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SMARTphone-based Cardiovascular Risk Reduction in BREAST Cancer Patients [SMART-BREAST]: A Randomised Controlled Trial. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Implementation of a care bundle for inpatient management of acute kidney injury among gynecologic oncology patients: Lessons learned from a quality improvement project. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Understanding of cancer risk differs based on FIGO stage in women with cervical cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Assessing Physician Adherence to Guidelines for Cervical Cancer Screening and Management of Abnormal Screening Results. J Low Genit Tract Dis 2020; 24:337-342. [PMID: 32976292 PMCID: PMC7673488 DOI: 10.1097/lgt.0000000000000558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to survey obstetrician-gynecologists' cervical cancer screening practices and management of cervical abnormalities to ascertain adherence to guidelines. METHODS From January to July 2019, obstetrician-gynecologists at 5 St. Louis area hospitals were surveyed online about cervical cancer screening and management practices through 13 clinical vignettes. Survey scores and the American Society of Colposcopy and Cervical Pathology (ASCCP) app use were compared using Mann-Whitney tests. RESULTS When screening 30- to 65-year-old participants, 114 (98%) of the 116 total participants used co-testing, but only 71 (61%) screened at 5-year intervals. None used primary human papillomavirus (HPV) testing. For 21- to 29-year-old participants, 17 (15%) screened with annual cytology, whereas 14 (12%) used annual or every 3-year co-testing. Forty eight (41%) screened younger than 21 years, regardless of risk factors or only if immunocompromised. Eleven (9%) continued screening after total hysterectomy for benign indications. Only 2 (2%) responded to all clinical vignettes in adherence to guidelines. More than 30% of participants would pursue unnecessary HPV testing and/or loop electrosurgical excision procedure for persistent low-grade cytology. Fifty eight (48%) incorrectly reported hysterectomy as management for adenocarcinoma in situ on biopsy. Participants would undertreat young women with high-grade abnormalities including high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 3 (48, 41%) and high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 1 (65, 56%). Forty one (35%) reported exiting women from screening prematurely. The median score for participants using the ASCCP app was significantly greater than those who did not (79% vs 71%, p = .002). CONCLUSIONS Midwestern obstetrician-gynecologists' adherence to the guidelines for cervical cancer screening and management of abnormal results is suboptimal. Although co-testing for women aged 30-65 years has been broadly adopted, primary HPV testing has not. Physicians overscreen, overtreat low-grade lesions, and undertreat high-grade lesions in young women.
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A fellow-run clinic achieves similar patient outcomes as faculty clinics: A safe and feasible model for gynecologic oncology fellow education. Gynecol Oncol 2020; 159:209-213. [PMID: 32694061 DOI: 10.1016/j.ygyno.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/11/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Fellow involvement in patient care is important for education, but effect on patient care is unclear. Our aim was to compare patient outcomes in gynecologic oncology attending clinics versus a fellow training clinic at a large academic medical center. METHODS A retrospective review of consecutive gynecologic oncology patients from six attending clinics and one faculty-supervised fellow clinic was used to analyze differences based on patient demographics, cancer characteristics, and practice patterns. Primary outcome was overall survival (OS); secondary outcomes included recurrence-free survival (RFS), postoperative complications and chemotherapy within the last 30 days of life. Survival analyses were performed using Kaplan-Meier curves with log-rank tests. RESULTS Of 159 patients, 76 received care in the attending clinic and 83 in the fellow clinic. Patients in the fellow clinic were younger, less likely to be Caucasian, and more overweight, but cancer site and proportion of advanced stage disease were similar. Both clinics had similar rates of moderate to severe adverse events related to surgery (15% vs. 8%, p = .76), chemotherapy (21% vs. 23%, p = .40), and radiation (14% vs. 17%, p = .73). There was no difference in median RFS in the fellow compared to attending clinic (38 vs. 47 months, p = .78). OS on both univariate (49 months-fellow clinic, 60 months-attending clinic vs. p = .40) and multivariate analysis [hazard ratio 1.3 (0.57, 2.75), P = .58] was not significantly different between groups. CONCLUSIONS A fellow-run gynecologic oncology clinic designed to provide learning opportunities does not compromise patient outcomes and is a safe and feasible option for fellow education.
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876 Relationship of Pulse Pressure to Outcomes Following Transcatheter Aortic Valve Implantation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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840 Impact of Sex on Outcomes Following Transcatheter Aortic Valve Implantation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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898 The Obesity Paradox Extends to TAVI – Medium-Term Outcomes According to BMI. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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882 Sex Differences in Outcomes of Patients Suffering From ST-Elevation Myocardial Infarction While Already in Hospital. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Patients with endometrial cancer continue to lack understanding of their risks for cancer. Gynecol Oncol Rep 2019; 29:106-110. [PMID: 31467962 PMCID: PMC6710550 DOI: 10.1016/j.gore.2019.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 01/07/2023] Open
Abstract
It is unclear if endometrial cancer (EC) patients are aware of their modifiable risk factors. We administered a 33-item questionnaire to EC patients at a university-based cancer center to assess their understanding of how comorbidities and lifestyle/sexual behaviors impact their cancer risk. We also inquired about their access to a primary care physician (PCP). Pearson's χ2 test or Fisher's exact test were used to assess differences in understanding based on a dichotomized Charlson comorbidity score, <7 vs ≥7. Of the 50 surveyed women (81% response rate), 39 reported hypertension (80%) and 36 (72%) diabetes. All had a PCP. Most were aware that obesity contributes to diabetes (43/48, 90%), hypertension (42/48, 88%), and heart attack (42, 88%), but only 19/49 (39%) knew that EC is more common in overweight/obese women. More than half lacked understanding of the following risks including modifiable risk factors–unhealthy diet (31, 62%), hormone replacement therapy (38, 76%), alcohol (30, 60%), and the protective effects of cigarette smoking (38, 76%). Most also incorrectly identified the following sexual health factors as risks for EC: early coitarche (30, 60%), or having an abortion (27, 54%), a sexually transmitted infection (35, 70%) or human immunodeficiency virus (34, 68%). Although EC patients recognize that obesity is linked to comorbidities, less than half are aware that it contributes to their cancer risk. Furthermore, responses to lifestyle/sexual health behaviors suggest women may lack understanding of global differences between endometrial and cervical cancer risk factors. Women with endometrial lack fundamental knowledge of their cancer risks. There is a discrepancy in knowledge related to the risk of obesity on comorbidities versus endometrial cancer. Women may be unaware of global differences between endometrial and cervical cancer risk factors.
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Integrated psychological care in gynecologic oncology outpatient clinics: A feasibility study. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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NCCN distress thermometer underscores unmet psychological needs. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Do gynecologic oncology patients with severely diminished renal function and urinary tract obstruction benefit from ureteral stenting or percutaneous nephrostomy? Gynecol Oncol Rep 2019; 28:136-140. [PMID: 31061871 PMCID: PMC6488532 DOI: 10.1016/j.gore.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 01/29/2023] Open
Abstract
Objective To assess the renal outcomes of gynecologic oncology patients who present with hydronephrosis and acute kidney injury (AKI), have <20% renal function on diuretic renal scintigraphy, and undergo placement of a ureteral stent or percutaneous nephrostomy (PCN) tube. Methods This is a single-institution case series of gynecologic oncology patients who underwent diuretic renal scintigraphy from January 1, 2007, to June 1, 2017. Univariate and multivariate logistic analyses were used to assess predictors of <20% renal function. Recovery from AKI or elevated creatinine was reported for women with <20% renal function who received a unilateral ureteral stent or PCN tube on the same side as their more compromised kidney. Results Among 353 gynecologic oncology patients who underwent diuretic renal scintigraphy, 58 (16%) had renal function <20%. Mean age was 59.6 years, 17% had preexisting chronic kidney disease, and 44% had a diagnosis of cervical cancer. Renal atrophy on computed tomography scan (aOR 18.24, 95% CI 1.21–274.92) predicted renal function <20%. Of 10 women with <20% renal function who received a stent or PCN tube, 7 recovered from AKI or elevated creatinine. Conclusions Gynecologic oncology patients with <20% renal function may recover from AKI after placement of a stent or PCN tube, indicating that a diuretic renal scintigraphy cutoff of <20% renal function may be overly conservative. Future studies are warranted to determine optimal renal function cutoffs for stent/PCN tube placement in gynecologic oncology patients. Renal atrophy on CT scan is an independent predictor of severely compromised renal function. Gynecologic oncology patients with <20% renal function may recover from AKI after placement of a stent or PCN tube. <20% relative renal function on diuretic renal scintigraphy may be an overly conservative cutoff for kidney salvageability.
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Long-term Survival and Valve Durability in Patients Undergoing Transcatheter Aortic Valve Implantation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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A cluster-randomized trial of a college health center-based alcohol and sexual violence intervention (GIFTSS): Design, rationale, and baseline sample. Contemp Clin Trials 2018; 65:130-143. [PMID: 29287667 PMCID: PMC5803349 DOI: 10.1016/j.cct.2017.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/09/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sexual violence (SV) on college campuses is common, especially alcohol-related SV. This is a 2-arm cluster randomized controlled trial to test a brief intervention to reduce risk for alcohol-related sexual violence (SV) among students receiving care from college health centers (CHCs). Intervention CHC staff are trained to deliver universal SV education to all students seeking care, to facilitate patient and provider comfort in discussing SV and related abusive experiences (including the role of alcohol). Control sites provide participants with information about drinking responsibly. METHODS Across 28 participating campuses (12 randomized to intervention and 16 to control), 2292 students seeking care at CHCs complete surveys prior to their appointment (baseline), immediately after (exit), 4months later (T2) and one year later (T3). The primary outcome is change in recognition of SV and sexual risk. Among those reporting SV exposure at baseline, changes in SV victimization, disclosure, and use of SV services are additional outcomes. Intervention effects will be assessed using generalized linear mixed models that account for clustering of repeated observations both within CHCs and within students. RESULTS Slightly more than half of the participating colleges have undergraduate enrollment of ≥3000 students; two-thirds are public and almost half are urban. Among participants there were relatively more Asian (10 v 1%) and Black/African American (13 v 7%) and fewer White (58 v 74%) participants in the intervention compared to control. CONCLUSIONS This study will offer the first formal assessment for SV prevention in the CHC setting. Clinical Trials #: NCT02355470.
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Long-Term Outcomes of Patients Undergoing TAVI in Australia. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Long-Term Valve Durability of Patients Undergoing Transcatheter Aortic Valve Implantation in Australia. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Favourable Short-Term Outcome of Transcatheter Aortic Valve Implantation in Nonagenarians. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Comparison of Early Outcomes in Low-, Intermediate- and High-Risk Transcatheter Aortic Valve Implantation Patients. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Integrating Reproductive Health Services Into Intimate Partner and Sexual Violence Victim Service Programs. Violence Against Women 2017; 24:1557-1569. [DOI: 10.1177/1077801217741992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study assessed the feasibility of integrating reproductive health services into intimate partner violence/sexual violence (IPV/SV) programs. After a training for victim service agencies on integration of health services, we conducted semistructured interviews with IPV/SV program leadership. Leadership reported advocates were more likely to recognize the need to refer clients to health services, and revealed challenges operationalizing partnerships with health care centers. Training to integrate basic health assessment into victim services may be one way to address women’s urgent health needs. Formal partnership agreements, protocols to facilitate referrals, and opportunities to cross-train are needed to nurture these cross-sector collaborations.
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School Nurse-Delivered Adolescent Relationship Abuse Prevention. THE JOURNAL OF SCHOOL HEALTH 2017; 87:524-530. [PMID: 28580675 DOI: 10.1111/josh.12520] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Project Connect is a national program to build partnerships among public health agencies and domestic violence services to improve the health care sector response to partner and sexual violence. Pennsylvania piloted the first school nurse-delivered adolescent relationship abuse intervention in the certified school nurses' office setting. The purpose of this study was to assess the feasibility of implementing this prevention intervention. METHODS In 5 schools in Pennsylvania, school nurses completed a survey before and 1 year after receiving training on implementing the intervention as well as a phone interview. Students seeking care at the nurses' offices completed a brief anonymous feedback survey after their nurse visit. RESULTS The school nurses adopted the intervention readily, finding ways to incorporate healthy relationship discussions into interactions with students. School nurses and students found the intervention to be acceptable. Students were positive in their feedback. Barriers included difficulty with school buy-in and finding time and private spaces to deliver the intervention. CONCLUSIONS A school nurse healthy relationships intervention was feasible to implement and acceptable to the students as well as the implementing nurses. While challenges arose with the initial uptake of the program, school nurses identified strategies to achieve school and student support for this intervention.
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The interacting roles of climate, soils, and plant production on soil microbial communities at a continental scale. Ecology 2017; 98:1957-1967. [DOI: 10.1002/ecy.1883] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/28/2017] [Accepted: 04/05/2017] [Indexed: 11/09/2022]
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A preliminary needs assessment of American Indians who inject drugs in northeastern Montana. Harm Reduct J 2017; 14:22. [PMID: 28482846 PMCID: PMC5422938 DOI: 10.1186/s12954-017-0146-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/26/2017] [Indexed: 11/24/2022] Open
Abstract
Background Injection drug use has not been well documented in American Indians living in the USA. American Indian and Alaskan Natives (AI/ANs) show higher rates of substance use compared to the general population, and have historically been subject to a number of risk factors that are known to increase the likelihood of substance use. AI/ANs also experience increased risk for infectious diseases that are transmitted via injection drug use and/or sexual activity. Harm reduction approaches have been shown to be effective for decreasing risk of disease transmission in at-risk populations, and may be well suited for AI/AN injection drug users residing in rural reservation communities. In this study, we aimed to examine the characteristics of American Indians (AI) who use injection drugs (PWUID) in northeastern Montana to identify needs that could be addressed with harm reduction programming. Methods For the present study, we used a respondent-driven sampling approach to generate a sample of 51 self-identified male and female injection drug users ≥18 years of age who were American Indians living on the Fort Peck Indian Reservation. Sampling weights were applied to all analyses using Respondent-Driven Sampling Analysis Tool (RDSAT). Results There were no strong recruitment patterns by age, sex, or ethnic identity status of the recruiter or participant, but there were strong within-group recruitment patterns by location within the reservation. The majority of the sample reported initiating substance use before the age of 18. Participants reported significant risk for HIV, hepatitis, and other infectious diseases through their drug use and/or risky sexual behavior. Sixty-five percent reported having reused syringes, and 53% reported drawing from the same filter. Seventy-five percent reported inconsistent condom use during the 3 months preceding the survey, and 53% reported injecting drugs during sex during the 3 months preceding the survey. Only 66% of participants reported having been tested for HIV in the 12 months preceding the survey. The vast majority (98%) of respondents expressed interest in a harm reduction program. Seventy-six percent reported that it was easy or very easy to obtain new syringes. Conclusions We documented several risks for blood-borne pathogens, including elevated levels of syringe reuse. Further, we documented significant interest in harm reduction interventions in the present sample of AI/AN injection drug users. Findings suggest a need for increased access to harm reduction programming for AI/AN injection drug users to reduce the transmission of infectious disease and increase access to compassionate care.
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Long-Term Clinical Outcomes of the Absorb Bioresorbable Vascular Scaffold – An Australian Experience. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ensuring the Quality in Clinical Quality Registries – Design and Implementation of Rigorous Audit Activities in the Victorian Cardiac Outcomes Registry (VCOR). Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
STUDY OBJECTIVE To identify barriers to long-acting reversible contraception (LARC) uptake among homeless young women. DESIGN In this mixed methods study surveys and guided interviews were used to explore women's contraceptive and reproductive experiences, interactions with the health care system, and their histories of homelessness. SETTING All surveys and interviews were conducted at a homeless drop-in center or shelter. PARTICIPANTS Fifteen women between 18 and 24 years of age with a past year history of homelessness. INTERVENTIONS None. MAIN OUTCOME MEASURES Perceived barriers to contraceptive use, including knowledge and access barriers and interactions with the health care system around reproductive health. RESULTS Confusion about the possibility of early termination of LARC, and the perception that providers deliberately withhold selective information about contraceptive options to bias contraceptive decision-making, were 2 key new findings. Women also reported interest in visual aids accompanying verbal contraceptive counseling. Pregnancy attitudes and history of reproductive and sexual coercion also influenced contraceptive decision-making and reported interest in LARC methods. CONCLUSION Comprehensive counseling about all contraceptive options, including LARC, are important for targeting the perceived gaps in contraceptive education and care among homeless young women.
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Bioresorbable scaffold stents, single centre experience. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Outcomes of conservative treatment of giant omphaloceles with dissodic 2% aqueous eosin: 15 years' experience. Afr J Paediatr Surg 2014; 11:170-3. [PMID: 24841021 DOI: 10.4103/0189-6725.132825] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The surgical management of giant omphalocele is a surgical challenge with high mortality and morbidity in our country due to the absence of neonatal resuscitation. This study evaluates conservative management of giant omphalocele with dissodic 2% aqueous eosin. MATERIALS AND METHODS In the period from January 1997 to December 2012, giant omphaloceles were treated with dissodic 2% aqueous eosin. The procedure consisted of twice a day application of dissodic 2% aqueous eosin (sterile solution for topical application) on the omphalocele sac. The procedure was taught to the mother to continue at home with an outpatient follow-up to assess epithelialization. We studied the duration of the hospital stay, the learning curve of the procedure by the mother, the complications, the duration and the percentage of complete epithelialization and the mortality. RESULTS A total of 173 giant omphaloceles had a conservative treatment with dissodic 2% aqueous eosin. The average hospital stay was 21 ± 6 days. The learning curve by the mother of the procedure was 10 ± 3 days. Complications of treatment were intestinal functional occlusion 22% and omphalocele sac infection 18%. The complete epithelialization of the omphaloceles sac after application of dissodic 2% aqueous eosin was 68.5%. Mortality was observed in 25.5%. CONCLUSION Conservative treatment of giant omphaloceles by dissodic 2% aqueous eosin is a simple, efficient and a good alternative to surgery. The mother can easily learn its procedure which reduces the duration of hospital stay.
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Permanent Pacemaker Implantation Rate pre- and post-CoreValve Accutrak Transcatheter Aortic Valve Implantation Delivery System. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Transcatheter Aortic Valve Implantation in a Private Hospital Setting. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Medium Term Follow Up of Medtronic Core Valve: Melbourne Experience. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Low Risk of Stroke is Achievable After Transcatheter Aortic Valve Implantation (TAVI): A Two-Centre Australian Experience. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Young Native American Men and Their Intention to Use Family Planning Services. Am J Mens Health 2012; 6:324-30. [DOI: 10.1177/1557988312439226] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examines the extent to which age, fatherhood, relationship status, self-control of birth control method, and the use of birth control influence young Native American men’s intention to use family planning services. Data were collected for this study during in-depth interviews with 112 Native American men between the ages of 18 and 24 years. The mean age reported was 21. Thirty-eight percent of the young men reported having children. Almost 70% of the young men reported being in a steady relationship. Eighty-eight percent reported that it was very important that they have self-control of the type of birth control that they use. In addition, 88% of the young men reported that they would use some type of birth control within the next year to prevent a pregnancy with their partner. Logistic regression analysis indicated that as age increased, young men were less likely to seek family planning services for birth control. The young men who reported being fathers were more likely than the young men who did not report being fathers to seek family planning services for birth control. Findings from this study suggest that public health efforts to educate Native American men about family planning services are most effective in their adolescence, before they transition into young adulthood. Fatherhood may also be considered a protective factor that may increase the likelihood that young Native American men will seek family planning services for birth control. Public health efforts that address reproductive health among young Native American men may be effective with Native American men in adolescence, prior to their transition to young adulthood. Family planning services that provide outreach education and care to Native American fathers may also be effective.
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Outcomes of a Newly Established TAVI Program. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Depth of Transcatheter Aortic Valve Implantation Does Not Correlate with Aortic Regurgitation or Need for Permanent Pacing. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pregnancy prevention among American Indian men ages 18 to 24: the role of mental health and intention to use birth control. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2012; 19:57-75. [PMID: 22569725 DOI: 10.5820/aian.1901.2012.57] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Fort Peck Sexual Health Project: A Contextual Analysis of Native American Men is a community-based participatory research (CBPR) project that explores the extent to which knowledge, attitudes, and beliefs about sex, intimate relationships, and mental health influence sexual and reproductive health. For the purpose of this study, the influence of age, fatherhood, and mental health factors related to historical trauma and loss on young American Indian (AI) men's intention to use birth control was examined. In-depth interviews were conducted with 112 Native American men between the ages of 18 and 24 years. The mean age reported was 21 years. Thirty-eight percent of the young men reported having children. The young men reported experiences of historical trauma during their lifetime as well as emotional responses due to historical losses. Ninety-five percent reported that it was very important that they use some form of birth control to prevent their partner from getting pregnant within the next year. Logistic regression analysis indicated that, as age increased, young men were less likely to use birth control to prevent pregnancy. The young men who reported feelings of loss due to experiences related to historical trauma and loss were more likely to use birth control. Findings from this study suggest that public health efforts to educate AI men about planned pregnancies and the use of birth control may be most effective in adolescence. Public health programs that address mental health concerns such as the emotional responses due to historical losses may assist young AI men in their decision to use birth control.
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Abstract
BACKGROUND This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA) and set the debate at the level of the humanist thinking in medicine. PATIENTS AND METHODS This was a multicentre study from 1 st May to 30 th October 2008. The African Society of paediatric surgeons' directory was used to identify paediatric surgeons in the Francophone's countries in Sub Saharan Africa. The parameters studied were number of surgeons per country, means of training, working conditions, remunerations, needs for continuous training and the research. RESULTS A total of 41 paediatric surgeons (68.33%) responded. The average number of paediatric surgeons per country was 5. The means of training included government scholarships among 7 paediatric surgeons (17.07%), scholarship from a non-governmental organisations in 14 (34.15%) and self-sponsorships in 20 (48.78%). The average salary was 450 Euros (€) (range: 120-1 400 Euros). Most of the paediatric surgeons (68.29%) had internet services for continuous update courses and research. Thirty six paediatric surgeons (87.80%) had no subscription to specialised scientific journals. CONCLUSION The paediatric surgeon in FSSA faces many problems related to his working and living conditions that may have a negative impact on their competences.
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AASM standards of practice compliant validation of actigraphic sleep analysis from SOMNOwatch™ versus polysomnographic sleep diagnostics shows high conformity also among subjects with sleep disordered breathing. Physiol Meas 2010; 31:1623-33. [PMID: 21071830 DOI: 10.1088/0967-3334/31/12/005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In recent AASM practice, parameter actimetry is cited to measure total sleep time in obstructive sleep apnoea patients, when polysomnography is not available. An actigraph was therefore compared to polysomnographic data in 28 subjects with known sleep disordered breathing. Total sleep time (TST), sleep period time (SPT), sleep efficiency (SE), sustained sleep efficiency (SSE), sleep onset latency (SL) and sleep/wake pattern were compared to gold standard polysomnography. The results of an epoch-by-epoch comparison of sleep/wake from actigraphy to sleep stages from polysomnography gave a sensitivity of 90.2%, a specificity of 95.2% and an overall accuracy of 85.9%. Correlations were moderately strong for SE (0.71, p < 0.001) and SSE (0.65, p < 0.001) and high for TST (0.89, p < 0.001), SPT (0.91, p < 0.001) and SL (0.89, p < 0.001). It was concluded that actigraphy is not identical with PSG recording but gives good results in sleep/wake patterns and predicting TST, SPT, SSE, SE and SL also in sleep apnoea patients not suffering from other sleep disorders. The difficult detection of correct sleep onset causes SSE and SL to be less predictable. Therefore a 15-epoch criterion was introduced and resulted in high correlation of 0.89 for sleep latency, but has to be tested on a bigger population.
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IMPACT OF A RURAL COMMUNITY-BASED ALL-TERRAIN VEHICLE SAFETY CAMPAIGN. J Investig Med 2007. [DOI: 10.1097/00042871-200701010-00805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Colorimetric Determination of Cobalt in Metallurgical Products with Nitroso R Salt. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/i560156a007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
UNLABELLED Overcrowding is common in emergency departments (EDs) throughout the United States. The history of ED overcrowding in Rochester, New York, is notable due to its unique health care system that introduced the concepts of managed care as early as the 1950s. An effect of this system was to intentionally restrict resources and allow the issue of access to limit utilization. Overcrowding in EDs was severe in the late 1990s-2000, and became an accepted local standard of care. OBJECTIVE To study the strategies to reduce ED overcrowding in Rochester in the last decade. METHODS A descriptive analysis of individual hospital and community efforts to decrease ED overcrowding. RESULTS Of the strategies tried, those that had little effect on ED overcrowding were based from the ED, such as ambulance diversion. Those that were successful were those that addressed factors external to the ED such as increased flexibility of inpatient resources; float nurses who responded to acute care needs; a transition team (mid-level provider along with registered nurse (RN)/licensed practical nurse) who cared for inpatients boarded in the ED; integrated services across affiliated hospitals/systems; an early alert system that notified key personnel before "code red" criteria were met; and a multidisciplinary team to round in the ED and analyze resource needs. Current community-wide initiatives include precise tracking of code red hours; monitoring patient length of stay (LOS) in the ED and inpatient units; education of physicians and nursing homes regarding ED alternatives; exploration of additional resources for subacute and long-term care; establishing a regional forum to address the nursing shortage; development of an ED triage system to coordinate diversion activities during code red; and consideration of a county-wide state of emergency when needed. CONCLUSIONS Emergency department overcrowding is the end result of a variety of factors that must be addressed system-wide.
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Structure--function relationships of rat hepatic tryptophan 2,3-dioxygenase: identification of the putative heme-ligating histidine residues. Arch Biochem Biophys 2001; 392:71-8. [PMID: 11469796 DOI: 10.1006/abbi.2001.2420] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The liver cytosolic enzyme tryptophan 2,3-dioxygenase (TDO) catalyzes the oxidation of L-tryptophan to formylkynurenine and controls the physiological flux of tryptophan into both the serotonergic and kynureninic pathways. This hemoprotein enzyme is composed of four noncovalently bound subunits of equivalent mass and contains two heme moieties per molecule. Electron paramagnetic resonance analyses have indicated that a histidyl nitrogen is involved in heme ligation [Henry et al., (1976) J. Biol. Chem. 251, 1578], but the identity of the His residue(s) is unknown. In an attempt to characterize the active site of the enzyme we have substituted each of the 12 His residues in the rat TDO subunit with Ala, to determine their relative importance in heme binding. Sequence alignment of the rat liver protein with that of known or putative TDO sequences from other organisms reveals that four of the His residues are conserved in eukaryotes, two of which are also conserved in prokaryotes. Our findings indicate that replacement of the evolutionarily conserved His 76 and 328 residues resulted in a dramatic reduction of TDO activity, whereas that of the eukaryotically conserved His70 resulted in a significant reduction relative to that of the wild-type enzyme. On the other hand, replacement of the other eukaryotically conserved His273 residue, while affecting the relative expression of the enzyme, had little effect on its specific activity. Size-exclusion analyses revealed that the His76Ala and His328Ala mutants retained little or no heme, suggesting that these may be key residues in ligating the prosthetic heme moieties. Whether these His residues are both provided by the same TDO subunit or a different TDO subunit remains to be determined.
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Agreement between clinical examination and quantitative tests of neurologic function among 384 subjects. Am J Ind Med 2001; 39:361-8. [PMID: 11323785 DOI: 10.1002/ajim.1026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Quantitative neurological tests are often cheaper and easier than clinical examinations, and provide continuous data which may discriminate between exposed and nonexposed groups with more sensitivity than dichotomous (normal/abnormal) examination data. METHODS We compare clinical examinations and analogous quantitative tests for arm tremor, postural sway, and vibrotactile sensitivity (finger and toe), for 384 subjects. RESULTS The "abnormal" clinical outcomes studied were relatively common (range, 3-36%), and did not result in impairment of daily activity for affected subjects. All the quantitative tests were reasonably good predictors of the corresponding clinical outcome. The most predictive test was for toe vibrotactile sensitivity. The probability of an abnormal clinical result for those in the worst quartile for the toe test was 0.63, compared with 0.36 for all subjects. CONCLUSIONS Our results suggest that certain quantitative tests might be used in epidemiologic studies instead of a physical examination.
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Abstract
Tremor is being increasingly evaluated by quantitative computer-based systems to differentiate its causes. In this study, a group of mercury-exposed workers were assessed to determine whether tremor characteristics differed by exposure level. Workers were classified into two groups: those with an average urine mercury concentration below the American Conference of Government Industrial Hygienist Biological Exposure Index of 35 micrograms/g creatinine, and those with an average urine mercury concentration above the Biological Exposure Index. Tremor characteristics (including intensity, harmonic index, center frequency, standard deviation of the center frequency, and tremor index) were measured and recorded with a computer-based tremor system. Sixteen of 17 workers who were potentially exposed to mercury participated in the study. Three workers had a mean urine mercury concentration of 27.0 micrograms/g-creatinine and were assigned to the low-exposure group, and 13 workers had a mean urine mercury concentration of 200.2 micrograms/g-creatinine and were assigned to the high-exposure group. There was a statistically significant difference in the tremor index (which compiles five individual tremor parameters into a single value) between the two groups (P = 0.04; Wilcoxon's rank sum test). Other tremor characteristics did not differ significantly between the groups. Tremor index may be more useful than measures of individual tremor parameters in differentiating normal from subclinical pathological tremors among groups of workers with chronic mercury exposure.
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Impact of early percutaneous coronary intervention on short- and long-term outcomes in patients with cardiogenic shock after acute myocardial infarction. Am J Cardiol 2001; 87:633-5, A9-10. [PMID: 11230852 DOI: 10.1016/s0002-9149(00)01443-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study assesses the impact of early percutaneous coronary intervention in patients presenting with cardiogenic shock after acute myocardial infarction. Predictors of in-hospital death include the need for intubation, cardiopulmonary resuscitation, and angiographic failure; long-term outcomes at 2 years in hospital survivors are favorable.
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Late outcomes after direct PTCA for acute myocardial infarction — A multicentre experience. Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.06541.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Predicting early mortality following percutaneous stent insertion for malignant biliary obstruction: a multivariate risk factor analysis. Eur J Gastroenterol Hepatol 2000; 12:1095-100. [PMID: 11057454 DOI: 10.1097/00042737-200012100-00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Percutaneous stent placement is an accepted method of palliation in malignant biliary obstruction. Factors predicting early mortality after this procedure have not been identified. METHODS We performed a retrospective study of 141 patients with malignant biliary obstruction who underwent percutaneous stent placement for biliary decompression to identify the risk factors associated with early mortality (< or = 30 days). RESULTS Of 14 clinicopathological and laboratory variables analysed blood urea, albumin, haemoglobin and alkaline phosphatase were found to be significant on univariate analysis. The age and gender of the patient along with cancer type, level of obstruction, presence of pyrexia and bilirubin level had no influence on early mortality. Stepwise logistic regression identified the haemoglobin level and blood urea to be independently significant in predicting early mortality. Overall 30-day mortality was 20.5% (29/141). Patients with blood urea over 4.3 mmol/l and a haemoglobin less than 10.9 g/dl had a mortality rate of 52% (12/23) compared with 14% (17/118) in the remainder. Using these two variables a regression equation has been derived which allows calculation of the probability of survival at 30 days after the percutaneous procedure. CONCLUSIONS Laboratory variables in patients with malignant obstructive jaundice can be used to predict mortality following percutaneous stent insertion.
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Abstract
OBJECTIVE To present findings from a collaborative study with the National College Athletic Association regarding the prevalence of disordered eating among student athletes. METHOD 1,445 student athletes from 11 Division 1 schools were surveyed using a 133-item questionnaire. RESULTS Results indicated that 1.1% of the females met DSM-IV criteria for bulimia nervosa versus 0% for males. None of the student athletes met DSM-IV criteria for anorexia nervosa. 9.2% of the females were identified as having clinically significant problems with bulimia versus .01% of the males. 2.85% of the females were identified as having a clinically significant problem with anorexia nervosa versus 0% for males. 10.85% of the females reported binge eating on a weekly or greater basis versus 13.02% of the males 5.52% of the females reported purging behavior (vomiting, laxatives, diuretics) on a weekly or greater basis versus 2.04% for the males. DISCUSSION Results from the current investigation are more conservative than previous studies of student athletes, but comparable to another large study of elite Norwegian athletes. Reasons for these differences are discussed. Clearly female athletes report more difficulty with disordered eating than male athletes. Some specific risk factors for female athletes are discussed.
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Results of percutaneous plastic stents for malignant distal biliary obstruction following failed endoscopic stent insertion and comparison with current literature on expandable metallic stents. Eur J Gastroenterol Hepatol 1999; 11:775-80. [PMID: 10445799 DOI: 10.1097/00042737-199907000-00016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Endoscopic stenting is an effective method of relieving biliary obstruction in patients with unresectable malignancy. If this fails, optimal management is controversial. Percutaneous insertion of plastic or mesh metal stents has been advocated. AIM To review the outcome of percutaneous plastic stents and compare this with contemporary data from the literature on mesh metal stenting. PATIENTS AND METHODS Over a period of six years, 400 patients had attempted endoscopic stenting for distal malignant biliary obstruction which failed in 54 (13.5%). These 54 patients were treated with percutaneously placed plastic stents. RESULTS Percutaneous stenting was technically successful in 48 patients (89%). Early complications occurred in 13 patients (24%), the commonest being acute cholangitis in seven (12%). There was no procedure-related mortality but a 30-day mortality of 11 % (n = 6). Ten patients (18%) required re-admission after 30 days for stent block (mean period 4 months). Forty-seven patients (87%) were followed up until death. The median survival for the patients undergoing palliative stenting was 3 months (5 days to 17 months). CONCLUSIONS These results suggest that percutaneous plastic stents can be used safely and effectively in patients who have failed endoscopic stenting.
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