Nursing Research Institute St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Daniel Mannix Building, Australian Catholic University Fitzroy, Fitzroy, VIC Australia
| | - M Angel
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - D Stacey
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada.,School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
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Sheppard JP, Tucker KL, Davison WJ, Stevens R, Aekplakorn W, Bosworth HB, Bove A, Earle K, Godwin M, Green BB, Hebert P, Heneghan C, Hill N, Hobbs FDR, Kantola I, Kerry SM, Leiva A, Magid DJ, Mant J, Margolis KL, McKinstry B, McLaughlin MA, McNamara K, Omboni S, Ogedegbe O, Parati G, Varis J, Verberk WJ, Wakefield BJ, McManus RJ. Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis. Am J Hypertens 2020; 33:243-251. [PMID: 31730171 PMCID: PMC7162426 DOI: 10.1093/ajh/hpz182] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. METHODS A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis. RESULTS A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (−3.12 mm Hg, [95% confidence intervals −4.78, −1.46 mm Hg]; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P < 0.001 for all outcomes), and possibly stroke (P < 0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease. CONCLUSIONS Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions.
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Affiliation(s)
- J P Sheppard
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - K L Tucker
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - W J Davison
- Ageing and Stroke Medicine, Norwich Medical School, University of East Anglia, United Kingdom
| | - R Stevens
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - W Aekplakorn
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University Bangkok, Thailand
| | - H B Bosworth
- Center for Health Services Research in Primary Care, Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - A Bove
- Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - K Earle
- Thomas Addison Diabetes Unit, St. George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - M Godwin
- Family Medicine, Memorial University of Newfoundland, St. John’s, Canada
| | - B B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - P Hebert
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | - C Heneghan
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - N Hill
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - F D R Hobbs
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - I Kantola
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - S M Kerry
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - A Leiva
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Mallorca, Spain
| | - D J Magid
- Colorado School of Public Health, University of Colorado, Denver, Colorado, USA
| | - J Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - K L Margolis
- HealthPartners Institute, Minneapolis, Minnesota, USA
| | - B McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - M A McLaughlin
- Icahn School of Medicine at Mount Sinai New York, New York, New York, USA
| | - K McNamara
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- School of Medicine, Deakin University, Geelong, Australia
| | - S Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - O Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, Langone School of Medicine, New York University, New York, USA
| | - G Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - J Varis
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - W J Verberk
- Cardiovascular Research Institute Maastricht and Departments of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - B J Wakefield
- Department of Veterans (VA) Health Services Research and Development Centre for Comprehensive Access and Delivery Research and Evaluation (CADRE), VA Medical Centre, Iowa City, USA
| | - R J McManus
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
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McNamara K, Hofmann L, Kothary N. 3:54 PM Abstract No. 214 Then and now: female involvement in establishing clinical practice guidelines. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.255] [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] Open
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Caswell-Jin JL, McNamara K, Reiter JG, Sun R, Hu Z, Ma Z, Suarez CJ, Tilk S, Raghavendra A, Forte V, Chin SF, Bardwell H, Provenzano E, Caldas C, Lang J, West R, Tripathy D, Press MF, Curtis C. Abstract P3-06-01: Clonal evolution and heterogeneity in breast tumors treated with neoadjuvant HER2-targeted therapy. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-06-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Understanding to what extent a breast tumor's genetic composition may change over the course of a few months of neoadjuvant therapy has implications for optimal therapeutic approach. However, genomic changes observed across treatment may result from either treatment-induced clonal evolution or geographically disparate sampling of a heterogeneous tumor. We sought to characterize the geographic heterogeneity in primary breast tumors, and to incorporate this information into analysis of clonal evolution with neoadjuvant therapy.
Methods: We assembled the largest cohort to date of multi-region (n=2-3) whole-exome sequenced (WES) or whole-genome sequenced untreated primary breast tumors with matched normal and adequate tumor purity for analysis: four tumors with data generated for this study and five tumors compiled from three previous studies. We also generated the first cohort of multi-region (n=2-6) WES breast tumors post-neoadjuvant HER2-targeted therapy and chemotherapy, sequencing one region from a pre-treatment diagnostic specimen, multiple regions from the post-treatment surgical specimen, and matched normal for five HER2+ breast tumors that did not achieve a pathologic complete response. We used an agent-based model of spatial tumor growth to investigate whether the mutational patterns we observed with treatment were consistent with pre-existing heterogeneity or treatment-induced selection.
Results: In untreated primary breast tumors, on average 30% (range 1-70%) of apparently clonal mutations from a single region were absent or rare in a second, spatially disparate region (high-frequency regional, or HFR). Intra-tumor heterogeneity was similar post-treatment (HFR 28%, range 10-54%), and was higher in breast tumors than in previously analyzed colon, brain, lung, and esophageal tumors. Simulation studies confirmed that with high heterogeneity as observed in breast tumors, analysis of one pre-treatment and one post-treatment region could not distinguish treatment-induced clonal evolution from pre-existing heterogeneity; however, obtaining at least two post-treatment regions allowed for detection of clonal shifts with treatment. Analysis of multi-region data revealed that clonal replacement occurred with neoadjuvant therapy in two of the five tumors. Candidate causes of therapeutic resistance included amplifications in CCND1, ERBB4, and MYC in one subclone, and functional protein-altering mutations in ERCC2, SMO, and WT1 in another. Mathematical modeling suggested that these putative resistant subclones comprised 0.02-12.5% of the overall pre-treatment cell population, substantially larger than previous estimates of resistant tumor clone size.
Conclusions: WES data from multiple regions of untreated and treated primary breast tumors revealed considerable heterogeneity that remained present throughout treatment with chemotherapy and HER2-targeted therapy, even while major clonal sweeps took place in a minority of tumors. Obtaining at least two samples for analysis from breast tumors post-neoadjuvant therapy may reveal the tumor's evolutionary path and, especially as increasing numbers of molecular and immune therapeutic targets are identified, inform new clinical strategies.
Citation Format: Caswell-Jin JL, McNamara K, Reiter JG, Sun R, Hu Z, Ma Z, Suarez CJ, Tilk S, Raghavendra A, Forte V, Chin S-F, Bardwell H, Provenzano E, Caldas C, Lang J, West R, Tripathy D, Press MF, Curtis C. Clonal evolution and heterogeneity in breast tumors treated with neoadjuvant HER2-targeted therapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-06-01.
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Affiliation(s)
- JL Caswell-Jin
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - K McNamara
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - JG Reiter
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - R Sun
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Z Hu
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Z Ma
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - CJ Suarez
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - S Tilk
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - A Raghavendra
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - V Forte
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - S-F Chin
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - H Bardwell
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - E Provenzano
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - C Caldas
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - J Lang
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - R West
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - D Tripathy
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - MF Press
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - C Curtis
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Leonard K, Robertson C, Hayes S, McNamara K. P2.15-15 Differentiating Characteristics of Patients Seeking a Second Opinion: A Survey on Non-Small Cell Lung Cancer Patients. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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McNamara K, O'Donoghue K, Greene RA. Intrapartum fetal deaths and unexpected neonatal deaths in the Republic of Ireland: 2011 - 2014; a descriptive study. BMC Pregnancy Childbirth 2018; 18:9. [PMID: 29301489 PMCID: PMC5755435 DOI: 10.1186/s12884-017-1636-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intrapartum fetal death, the death of a fetus during labour, is a tragic outcome of pregnancy. The intrapartum death rate of a country is reflective of the care received by mothers and babies in labour and it is through analysing these cases that good aspects of care, as well as areas for improvement can be identified. Investigating unexpected neonatal deaths that may be associated with an intrapartum event is also helpful to fully appraise intrapartum care. This is a descriptive study of intrapartum fetal deaths and unexpected neonatal deaths in Ireland from 2011 to 2014. METHODS Anonymised data pertaining to all intrapartum fetal deaths and unexpected neonatal deaths for the study time period was obtained from the national perinatal epidemiology centre. All statistical analyses were conducted using Statistical package for the Social Sciences (SPSS). RESULTS There were 81 intrapartum fetal deaths from 2011 to 2014, and 36 unexpected neonatal deaths from 2012 to 2014. The overall intrapartum death rate was 0.29 per 1000 births and the corrected intrapartum fetal death rate was 0.16 per 1000 births. The overall unexpected neonatal death rate was 0.17 per 1000 live births. Major Congenital Malformation accounted for 36/81 intrapartum deaths, chorioamnionitis for 18/81, and placental abruption accounted for eight babies' deaths. Intrapartum asphyxia accounted for eight of the intrapartum deaths. With respect to the neonatal deaths over half (21/36, 58.3%) of the babies died as a result of hypoxic ischaemic encephalopathy. Information is also reported on both maternal and individual baby demographics. CONCLUSIONS This is the first detailed descriptive analysis of intrapartum deaths and unexpected intrapartum event related neonatal deaths in Ireland. The corrected intrapartum fetal death rate was 0.16 per 1000 births. Despite our results being based on the best available national data on intrapartum deaths and unexpected neonatal deaths, we were unable to identify if any of these deaths could have been prevented. A more formal confidential inquiry based system is necessary to fully appraise these cases.
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Affiliation(s)
- K McNamara
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland. .,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, 5th Floor, Wilton, Cork, Ireland.
| | - K O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - R A Greene
- The National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
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Jatana C, Mallery S, McNamara K, Harrington C, Crock E, Emam H. Evaluation of 3% Diclofenac Sodium Gel's Effect on Oral Lichenoid Atypia. J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.joms.2017.07.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hayes-Ryan D, McNamara K, Russell N, Kenny L, O'Donoghue K. Maternity Ultrasound in the Republic of Ireland 2016; A Review. Ir Med J 2017; 110:598. [PMID: 29341510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Antenatal ultrasound, comprising of a dating ultrasound in the late first trimester followed by a fetal anomaly scan, is a recognised and necessary component of good antenatal care. We conducted a telephone survey of all 19 obstetric units to ascertain the status of maternity ultrasound provision in Ireland. Fetal anomaly ultrasound is offered universally to all women in 7/19 (37%) units, selectively to some women in 7/19 (37%) units and not offered at all in the remaining 5/19 (26%) units. Overall ? 41,700 (64%) women receive a fetal anomaly ultrasound nationally. Universal first trimester ultrasound, performed in a dedicated ultrasound department by a suitably qualified sonographer, is offered to 47% of women nationally. This study highlights the lack of development in Irish maternity ultrasound services over the last decade. Substantial investment by health care policy makers is urgently needed.
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Affiliation(s)
- D Hayes-Ryan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork
- Cork University Maternity Hospital, Wilton, Cork
| | - K McNamara
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork
- Cork University Maternity Hospital, Wilton, Cork
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork
| | - N Russell
- Cork University Maternity Hospital, Wilton, Cork
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork
| | - L Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork
- Cork University Maternity Hospital, Wilton, Cork
| | - K O'Donoghue
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork
- Cork University Maternity Hospital, Wilton, Cork
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork
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Tajaesu M, Tamaki K, Nagamine S, Kamada Y, Uehara K, Arakaki M, Tamatsu Y, Yamashiro K, Miyashita M, Ishida T, Ohuchi N, McNamara K, Terukina S, Sasano H, Tamaki N. Abstract P5-12-01: Randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-12-01] [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
Purpose: Arthralgia sometimes occurs in the breast cancer patients treated with aromatase inhibitors (AIs). It is one of the most important reasons for poor AIs adherence.
Background; The HOPE study previously demonstrated that exercise was effective in improving AI-induced arthralgia in breast cancer patients. However, recruitment to this study was limited to severe cases (Criteria; physically inactive, >6 months AT treatment, >2 months arthralgia). To asses if these findings were more generalizable to all breast cancer contexts we conducted a randomized trial of exercise intervention using wider eligibility criteria that the hope study to assess the impact on AI induced arthralgia in breast cancer patients.
Methods: We examined Japanese breast cancer patients operated at Nahanishi Clinic, Okinawa, Japan. Following the informed consent the patients were randomly assigned to a 3:1 ratio to exercise intervention or usual care, . Eligibility criteria included receiving an AI for 0-4 years, no metastases, any arthralgia level and any exercise habits. Following randomization participants could choose from 3 types of exercise including strong (120-150 minutes per week of walking or running), intermediate (gentle calisthenics (daily NIPPON HOSO KYOKAI: NHK broadcast exercise)) and weak (going up the stairs- frequency). Arthralgia was assessed using the Brief Pain Inventory (BPI), in which the patients completed a baseline, 6month and 12 month BPI assessment. Primary endpoint was BPI change at 12 months.
Results: Among 227 women screened, we randomized 108 women, with 80 to exercise intervention (46 of strong, 19 of intermediate and 15 of weak) and 28 to usual care. Base line BPI were well balanced between exercise intervention and usual care. Overall exercise intervention reduced BPI scores relative to control. The BPI changes of worst pain, least pain, average pain and pain right now were 0.09, -0.25, -0.14 and 0 for exercise intervention group and 0.21, 0.46, 0.07 and 0.61 for usual care group, respectively. There was a statistically significant difference of AIs adherence between exercise intervention group (99%) and usual care group (92%) (P=0.03).
Conclusion: Exercise intervention tends to improve the AI-induced arthralgia and has a positive effect on AIs adherence.
Citation Format: Tajaesu M, Tamaki K, Nagamine S, Kamada Y, Uehara K, Arakaki M, Tamatsu Y, Yamashiro K, Miyashita M, Ishida T, Ohuchi N, McNamara K, Terukina S, Sasano H, Tamaki N. Randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-12-01.
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Affiliation(s)
- M Tajaesu
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - K Tamaki
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - S Nagamine
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - Y Kamada
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - K Uehara
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - M Arakaki
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - Y Tamatsu
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - K Yamashiro
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - M Miyashita
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - T Ishida
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - N Ohuchi
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - K McNamara
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - S Terukina
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - H Sasano
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
| | - N Tamaki
- Nahanishi Clinic Okinawa, Naha, Okinawa, Japan; Tohoku University, Sendai, Miyagi, Japan
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O'Brien D, Geoghegan A, McNamara K, Shalloo L. How can grass-based dairy farmers reduce the carbon footprint of milk? Anim Prod Sci 2016. [DOI: 10.1071/an15490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Irish dairy industry aims to increase milk production from grass-based farms following the removal of the EU milk-quota system, but is also required to minimise greenhouse gas (GHG) emissions to meet European reduction targets. Consequently, the sector is under increasing pressure to reduce GHG emissions per unit of milk, or carbon footprint (CF). Therefore, the goal of the present study was to determine the main sources of the CF of grass-based milk production and to identify mitigation strategies that can be applied to reduce farm footprints. In total, the CF of milk was estimated for 62 grass-based dairy farms in 2014. The method used to quantify GHG emissions was a life cycle assessment (LCA), independently certified to comply with the British standard for LCA (PAS 2050). The LCA method was applied to calculate annual on- and off-farm GHG emissions associated with dairy production until milk was sold from the farm in CO2-equivalent (CO2-eq). Annual GHG emissions computed using LCA were allocated to milk on the basis of the economic value of dairy products and expressed per kilogram of fat- and protein-corrected milk to estimate CF. Enteric methane was the main source of the CF of milk (46%), followed by emissions from inorganic N fertilisers (16%), manure (16%) and concentrate feedstuffs (8%). The mean CF of milk from the 62 farms was 1.26 kg of CO2-eq per kilogram of fat- and protein-corrected milk, but varied from 0.98 kg to 1.67 kg as measured using the 95% confidence interval. The CF of milk was correlated with numerous farm attributes, particularly N-fertiliser, the percentage of grazed grass in the diet, and production of milk solids. Grass-based dairy farmers can significantly improve these farm attributes by increasing herd genetic merit, extending the length of the grazing season and optimising N fertiliser use and, thereby, reduce the CF of milk.
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McNamara K, Isbister GK. Hyperlactataemia and clinical severity of acute metformin overdose. Intern Med J 2015; 45:402-8. [DOI: 10.1111/imj.12713] [Citation(s) in RCA: 16] [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] [Received: 10/15/2014] [Accepted: 02/02/2015] [Indexed: 11/29/2022]
Affiliation(s)
- K. McNamara
- Department of Clinical Toxicology and Pharmacology; Calvary Mater Newcastle; Newcastle New South Wales Australia
| | - G. K. Isbister
- Department of Clinical Toxicology and Pharmacology; Calvary Mater Newcastle; Newcastle New South Wales Australia
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
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Goldstein JN, Brouwers HB, Romero JM, McNamara K, Schwab K, Greenberg SM, Rosand J. SCORE-IT: the Spot Sign score in restricting ICH growth─an Atach-II ancillary study. J Vasc Interv Neurol 2012; 5:20-5. [PMID: 23230461 PMCID: PMC3517028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The ATACH-II trial is designed to evaluate whether intensive blood pressure reduction can reduce hematoma growth and improve outcome. However, it is difficult to determine, at presentation, which patients are at highest risk of ongoing bleeding, and will receive the most clinical benefit from blood pressure therapy. It may be that improved predictive markers will lead to efficient, personalized selection of optimal therapy. We hypothesize that specific imaging findings on CT angiography (CTA) and MRI will mark those patients who receive the most benefit from intensive blood pressure reduction. METHODS Many patients enrolled in ATACH-II will undergo CTA and/or MRI as part of routine clinical care. We will perform a blinded analysis of these images. For CTA, we will determine the presence of contrast pooling (also termed contrast extravasation or the "Spot Sign"). In addition, we will calculate a Spot Sign Score, a score that includes number of Spot Signs, diameter, and contrast density. For MRI, we will focus on the presence, number, and location of cerebral microbleeds (CMBs) on sensitive T2*-weighted MRI sequences. RESULTS We will test the hypothesis that patients with a Spot Sign will receive clinical benefit from intensive blood pressure reduction. In addition, we will determine whether patients with the highest Spot Sign Scores receive the most benefit from intensive blood pressure reduction. Finally, we will determine whether the absence of CMBs marks those at higher risk for hematoma expansion, and therefore more likely to benefit from treatment. CONCLUSION This ancillary study offers the tremendous opportunity to determine whether imaging findings can risk stratify ICH patients for acute therapies aimed at limiting hematoma growth.
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Affiliation(s)
- JN Goldstein
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA 02114, USA
| | - HB Brouwers
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - JM Romero
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA 02114, USA
| | - K McNamara
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
| | - K Schwab
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
| | - SM Greenberg
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - J Rosand
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Neuroradiology Service, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Abstract
There is ample evidence in the international literature for pharmacist involvement in the prevention and management of cardiovascular disease (CVD) conditions in primary care. Systematic reviews and meta-analyses have confirmed the significant clinical benefits of pharmacist interventions for a range of CVD conditions and risk factors. Evidence generated in research studies of Australian community pharmacist involvement in CVD prevention and management is summarised in this article.Commonwealth funding through the Community Pharmacy Agreements has facilitated research to establish the feasibility and effectiveness of new models of primary care involving community pharmacists. Australian community pharmacists have been shown to effect positive clinical, humanistic and economic outcomes in patients with CVD conditions. Improvements in blood pressure, lipid levels, medication adherence and CVD risk have been demonstrated using different study designs. Satisfaction for GPs, pharmacists and consumers has also been reported. Perceived 'turf' encroachment, expertise of the pharmacist, space, time and remuneration are challenges to the implementation of disease management services involving community pharmacists.
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Affiliation(s)
- J George
- Centre for Medicine Use and Safety, Monash University, Australia
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21
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Ley-Hui Tan M, McNamara K, Azam A, Carmichael A. An Audit of Practice: Advanced Breast Cancer Treated Solely with Endocrine Therapy. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.03.084] [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] Open
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Simon NM, McNamara K, Chow CW, Maser RS, Papakostas GI, Pollack MH, Nierenberg AA, Fava M, Wong KK. A detailed examination of cytokine abnormalities in Major Depressive Disorder. Eur Neuropsychopharmacol 2008; 18:230-3. [PMID: 17681762 PMCID: PMC2267745 DOI: 10.1016/j.euroneuro.2007.06.004] [Citation(s) in RCA: 217] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 06/19/2007] [Indexed: 12/13/2022]
Abstract
Recent technological advances offer an opportunity to further elucidate the complex cytokine network in Major Depressive Disorder (MDD). Twenty cytokines were simultaneously assessed in 49 individuals with MDD and 49 age and gender matched controls. Multiple pro-inflammatory and two anti-inflammatory cytokines were significantly elevated in the MDD sample, including an antidepressant naïve subset. These data support a generalized chronic inflammatory state in MDD, and implicate additional cytokines and chemokines previously linked to cardiovascular disease.
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Affiliation(s)
- N M Simon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Minehan KJ, Groshek D, McNamara K, Mitchell E, Emme M, Price M, Davis B. An analysis quantifies prostate brachytherapy swelling using peripheral seeds as fiducial reference points. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15639] [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: 11/20/2022] Open
Abstract
15639 Background: Permanent prostate brachytherapy (PPB) assesses implant quality but may suffer significant variability due to: 1) Prostate edema may occur during the procedure which usually subsides within several months, and 2) interobserver variability of CT- derived prostate volumes. An analysis is described, which uses the seeds as prostate fiducials to produce an implant reference volume (IRV). The ratio of the IRV volumes at day 0 and day 33 provides a unique way to quantify prostate edema; thus reducing this factor as a source of variability. Methods: Thirteen low risk prostate cancer patients, (Stage ≤ T2, PSA<13.9, Gleason Score ≤7) were implanted with 125Iodine seeds (77% stranded; prescription dose of 145 Gy). PPB was completed for each patient on day 0 and 33 ±3 days following the implant. The IRV was defined as the volume obtained by contouring the outer most peripheral seeds, circumferentially, on each axial image, resulting in a 3D volume. Contouring was performed by three separate investigators (KJM, DCG, EKM), who were blinded with respect to patient identification. The IRV's were compared both by investigator and by time of PPB (day 0 vs. day 33). The radiation dose encompassing 90% (D90) of the IRV and Prostate (PST) was calculated and compared . Results: The IRVs contoured were reproducible between the investigators with a maximum mean difference of .56 (SD .33) cc. There was no statistical difference between any of the investigators contoured volume (minimum Spearman correlation was 0.978). The average IRV was significantly larger on day 0 (Avg. 52.7;SD 19.7 cc) compared to day 33 (Avg. 44.6; SD 19.1 cc) (p<0.001). The day 0 IRV was an average of 1.18 times larger than the Day 33 PRV. There was no difference between either the day 0 D90PST (Avg.149.1; SD18.7 cGy) vs the day 0 D90IRV (Avg.149.8, SD 27.5 cGy) (p=.442) nor between the day 33 D90PST (Avg.163.7; SD22.7 cGy) vs the day 33 D90IRV (Avg.166.6, SD 30.3 cGy) (p=.257). Both the D90IRV and D90PST were significantly different at day 0 vs 33 (p=.0003, p=<.0001 respectively). Conclusions: The IRV analysis demonstrates no significant interobserver variability, provides accurate quantification of prostate swelling after PPB, and is an accurate objective surrogate analysis for PSI quality. No significant financial relationships to disclose.
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Affiliation(s)
- K. J. Minehan
- Mayo Clinic, Rochester, MN; Fransican Skemp Healthcare Mayo Health System, LaCrosse, WI
| | - D. Groshek
- Mayo Clinic, Rochester, MN; Fransican Skemp Healthcare Mayo Health System, LaCrosse, WI
| | - K. McNamara
- Mayo Clinic, Rochester, MN; Fransican Skemp Healthcare Mayo Health System, LaCrosse, WI
| | - E. Mitchell
- Mayo Clinic, Rochester, MN; Fransican Skemp Healthcare Mayo Health System, LaCrosse, WI
| | - M. Emme
- Mayo Clinic, Rochester, MN; Fransican Skemp Healthcare Mayo Health System, LaCrosse, WI
| | - M. Price
- Mayo Clinic, Rochester, MN; Fransican Skemp Healthcare Mayo Health System, LaCrosse, WI
| | - B. Davis
- Mayo Clinic, Rochester, MN; Fransican Skemp Healthcare Mayo Health System, LaCrosse, WI
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Wong KK, Maser RS, Sahin E, Bailey ST, Xia H, Ji H, McNamara K, Naylor M, Bronson RT, Ghosh S, Welsh R, DePinho RA. Diminished lifespan and acute stress-induced death in DNA-PKcs-deficient mice with limiting telomeres. Oncogene 2006; 26:2815-21. [PMID: 17072335 DOI: 10.1038/sj.onc.1210099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An adequate and appropriate response to physiological and pathophysiological stresses is critical for long-term homeostasis and viability of the aging organism. Previous work has pointed to the immune system, telomeres and DNA repair pathways as important and distinct determinants of a normal healthy lifespan. In this study, we explored the genetic interactions of telomeres and DNA-PKcs, a protein involved in non-homologous end-joining (NHEJ) and immune responses, in the context of a key aspect of aging and lifespan--the capacity to mount an acute and appropriate immune-mediated stress response. We observed that the combination of DNA-PKcs deficiency and telomere dysfunction resulted in a shortened lifespan that was reduced further following viral infection or experimental activation of the innate immune response. Analysis of the innate immune response in the DNA-PKcs-deficient mice with short dysfunctional telomeres revealed high basal serum levels of tumor necrosis factor alpha (TNFalpha) and hyper-active cytokine responses upon challenge with polyinosinic-polycytidylic acid (poly-IC). We further show that serum cytokine levels become elevated in telomere dysfunctional mice as a function of age. These results raise speculation that these genetic factors may contribute to misdirected immune responses of the aged under conditions of acute and chronic stress.
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Affiliation(s)
- K-K Wong
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02115, USA
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Ji H, Houghton AM, Mariani TJ, Perera S, Kim CB, Padera R, Tonon G, McNamara K, Marconcini LA, Hezel A, El-Bardeesy N, Bronson RT, Sugarbaker D, Maser RS, Shapiro SD, Wong KK. K-ras activation generates an inflammatory response in lung tumors. Oncogene 2006; 25:2105-12. [PMID: 16288213 DOI: 10.1038/sj.onc.1209237] [Citation(s) in RCA: 212] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Activating mutations in K-ras are one of the most common genetic alterations in human lung cancer. To dissect the role of K-ras activation in bronchial epithelial cells during lung tumorigenesis, we created a model of lung adenocarcinoma by generating a conditional mutant mouse with both Clara cell secretory protein (CC10)-Cre recombinase and the Lox-Stop-Lox K-ras(G12D) alleles. The activation of K-ras mutant allele in CC10 positive cells resulted in a progressive phenotype characterized by cellular atypia, adenoma and ultimately adenocarcinoma. Surprisingly, K-ras activation in the bronchiolar epithelium is associated with a robust inflammatory response characterized by an abundant infiltration of alveolar macrophages and neutrophils. These mice displayed early mortality in the setting of this pulmonary inflammatory response with a median survival of 8 weeks. Bronchoalveolar lavage fluid from these mutant mice contained the MIP-2, KC, MCP-1 and LIX chemokines that increased significantly with age. Cell lines derived from these tumors directly produced MIP-2, LIX and KC. This model demonstrates that K-ras activation in the lung induces the elaboration of inflammatory chemokines and provides an excellent means to further study the complex interactions between inflammatory cells, chemokines and tumor progression.
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Affiliation(s)
- H Ji
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02115, USA
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26
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Minehan KJ, Furutani K, McNamara K, Groshek D, Mitchell E, Price M, Emme M, Harms T. Prostate brachytherapy post implant dosimetry: Timing matters. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14597] [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: 11/20/2022] Open
Abstract
14597 Background: Permanent seed implant (PSI) brachytherapy is a common treatment modality for low-risk prostate cancer. Post implant dosimetry (PID) is utilized to asses the quality of the implant. Significant prostate swelling occurs as a result of the implant procedure, and this swelling subsides over time. PID completed on Day 0 after the implant procedure captures the prostate swelling from the procedure. Conversely, PID completed one month later does not have this swelling. PID can therefore show great variation, depending on the timing of the analysis. It is hypothesized that PID completed on Day 0 demonstrates lower dosimetric parameters than PID completed one month later. Methods: Thirteen low risk prostate cancer patients, (Stage ≤ T2, PSA < 13.9, Gleason Score ≤7) were implanted with 125Iodine seeds, with a prescription dose of 145Gy to the prostate plus a 5mm margin. Computed Tomography (CT) PID was completed for each patient on day 0 and on average 33 days following the implant. The prostate was contoured on each axial CT image and the data was analyzed using commercially available PSI planning software. The dose which encompassed 90% of the prostate volume (D90) was calculated for day 0 and day 33 PID. Results: On average, the prostate volume contoured was larger on day 0 PID (Avg. 44.9 cc; range 19–97 cc) compared to day 33 PID (Avg. 38.9 cc; range 18–59 cc) (P = 0.068). The D90 values however, were significantly higher on day 33 PID (Avg.163.7 Gy; range 125–212 Gy) than on day 0 PID (Avg.149 Gy; range 112–166 Gy) (P = 0.003). This D90 relationship was even demonstrated paradoxically in two patients whose contoured prostate volume was larger on the day 33 PID as compared to the day 0 PID. Conclusions: Timing does matter in the analysis of post implant dosimetry for PSI brachytherapy. The D90 values were significantly greater on day 33 PID compared to Day 0 PID while the contoured prostate volumes were not. Future studies which use PID planning to evaluate implant quality should specify the timing of the PID, as this would facilitate cross study comparison. No significant financial relationships to disclose.
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Affiliation(s)
- K. J. Minehan
- Mayo Clinic, Rochester, MN; Franciscan Skemp Heathcare/Mayo Health System, LaCrosse, WI
| | - K. Furutani
- Mayo Clinic, Rochester, MN; Franciscan Skemp Heathcare/Mayo Health System, LaCrosse, WI
| | - K. McNamara
- Mayo Clinic, Rochester, MN; Franciscan Skemp Heathcare/Mayo Health System, LaCrosse, WI
| | - D. Groshek
- Mayo Clinic, Rochester, MN; Franciscan Skemp Heathcare/Mayo Health System, LaCrosse, WI
| | - E. Mitchell
- Mayo Clinic, Rochester, MN; Franciscan Skemp Heathcare/Mayo Health System, LaCrosse, WI
| | - M. Price
- Mayo Clinic, Rochester, MN; Franciscan Skemp Heathcare/Mayo Health System, LaCrosse, WI
| | - M. Emme
- Mayo Clinic, Rochester, MN; Franciscan Skemp Heathcare/Mayo Health System, LaCrosse, WI
| | - T. Harms
- Mayo Clinic, Rochester, MN; Franciscan Skemp Heathcare/Mayo Health System, LaCrosse, WI
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McNamara K. Life on hold. Kaiser fined for deadly delay. Revolution (Oakl) 2000; 1:12-3. [PMID: 12017594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Abstract
This pilot study examined outcomes of a school-based effort to promote bonding to the conventional mainstream by integrating socially disengaged youth with conventional peers in a service activity. A sample of forty-two ninth-graders in four schools achieved significant improvements in attendance, achievement, ratings of social-academic competence and conventionality, and in positive peer associations, which protect against risk for problems such as dropout, delinquency, and substance abuse. Comparisons of improvements in school performance with changes in performance exhibited by a group of similar peers indicate that effects were probably not due to the effects of maturation over the ninth-grade year. Findings lend tentative support to the notion that social bonding is enhanced through opportunities for service, and justify efforts to develop and study methods for incorporating service components in school programs. Recommendations for further experimental study addressing design limitations of this pilot study are discussed.
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Abstract
This article describes a community-based survey of patients' experiences in community and migrant health centers that was designed to (1) develop a method to measure patients' experiences and (2) create a national database of patient experiences. The project succeeded in surveying the most difficult-to-reach poor and minority populations (mainly Medicaid and uninsured populations) in medically underserved areas, although more than 10% lack ready access to a telephone, another 22% do not speak English well enough to be interviewed in English, and many have limited literacy. We analyzed the responses from 3 perspectives: (1) demographics and health status, (2) dimensions of care, and (3) patient progress through the community and migrant health center system.
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Affiliation(s)
- A Zuvekas
- Center for Health Services Research and Policy, George Washington University Medical Center, Washington, DC, USA
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Abstract
The case of a young woman with basilar artery dissection, possibly precipitated by trauma, is presented, and the literature is reviewed.
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Affiliation(s)
- M J Kothari
- Division of Neurology, Pennsylvania State University, College of Medicine, Hershey, USA
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Abstract
Polyglycolic acid (PGA) fibre meshes are attractive candidates to transplant cells, but they are incapable of resisting significant compressional forces. To stabilize PGA meshes, atomized solutions of poly(L-lactic acid) (PLLA) and a 50/50 copolymer of poly(D,L-lactic-co-glycolic acid) (PLGA) dissolved in chloroform were sprayed over meshes formed into hollow tubes. The PLLA and PLGA coated the PGA fibres and physically bonded adjacent fibres. The pattern and extent of bonding was controlled by the concentration of polymer in the atomized solution and the total mass of polymer sprayed on the device. The compression resistance of devices increased with the extent of bonding, and PLLA bonded tubes resisted larger compressive forces than PLGA bonded tubes. Tubes bonded with PLLA degraded more slowly than devices bonded with PLGA. Implantation of PLLA bonded tubes into rats revealed that the devices maintained their structure during fibrovascular tissue ingrowth, resulting in the formation of a tubular structure with a central lumen. The potential of these devices to engineer specific tissues was exhibited by the finding that smooth muscle cells and endothelial cells seeded onto devices in vitro formed a tubular tissue with appropriate cell distribution.
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Affiliation(s)
- D J Mooney
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge 02139, USA
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Mooney DJ, Park S, Kaufmann PM, Sano K, McNamara K, Vacanti JP, Langer R. Biodegradable sponges for hepatocyte transplantation. J Biomed Mater Res 1995; 29:959-65. [PMID: 7593039 DOI: 10.1002/jbm.820290807] [Citation(s) in RCA: 164] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Liver cell transplantation may provide a means to replace lost or deficient liver tissue, but devices capable of delivering hepatocytes to a desirable anatomic location and guiding the development of a new tissue from these cells and the host tissue are needed. We have investigated whether sponges fabricated from poly-L-lactic acid (PLA) infiltrated with polyvinyl alcohol (PVA) would meet these requirements. Highly porous sponges (porosity = 90-95%) were fabricated from PLA using a particulate leaching technique. To enable even and efficient cell seeding, the devices were infiltrated with the hydrophilic polymer polyvinyl alcohol (PVA). This reduced their contact angle with water from 79 to 23 degrees, but did not inhibit the ability of hepatocytes to adhere to the polymer. Porous sponges of PLA infiltrated with PVA readily absorbed aqueous solutions into 98% of their pore volume, and could be evenly seeded with high densities (5 x 10(7) cells/mL) of hepatocytes. Hepatocyte-seeded devices were implanted into the mesentery of laboratory rats, and 6 +/- 2 x 10(5) of the hepatocytes engrafted per sponge. Fibrovascular tissue invaded through the devices' pores, leading to a composite tissue consisting of hepatocytes, blood vessels and fibrous tissue, and the polymer sponge.
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Affiliation(s)
- D J Mooney
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge 02139, USA
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Mooney D, Breuer C, McNamara K, Vacanti J, Langer R. Fabricating Tubular Devices from Polymers of Lactic and Glycolic Acid for Tissue Engineering. ACTA ACUST UNITED AC 1995; 1:107-18. [DOI: 10.1089/ten.1995.1.107] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.5] [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]
Affiliation(s)
- D.J. Mooney
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
- Department of Surgery, Harvard Medical School and the Children's Hospital, Boston, Massachusetts 02115
- Current address: Departments of Biologic and Materials Sciences and Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109-2136
| | - C. Breuer
- Department of Surgery, Harvard Medical School and the Children's Hospital, Boston, Massachusetts 02115
| | - K. McNamara
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - J.P. Vacanti
- Department of Surgery, Harvard Medical School and the Children's Hospital, Boston, Massachusetts 02115
| | - R. Langer
- Department of Surgery, Harvard Medical School and the Children's Hospital, Boston, Massachusetts 02115
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Abstract
A multicentered study was performed to determine the mortality rate of patients with multiple injuries with major pelvic and long bone fractures who have early total care of their injuries. A 2-year review of patients with ISSs > or = 18 with major fractures treated at the trauma centers in Buffalo, New York, Camden, New Jersey, Nashville, Tennessee, Baltimore, Maryland, Tampa, Florida, and Seattle, Washington was performed. This group of 676 patients was compared with a similar group of 906 patients from the American College of Surgeons' Multiple Trauma Outcome Study. Mortality was significantly reduced in the patients who had early total care of all their injuries including fracture stabilization for patients less than 50 years of age and those 50 years and older. In a subgroup of patients less than 50 years of age and an ISS of 18-34 and 35-45 there was a mortality reduction from 11.8% to 5.1% and from 25.8% to 11.5%, respectively, when the fractures were managed acutely. Similar reductions in mortality were found in the patients 50 years of age and older with early fracture stabilization with a reduction from 26.4% to 8% in patients with ISSs of 18-24 and a reduction from 42.3% to 18.4% in the patients with ISSs of 35-45. This study clearly shows the additional benefit of early fracture stabilization in reducing mortality rates in the patient with multiple injuries.
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Affiliation(s)
- L B Bone
- State University of New York at Buffalo
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Bone L, Stegemann P, McNamara K, Seibel R. External fixation of severely comminuted and open tibial pilon fractures. Clin Orthop Relat Res 1993:101-7. [PMID: 8519096] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Twenty patients with severely comminuted fractures about the ankle, either severely comminuted pilon fractures or open pilon fractures (three Grade II, seven Grade III), were managed with the use of a Delta-framed external fixator across the ankle joint. All fractures had open reduction and internal fixation (ORIF) with either screw fixation or small plates to stabilize the articular surface with minimal soft-tissue dissection. Average external fixator time was 2.5 months, and the time to union averaged 4.5 months. All fractures healed. Three delayed unions required bone grafting and two had plate stabilization. No infection occurred in the 12 open fractures. There was no infection of the closed injuries, no skin sloughs, and only two minor pin tract infections. Follow-up analysis averaged 12 months (range, six to 30 months). Range of motion (ROM) at last follow-up observation was excellent in six patients, good in nine, fair in three, and poor in two. Two patients required ankle arthrodesis because of posttraumatic arthritis. The ROM and outcomes of the severely comminuted or open fractures of the distal intraarticular tibia were very good.
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Affiliation(s)
- L Bone
- Department of Orthopaedics, State University of New York, Buffalo
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Herring L, McNamara K, Kelly M. T.B. ventilation control: Working with engineering technology and hepa filters. Am J Infect Control 1993. [DOI: 10.1016/0196-6553(93)90256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
This article examined bulimics' (n = 31) perceptions of how their families function relative to a group of women at risk for developing bulimia (repeat dieters) (n = 61) and a group not at risk for an eating disorder (nondieters) (n = 59). The results indicated that bulimics perceive their families to be more dysfunctional than do repeat dieters or nondieters. The bulimics reported poorer general family functioning, more affective involvement, less affective responsiveness, poorer family communication, poorer problem-solving skills, and poorer behavior control. The hypothesis that repeat dieters would evidence more family dysfunction relative to the nondieters was not supported. The results are discussed in terms of how family variables may contribute etiologically to bulimia.
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Affiliation(s)
- K McNamara
- Department of Psychology, Colorado State University, Fort Collins 80523
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Abstract
All 53 of the general practitioners from one community health area of the Hunter region of New South Wales were interviewed about patients with psychiatric illnesses who had presented to their practices. Four main themes were covered: personal data which included details of medical and psychiatric training and experience; attitudes to psychiatric illness; pharmacological management; and the effectiveness of existing services. Ninety-four per cent of the general practitioners felt that dealing with psychiatric problems was an integral part of their role as a general practitioner and 60% of the general practitioners believed that their management of these problems was adequate. Patients with personality problems and those with hypochondriasis were identified as their most difficult patient groups, while inability to refer quickly was cited as the major obstacle to successful psychiatric treatment. An increased awareness of the hazards of psychotropic drugs and of the proper uses of these agents existed. Finally, private psychiatrists and the mental hospitals were criticized for not providing an adequate back-up service for this group of general practitioners.
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Affiliation(s)
- K McNamara
- Psychiatry Department, Newcastle Mater Misericordiae Hospital, Waratah, NSW
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McNamara K. A recognition of student maturity. Nurs Stand (1984) 1985:5. [PMID: 3850374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Klestov AC, Webb J, Latt D, Schiller G, McNamara K, Young DY, Hobbes J, Fetherston J. Treatment of xerostomia: a double-blind trial in 108 patients with Sjögren's syndrome. Oral Surg Oral Med Oral Pathol 1981; 51:594-9. [PMID: 7019805 DOI: 10.1016/s0030-4220(81)80008-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The first-ever controlled study of a therapeutic modality for xerostomia is reported. A recently described formulation for saliva substitute (SS) has been tested against a glycerine mouthwash as a control saliva substitute (placebo) in a double-blind clinical trial in 108 patients with varying grades of xerostomia of Sjögren's syndrome. The results indicate that SS offered significant relief of nocturnal oral discomfort (p less than 0.02) and more patients reported "excellent" improvement (p less than 0.01) on a five-point graded response. In all other respects, the SS was not significantly better than the placebo. Significant adverse effects were not reported. It is suggested that any such current and future therapeutic modalities for Sjögren's syndrome be subjected to similar critical appraisal of their worth.
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Mershimer R, McNamara K. Automating the paperwork. Am J Nurs 1971; 7:1164-7. [PMID: 5206445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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