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Medication tapering in stable rheumatoid arthritis: where do we stand and what work needs to be done? Rheumatology (Oxford) 2023; 62:iv1-iv2. [PMID: 37855677 DOI: 10.1093/rheumatology/kead410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/01/2023] [Indexed: 10/20/2023] Open
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Establishment, persistence and the importance of longitudinal monitoring in multi‐source reintroductions. Anim Conserv 2022. [DOI: 10.1111/acv.12764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Initial experience of TAS-102 chemotherapy in Australian patients with Chemo-refractory metastatic colorectal cancer. Curr Probl Cancer 2021; 46:100793. [PMID: 34565601 DOI: 10.1016/j.currproblcancer.2021.100793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
For patients with refractory metastatic colorectal cancer (mCRC) treatment with Trifluridine/Tipiracil, also known as TAS-102, improves overall survival. This study aims to investigate the efficacy and safety of TAS-102 in a real-world population from Victoria, Australia. A retrospective analysis of prospectively collected data from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry was undertaken. The characteristics and outcomes of patients receiving TAS-102 were assessed and compared to those enrolled in the registration study (RECOURSE). Across 13 sites, 107 patients were treated with TAS-102. The median age was 60 years (range: 31-83), compared to 63 for RECOURSE. Comparing registry TAS-102-treated and RECOURSE patients, 75% vs 100% were ECOG performance status 0-1, 74% vs 79% had initiated treatment more than 18 months from diagnosis of metastatic disease and 36% vs 49% were RAS wild-type. Median time on treatment was 10.4 weeks (range: 1.7-32). Median progression-free survival (PFS) was 3.3 months compared to 2 months in RECOURSE, while median overall survival was the same at 7.1 months. Two patients (2.3%) had febrile neutropenia and there were no treatment-related deaths, where TAS-102 dose at treatment initiation was at clinician discretion.TRACC registry patients treated with TAS-102 were younger than those from the RECOURSE trial, with similar overall survival observed. Less strict application of RECIST criteria and less frequent imaging may have contributed to an apparently longer PFS.
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Monotonous driving induces shifts in spatial attention as a function of handedness. Sci Rep 2021; 11:10155. [PMID: 33980882 PMCID: PMC8114912 DOI: 10.1038/s41598-021-89054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/13/2021] [Indexed: 11/08/2022] Open
Abstract
Current evidence suggests that the ability to detect and react to information under lowered alertness conditions might be more impaired on the left than the right side of space. This evidence derives mainly from right-handers being assessed in computer and paper-and-pencil spatial attention tasks. However, there are suggestions that left-handers might show impairments on the opposite (right) side compared to right-handers with lowered alertness, and it is unclear whether the impairments observed in the computer tasks have any real-world implications for activities such as driving. The current study investigated the alertness and spatial attention relationship under simulated monotonous driving in left- and right-handers. Twenty left-handed and 22 right-handed participants (15 males, mean age = 23.6 years, SD = 5.0 years) were assessed on a simulated driving task (lasting approximately 60 min) to induce a time-on-task effect. The driving task involved responding to stimuli appearing at six different horizontal locations on the screen, whilst driving in a 50 km/h zone. Decreases in alertness and driving performance were evident with time-on-task in both handedness groups. We found handedness impacts reacting to lateral stimuli differently with time-on-task: right-handers reacted slower to the leftmost stimuli, while left-handers showed the opposite pattern (although not statistically significant) in the second compared to first half of the drive. Our findings support suggestions that handedness modulates the spatial attention and alertness interactions. The interactions were observed in a simulated driving task which calls for further research to understand the safety implications of these interactions for activities such as driving.
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Sexual Risk Behaviors Associated with Sexually Transmitted Infections in a US Military Population Living with HIV After the Repeal of "Don't Ask, Don't Tell". AIDS Patient Care STDS 2020; 34:523-533. [PMID: 33296270 DOI: 10.1089/apc.2020.0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Risk behaviors associated with sexually transmitted infections (STIs) among people living with HIV (PLWH) have not been well characterized in the US military. We identified risk behaviors associated with a new STI in this population after the repeal of "Don't Ask, Don't Tell." US Military HIV Natural History Study participants who completed the risk behavior questionnaire (RBQ) between 2014 and 2017 and had at least 1 year of follow-up were included (n = 1589). Logistic regression identified behaviors associated with incident STI in the year following RBQ completion. Overall, 18.9% acquired an STI and 52.7% reported condom use at last sexual encounter. Compared with those with no new sex partners, participants with between one and four or five or more new partners were 1.71 [1.25-2.35] and 6.12 [3.47-10.79] times more likely to get an STI, respectively. Individuals reporting low or medium/high perceived risk of STI were 1.83 [1.23-2.72] and 2.65 [1.70-4.15] times more likely to acquire a new STI than those reporting no perceived risk, respectively. Participants who preferred not to answer about sexual preference, number of new partners, or perceived STI risk were also more likely to acquire a new STI. Our study illustrates that despite regular access to health care and accurate perceptions of risk, rates of STI among PLWH remain high in the US military setting, as in others. Given the potential individual and public health consequences of STI coinfection after HIV, more work is needed to assess interventions aimed at sexual behavior change for PLWH.
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The relationship between alertness and spatial attention under simulated shiftwork. Sci Rep 2020; 10:14946. [PMID: 32917940 PMCID: PMC7486912 DOI: 10.1038/s41598-020-71800-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/22/2020] [Indexed: 01/28/2023] Open
Abstract
Higher and lower levels of alertness typically lead to a leftward and rightward bias in attention, respectively. This relationship between alertness and spatial attention potentially has major implications for health and safety. The current study examined alertness and spatial attention under simulated shiftworking conditions. Nineteen healthy right-handed participants (M = 24.6 ± 5.3 years, 11 males) completed a seven-day laboratory based simulated shiftwork study. Measures of alertness (Stanford Sleepiness Scale and Psychomotor Vigilance Task) and spatial attention (Landmark Task and Detection Task) were assessed across the protocol. Detection Task performance revealed slower reaction times and higher omissions of peripheral (compared to central) stimuli, with lowered alertness; suggesting narrowed visuospatial attention and a slight left-sided neglect. There were no associations between alertness and spatial bias on the Landmark Task. Our findings provide tentative evidence for a slight neglect of the left side and a narrowing of attention with lowered alertness. The possibility that one’s ability to sufficiently react to information in the periphery and the left-side may be compromised under conditions of lowered alertness highlights the need for future research to better understand the relationship between spatial attention and alertness under shiftworking conditions.
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0300 The Circadian Timing of Sleep Affects the Rate of Accumulation of Neurobehavioral Impairment Across Days of Sleep Restriction. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Chronic restriction of nighttime sleep to less than ~8h/day leads to build-up of neurobehavioral impairment across days. Although it is known that sleep loss effects depend on the circadian timing of sleep, it is not known how the timing of restricted sleep influences the accumulation of neurobehavioral impairment over days. Here we studied the accumulation of impairment across days of restricted sleep placed in the morning or afternoon.
Methods
N=71 healthy young adults (39% female; ages 21-45y, mean±SD: 27.9±6.6y) completed a 14-day laboratory study. After two baseline days with nighttime sleep (8h TIB: 23:30-07:30), subjects were randomized to 10 consecutive days of A) morning sleep at 4h, 6h, or 8h TIB ending at 11:30 each day (n=18, 8, 8, respectively), or B) afternoon sleep at 4h, 6h, or 8h TIB ending at 19:30 each day (n=13, 17, 7, respectively). Subjects were tested on the 10min psychomotor vigilance test (PVT) every ~2 hours during scheduled wakefulness. Daily averages for PVT lapses (RTs>500ms) observed between 2h and 14h after awakening were analyzed with non-linear mixed-effects regression to investigate differences in the neurobehavioral impairment build-up rate between sleep restriction conditions.
Results
Afternoon sleep conditions showed a significant sleep dose-response effect (p<0.001), with the fastest accrual of PVT performance deficits across days in the 4h condition, and slow-to-negligible accumulation (p=0.36) of PVT performance deficits in the 8h condition. However, morning sleep resulted in no significant sleep dose-response effect (p=0.96). All 3 morning sleep doses displayed negligible (p≥0.12) accumulation of impairment across days.
Conclusion
In this sample of young adults, sleep dosages ending in the morning (at 11:30) appear to provide considerable protection against cumulative performance deficits from sleep restricted to 4h-6h/day over 10 days, suggesting that the afternoon circadian promotion of wakefulness can sustain behavioral alertness even over multiple days of repeated sleep restriction.
Support
NIH grants R01-NR04281 and M01-RR00040
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Immune mediated necrotizing myopathy: A rare complication of statin therapy. Clin Pract 2020; 10:1248. [PMID: 32670535 PMCID: PMC7336269 DOI: 10.4081/cp.2020.1248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Immune mediated necrotizing myopathy (IMNM) is part of the inflammatory myopathies group of diseases and presents with muscle weakness, myalgias and elevated serum creatine phosphokinase (CPK). Statin-induced IMNM is a rare complication. We present a patient with IMNM secondary to simvastatin use. The patient presented with proximal myopathy, dysphagia, and elevated creatinine kinase levels, and was subsequently found to have anti-3- hydroxy-3-methylglutaryl-CoA reductase (HMGCR) autoantibodies with a necrotizing process on muscle biopsy. This patient’s case was further complicated by sequelae of multiple disease processes, ultimately leading to deterioration of his health.
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Relationship Between Verbal Fluency Performance, Fight Exposure, and Subcortical Region Brain Volumes in Professional Fighters. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
Verbal fluency performance has been shown to be sensitive to preclinical cognitive changes in neurodegenerative diseases and may detect early, trauma-related cognitive and volumetric changes amongst professional fighters. Baseline verbal fluency performance and volumes of relevant subcortical brain structures were expected to decline as number of professional fights (NoPF) increased, while controlling for education.
Methods
Baseline letter and semantic fluency performance, NoPF, and structural brain imaging from 548 active and retired fighters who participated in the Professional Fighters Brain Health Study were considered. ANCOVAs were conducted to assess differences in verbal fluency performance by NOPF, while controlling for years of education. Number of professional fights were stratified into low (0-20 fights), medium (21-40 fights), and high (41 or more fights).
Results
Semantic fluency performance differed across the three levels of NoPF (F(2, 542)=4.56; p<.02). In addition, significant positive correlations between semantic fluency performance and volumes in the following regions were observed: left thalamus, left putamen, left pallidum, bilateral caudates, bilateral amygdalae, bilateral hippocampi, and bilateral accumbens (all p’s<.05). In contrast, letter fluency performance was not significantly associated with NoPF or volumes of relevant subcortical brain structures (all p’s>.05).
Conclusion
Semantic fluency may be low-cost, easy-to-administer harbinger of emerging cognitive dysfunction and lower volumes in related subcortical brain regions. Additional assessment of clinical utility is necessary.
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The role of active nutritional intervention in patients receiving chemoradiation (CRT) for oesophageal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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"I love having a healthy lifestyle" - a qualitative study investigating body mass index trajectories from childhood to mid-adulthood. BMC OBESITY 2019; 6:16. [PMID: 31080626 PMCID: PMC6501298 DOI: 10.1186/s40608-019-0239-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 03/14/2019] [Indexed: 12/29/2022]
Abstract
Background Children with overweight or obesity are at greatly increased risk of experiencing obesity in adulthood but for reasons generally unknown some attain a healthier adult weight. This qualitative study investigated individual, social and environmental factors that might explain diverging body mass index (BMI) trajectories. This knowledge could underpin interventions to promote healthy weight. Methods This 2016 study included participants from three adult follow-ups of children who (when 7–15 years) participated in the 1985 Australian Schools Health and Fitness Survey and provided BMI data at each time point. Trajectory-based group modelling identified five BMI trajectories: stable below average, stable average, increasing from average, increasing from very high and decreasing from very high. Between six and 12 participants (38–46 years) from each BMI trajectory group were interviewed (n = 50; 60% women). Thematic analysis guided by a social-ecological framework explored individual, social and environmental influences on diet and physical activity within the work setting. Results A distinct approach to healthy behaviour was principally identified in the stable and decreasing BMI groups – we term this approach “health identity” (exemplified by “I love having a healthy lifestyle”). This concept was predominant in the stable or decreasing BMI groups when participants explained why work colleagues seemingly did not influence their health behaviour. Participants in the stable and decreasing BMI groups also more commonly reported, bringing home-prepared lunches to work, working or being educated in a health-related field, having a physically active job or situating physical activity within and around work – the latter three factors were common among those who appeared to have a more distinct “health identity”. Alcohol, workplace food culture (e.g. morning teas), and work-related stress appeared to influence weight-related behaviours, but generally these factors were similarly discussed across all trajectory groups. Conclusion Work-related factors may influence weight or weight-related behaviours, irrespective of BMI trajectory, but the concept of an individual’s “health identity” may help to explain divergent BMI trajectories. “Health identity” and its influence on health behaviour warrants further exploratory work. Electronic supplementary material The online version of this article (10.1186/s40608-019-0239-3) contains supplementary material, which is available to authorized users.
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Use of folfirinox chemotherapy in an Australasian population of pancreatic cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy432.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Synchronized drowsiness monitoring and simulated driving performance data under 50-hr sleep deprivation: A double-blind placebo-controlled caffeine intervention. Data Brief 2018; 19:1335-1340. [PMID: 30229009 PMCID: PMC6141128 DOI: 10.1016/j.dib.2018.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/23/2018] [Accepted: 06/05/2018] [Indexed: 12/02/2022] Open
Abstract
This paper presents the 60-s time-resolution segment from our 50-h total sleep deprivation (TSD) dataset (Aidman et al., 2018) [1] that captures minute-by-minute dynamics of driving performance (lane keeping and speed variability) along with objective, oculography-derived drowsiness estimates synchronised to the same 1-min driving epochs. Eleven participants (5 females, aged 18–28) were randomised into caffeine (administered in four 200 mg doses via chewing gum in the early morning hours) or placebo groups. Every three hours they performed a 40 min simulated drive in a medium fidelity driving simulator, while their drowsiness was continuously measured with a spectacle frame-mounted infra-red alertness monitoring system. The dataset covers 15 driving periods of 40 min each, and thus contains over 600 data points of paired data per participant. The 1-min time resolution enables detailed time-series analyses of both time-since-wake and time-on-task performance dynamics and associated drowsiness levels. It also enables direct examination of the relationships between drowsiness and task performance measures. The question of how these relationships might change under various intervention conditions (caffeine in our case) seems worth further investigation.
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A - 26Awareness of Psychiatric Symptoms and Caregiver Distress Among Older Adults in a Memory Disorders Clinic. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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0216 The Effect Of Caffeine On Glucose Metabolism, Self-reported Hunger And Mood State During Extended Wakefulness. Sleep 2018. [DOI: 10.1093/sleep/zsy061.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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0200 The Effectiveness Of Caffeine Gum In Reducing Sleep Inertia Following A 30min Nighttime Nap Opportunity: Preliminary Results. Sleep 2018. [DOI: 10.1093/sleep/zsy061.199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reply to letter to the editor on: "is there a relationship between excessive sugar consumption and sleep quality in children?"<sup/>. Int J Food Sci Nutr 2018; 69:902-903. [PMID: 29508653 DOI: 10.1080/09637486.2018.1445203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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A-17Sex Differences in Hippocampal Subfield Volume: The Impact of Amyloid Burden. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Prevalence of Traumatic Findings on Routine MRI in a Large Cohort of Professional Fighters. AJNR Am J Neuroradiol 2017; 38:1303-1310. [PMID: 28473342 PMCID: PMC7959893 DOI: 10.3174/ajnr.a5175] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 02/10/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies investigating MR imaging abnormalities among fighters have had small sample sizes. This investigation assessed a large number of fighters using the same conventional sequences on the same scanner. MATERIALS AND METHODS Conventional 3T MR imaging was used to assess 499 fighters (boxers, mixed martial artists, and martial artists) and 62 controls for nonspecific WM changes, cerebral microhemorrhage, cavum septum pellucidum, and cavum vergae. The lengths of the cavum septum pellucidum and cavum vergae and the ratio of cavum septum pellucidum to the septum pellucidum lengths were assessed. RESULTS The prevalence of nonspecific WM changes was similar between groups. Fighters had a prevalence of cerebral microhemorrhage (4.2% versus 0% for controls, P = .152). Fighters had a higher prevalence of cavum septum pellucidum versus controls (53.1% versus 17.7%, P < .001) and cavum vergae versus controls (14.4% versus 0%, P < .001). The lengths of the cavum septum pellucidum plus the cavum vergae (P < .001), cavum septum pellucidum (P = .025), and cavum septum pellucidum to the septum pellucidum length ratio (P = .009) were higher in fighters than in controls. The number of fights slightly correlated with cavum septum pellucidum plus cavum vergae length (R = 0.306, P < .001) and cavum septum pellucidum length (R = 0.278, P < .001). When fighters were subdivided into boxers, mixed martial artists, and martial artists, results were similar to those in the whole-group analysis. CONCLUSIONS This study assessed MR imaging findings in a large cohort demonstrating a significantly increased prevalence of cavum septum pellucidum among fighters. Although cerebral microhemorrhages were higher in fighters than in controls, this finding was not statistically significant, possibly partially due to underpowering of the study.
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0912 THE INFLUENCE OF PARENTAL SHIFT WORK ON THEIR CHILD’S DIET. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
The aim of this study was to measure validity and reproducibility of a caffeine food frequency questionnaire (C-FFQ) developed for the Australian population. The C-FFQ was designed to assess average daily caffeine consumption using four categories of food and beverages including; energy drinks; soft drinks/soda; coffee and tea and chocolate (food and drink). Participants completed a seven-day food diary immediately followed by the C-FFQ on two consecutive days. The questionnaire was first piloted in 20 adults, and then, a validity/reproducibility study was conducted (n = 90 adults). The C-FFQ showed moderate correlations (r = .60), fair agreement (mean difference 63 mg) and reasonable quintile rankings indicating fair to moderate agreement with the seven-day food diary. To test reproducibility, the C-FFQ was compared to itself and showed strong correlations (r = .90), good quintile rankings and strong kappa values (κ = 0.65), indicating strong reproducibility. The C-FFQ shows adequate validity and reproducibility and will aid researchers in Australia to quantify caffeine consumption.
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Sugar intake in a cohort of Australian children. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2016. [DOI: 10.1016/j.jnim.2015.12.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Relationship between caffeine consumption and sleep in Australian children. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2016. [DOI: 10.1016/j.jnim.2015.12.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tick abundances in South London parks and the potential risk for Lyme borreliosis to the general public. MEDICAL AND VETERINARY ENTOMOLOGY 2015; 29:448-452. [PMID: 26400641 DOI: 10.1111/mve.12137] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 06/05/2023]
Abstract
Tick abundances and prevalences of infection with Borrelia burgdorferi sensu lato, the causative agent of Lyme disease, were investigated in four South London parks. A total of 360 transects were sampled using three methods of collection (blanket, leggings and flags) simultaneously. No ticks were found on Wimbledon Common or at Hampton Court, but 1118 Ixodes ricinus (Ixodida: Ixodidae) ticks were collected at Richmond and Bushy Parks. At Richmond Park, lower canopy humidity [odds ratio (OR) 0.94; P = 0.005], increased mat depth (OR 1.15; P < 0.001) and increased soil moisture (OR 1.40; P = 0.001) predicted the presence of I. ricinus, and increased sward height [incidence rate ratio (IRR) 1.01; P = 0.006] and decreased ground temperature (IRR 0.90; P = 0.009) predicted increased abundance. At Bushy Park, thicker mat depth predicted tick presence (OR 1.17; P = 0.006) and increasing temperature correlated with tick absence (OR 0.57; P = 0.023). A total of 279 ticks were screened for the presence of B. burgdorferi using quantitative polymerase chain reaction. Point prevalences of 0% for larvae (n = 78), 2.14% for nymphs (n = 174) and 0% for adult ticks (n = 7) related to an acarological risk of 0.22 infected ticks per 40 m transect in Richmond Park. The abundance of ticks and the acarological risk, particularly at Richmond Park, highlight the need for appropriate communication of the associated risk to the general public frequenting these recreational areas.
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An assessment of variables affecting transition readiness in pediatric rheumatology patients. Pediatr Rheumatol Online J 2015; 13:42. [PMID: 26463343 PMCID: PMC4604737 DOI: 10.1186/s12969-015-0040-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/06/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We sought to identify which adolescent patient characteristics might lead to subjective reported independence in accessing medical care when patients transition from pediatric to adult medicine. METHODS Pediatric and adult rheumatologists were asked which pediatric patient characteristics they believed would improve transition to adult medical care. Based on these responses, a questionnaire was created and administered to 76 teenage/young adult patients in a pediatric rheumatology clinic. The first set of questions included demographic, disease features, and life skills questions. The second set of questions pertained to self-reported independence in managing medical care. Data was analyzed to see if there were any significant associations between an individual's response to demographic, disease feature, or life skills questions and the independence outcome questions. RESULTS In our study, older age correlated with self-reported independence in almost all questions asked regarding accessing medical care. Other patient characteristics that were associated with increased self-perceived autonomy included having a younger parent, having a family member with a similar disease, longer disease duration, having a comorbid non-rheumatic diagnosis, and having had a summer job. CONCLUSIONS The patient characteristics that we found associated with self-reported independence in obtaining medical care should be considered when determining which patients might be more likely to make a successful transition.
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Abstract
BACKGROUND Health professionals often avoid talking about death and dying with patients and relatives, and this avoidance is compounded in cases of dementia by lack of knowledge of trajectory and prognosis. Unfortunately, this impacts on care, with many terminally ill dementia clients receiving inadequate palliation and excessive intervention at end-of-life. This study developed and evaluated a tool to facilitate conversations about death and dying in aged care facilities. METHODS This study utilised available best-practice evidence, feedback from aged care facility nursing and care staff and specialist input to develop the 'discussion tool', which was subsequently trialled and qualitatively evaluated, via thematic analysis of data from family interviews and staff diaries. The study was part of a larger mixed method study, not yet reported. The tool provided knowledge and also skills-based 'how to' information and specific examples of 'what to say'. RESULTS The tool facilitated a more open dialogue between dementia palliation resource nurses (a role specifically developed during this project) and family members. Both resource nurses and family members gained confidence in discussing the death of their relative with dementia, and in relevant cases discussed specific decisions around future care. Family members and nurses reported satisfaction with these discussions. CONCLUSION Providing specific skills-based support, such as the 'discussion tool' can help staff to gain confidence and change practice in situations where unfamiliar and uncomfortable practices might normally be avoided. As our populations age, health professionals will increasingly need to be able to openly discuss care options towards end-of-life.
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A-24 * Difference between Patients with AD and Patients with FTD on a Test of Practical Judgment. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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B-70 * D-KEFS Color Word Interference: Atypical Performance Patterns and Working Memory Contributions. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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A-88 * The Confusing Case of the Stuttering Sommelier. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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A-23 * Using a Nonverbal Test to Assess Memory in Patients with FTD. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pilot phase I/II personalized therapy trial for metastatic colorectal cancer: evaluating the feasibility of protein pathway activation mapping for stratifying patients to therapy with imatinib and panitumumab. J Proteome Res 2014; 13:2846-55. [PMID: 24787230 DOI: 10.1021/pr401267m] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This nonrandomized phase I/II trial assessed the efficacy/tolerability of imatinib plus panitumumab in patients affected by metastatic colorectal cancer (mCRC) after stratification to treatment by selection of activated imatinib drug targets using reverse-phase protein array (RPPA). mCRC patients presenting with a biopsiable liver metastasis were enrolled. Allocation to the experimental and control arms was established using functional pathway activation mapping of c-Kit, PDGFR, and c-Abl phosphorylation by RPPA. The experimental arm received run-in escalation therapy with imatinib followed by panitumumab. The control arm received panitumumab alone. Seven patients were enrolled in the study. For three of the seven patients, sequential pre- and post-treatment biopsies were used to evaluate the effect of the therapeutic compounds on the drug targets and substrates. A decrease in the activation level of the drug targets and downstream substrates was observed in two of three patients. Combination therapy increased the activation of the AKT-mTOR pathway and several receptor tyrosine kinases. This study proposes a novel methodology for stratifying patients to personalized treatment based on the activation level of the drug targets. This workflow provides the ability to monitor changes in the signaling pathways after the administration of targeted therapies and to identify compensatory mechanisms.
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An assessment of musculoskeletal knowledge in graduating medical and physician assistant students and implications for musculoskeletal care providers. J Bone Joint Surg Am 2012; 94:343-8. [PMID: 22336973 PMCID: PMC3273875 DOI: 10.2106/jbjs.j.00417] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the present study was to evaluate musculoskeletal knowledge among graduating medical students and physician assistant students with use of a National Board of Medical Examiners (NBME) examination. We hypothesized that there would be no difference in scores between the two groups. In addition, we looked for relationships between examination scores and both the student-reported musculoskeletal experiences and the school-reported musculoskeletal curriculum. METHODS One hundred and forty-four students from three medical schools and ninety-one students from four physician assistant schools were included in the present study; both groups were graduating students in the final semester of education. The National Board of Medical Examiners Musculoskeletal Subject Examination (NBME MSK) was utilized to assess musculoskeletal knowledge. RESULTS The mean examination score (and standard deviation) was 73.8% ± 9.7% for medical students and 62.3% ± 11% for physician assistant students (95% confidence interval [CI], -13.8 to 0.00; p < 0.05). Medical students with an interest in orthopaedics as a career scored significantly higher than those without an expressed orthopaedic interest, and medical students without an expressed career interest in orthopaedics scored significantly higher than physician assistant students (p < 0.05). Among medical students, a longer duration of a clinical rotation in orthopaedics was associated with a higher examination score (p < 0.05). The average number of hours of preclinical musculoskeletal education in the first two years of school was significantly higher for medical schools (122.1 ± 25.1 hours) than for physician assistant schools (89.8 ± 74.8 hours) (p < 0.05). CONCLUSIONS Graduating medical students scored significantly higher than graduating physician assistant students on the NBME MSK. This may be related to multiple factors, and further studies are necessary to evaluate the overall musculoskeletal clinical competence of both groups of students.
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DCIS neoadjuvant therapy: Targeting the autophagy pathway in malignant precursor cells. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps341] [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] Open
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Phase I/II personalized therapy trial for metastatic colorectal cancer using functional pathway mapping: Stratification to imatinib therapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pre-existence of invasive cells in breast ductal carcinoma in situ. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.10508] [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] Open
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Impact of Routine Duplex Surveillance on Venous Thromboembolic Disease in Trauma Patients. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Improved Positioning Accuracy of the PA10-6CE Robot with Geometric and Flexibility Calibration. IEEE T ROBOT 2008. [DOI: 10.1109/tro.2007.914003] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Effects of moderate sleep deprivation and low-dose alcohol on driving simulator performance and perception in young men. Sleep 2008; 30:1327-33. [PMID: 17969466 DOI: 10.1093/sleep/30.10.1327] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVE To determine the combined effects of sleep restriction and low-dose alcohol on driving simulator performance, EEG, and subjective levels of sleepiness and performance in the mid-afternoon. DESIGN Repeated measures with 4 experimental conditions. Normal sleep without alcohol, sleep restriction alone (4 hours) and sleep restriction in combination with 2 different low blood alcohol concentrations (0.025 g/dL and 0.035 g/dL). SETTING Sleep Laboratory, Adelaide Institute for Sleep Health. PARTICIPANTS Twenty-one healthy young men, aged 18-30 years, mean (+/-SD) = 22.5(+/-3.7) years, BMI = 25(+/-6.7) kg/m2; all had normal sleep patterns and were free of sleep disorders. MEASUREMENTS Participants completed a 70-minute simulated driving session, commencing at 14:00. Driving parameters included steering deviation, braking reaction time, and number of collisions. Alpha and theta EEG activity and subjective driving performance and sleepiness were also measured throughout the driving task. RESULTS All measures were significantly affected by time. Steering deviation increased significantly when sleep restriction was combined with the higher dose alcohol. This combination also resulted in a significant increase in alpha/theta EEG activity throughout the drive, as well as greater subjective sleepiness and negative driving performance ratings compared to control or sleep restriction alone. DISCUSSION These data indicate that combining low-dose alcohol with moderate sleep restriction results in significant decrements to subjective alertness and performance as well as to some driving performance and EEG parameters. This highlights the potential risks of driving after consumption of low and legal doses of alcohol when also sleep restricted.
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Sagittal curvature of total knee replacements predicts in vivo kinematics. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)83418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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L6: Influences of Past and Current Vitamin E Intake on Serum α-Tocopherol and Its Association with Cognitive Impairment in Older Women: A WHI Ancillary Study. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s151b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study. ACTA ACUST UNITED AC 2005; 87:646-55. [PMID: 15855366 DOI: 10.1302/0301-620x.87b5.15602] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We performed a prospective, randomised trial of 44 patients to compare the functional outcomes of a posterior-cruciate-ligament-retaining and posterior-cruciate-ligament-substituting total knee arthroplasty, and to gain a better understanding of the in vivo kinematic behaviour of both devices. At follow-up at five years, no statistically significant differences were found in the clinical outcome measurements for either design. The prevalence of radiolucent lines and the survivorship were the same. In a subgroup of 15 knees, additional image-intensifier analysis in the horizontal and sagittal planes was performed during step-up and lunge activity. Our analysis revealed striking differences. Lunge activity showed a mean posterior displacement of both medial and lateral tibiofemoral contact areas (roll-back) which was greater and more consistent in the cruciate-substituting than in the cruciate-retaining group (medial p < 0.0001, lateral p = 0.011). The amount of posterior displacement could predict the maximum flexion which could be achieved (p = 0.018). Forward displacement of the tibiofemoral contact area in flexion during stair activity was seen more in the cruciate-retaining than in the cruciate-substituting group. This was attributed mainly to insufficiency of the posterior cruciate ligament and partially to that of the anterior cruciate ligament. We concluded that, despite similar clinical outcomes, there are significant kinematic differences between cruciate-retaining and cruciate-substituting arthroplasties.
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The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2005; 13:193-6. [PMID: 15824934 DOI: 10.1007/s00167-004-0557-x] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 06/10/2004] [Indexed: 11/29/2022]
Abstract
Many surgeons believe that increasing the tibial slope in total knee arthroplasty (TKA) is beneficial with regard to maximal postoperative flexion. Review of the clinical literature, however, does not confirm this hypothesis, neither does it give an answer to the question of how much flexion gain can be expected per degree extra tibial slope. The purpose of this study was, therefore, to evaluate and quantify the influence of tibial slope on maximal postoperative flexion in contemporary posterior cruciate ligament (PCL)-retaining TKA. Twenty-one cadaver simulations of a standard PCL-retaining TKA were studied while reproducing identical deep flexion femorotibial kinematics as documented by three-dimensional computer-aided videofluoroscopy from patients with well-functioning TKAs of the same design. In each knee the tibial component was consecutively implanted with 0 degrees posterior slope, 4 degrees posterior slope, and 7 degrees posterior slope. Maximal flexion was recorded for each configuration. Average maximal flexion at 0 degrees tibial slope was 104 degrees, and increased significantly to 112 degrees when the same knees were implanted with 4 degrees tibial slope. Increasing the slope further to 7 degrees again significantly improved average maximal flexion to 120 degrees. When postoperative radiographic tibial slope was compared to maximal flexion, an average gain of 1.7 degrees flexion for every degree extra tibial slope was noted. Increasing the tibial slope in PCL-retaining TKA does indeed improve maximal flexion before tibial insert impingement occurs against the femoral bone. The surgeon can expect an average gain of 1.7 degrees flexion for every degree extra tibial slope.
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An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients. Int J Obstet Anesth 2004; 10:162-7. [PMID: 15321604 DOI: 10.1054/ijoa.2000.0825] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a prospective audit of 100 parturients who experienced accidental dural puncture by a Tuohy needle, while attending a tertiary referral obstetric unit during the period 1993-1999. The post dural puncture headache rate was 81% and the diagnosis of dural puncture was delayed until presentation of the headache in 27% of these cases. The incidence of unrecognised dural puncture was not influenced by the technique used for identification of the epidural space. Intraspinal opioid administration after dural puncture was associated with a significant reduction in the incidence of headache (P < 0.04). There was no association between mode of delivery and post dural puncture headache. Deliberate cannulation of the subarachnoid space with an epidural catheter at the time of dural puncture, for continuous spinal analgesia or anaesthesia, did not affect the incidence of post dural puncture headache but was associated with a significantly reduced rate of epidural blood patch (43% versus 80%, P < 0.01). Of those who developed post dural puncture headache, 48% were classified 'severe' and in 49% the headache presented within 24 h of dural puncture. There was a trend to earlier onset of headache (either immediate or within 24 h) when the epidural identification technique was loss-of-resistance to air rather than saline (54% versus 33%, P = 0.07). Twenty-eight percent of those suffering from post dural puncture headache were treated expectantly and 72% received a therapeutic blood patch. Of seven parturients who received sumatriptan, six found it ineffective and five subsequently received a blood patch.
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An audit of epidural blood patch after accidental dural puncture with a Tuohy needle in obstetric patients. Int J Obstet Anesth 2004; 10:172-6. [PMID: 15321606 DOI: 10.1054/ijoa.2000.0826] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report the results of a prospective audit of accidental dural puncture in 100 obstetric patients in a single tertiary referral institution during the period 1993 to 1999. The post dural puncture headache rate was 81%. Of the 81 parturients with post dural puncture headache, 58 (72%) received a therapeutic epidural blood patch, using 7 to 25 mL of autologous blood. After the initial blood patch, complete relief of headache was obtained in 67% and complete or partial relief in 95%. However, severe headache returned in 31% and 28% received more than one blood patch. The incidence of complete relief of headache with one blood patch or more was 50%, with 38% achieving partial relief and 12% having unrelieved headache. There was no significant association between volume of blood used for blood patch and success rate. The initial rate of resolution of headache did not differ significantly between parturients receiving a blood patch within 48 h of dural puncture and after 48 h (P =0.70). However, in the former group, the incidence of recurrent headache was significantly higher (59% versus 11%, P<0.001).
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Abstract
Our purpose was to determine the mechanism which allows the maximum knee flexion in vivo after a posterior-cruciate-ligament (PCL)-retaining total knee arthroplasty. Using three-dimensional computer-aided design videofluoroscopy of deep squatting in 29 patients, we determined that in 72% of knees, direct impingement of the tibial insert posteriorly against the back of the femur was the factor responsible for blocking further flexion. In view of this finding we defined a new parameter termed the ‘posterior condylar offset’. In 150 consecutive arthroplasties of the knee, the magnitude of posterior condylar offset was found to correlate with the final range of flexion.
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Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 2002; 84:50-3. [PMID: 11837832 DOI: 10.1302/0301-620x.84b1.12432] [Citation(s) in RCA: 283] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our purpose was to determine the mechanism which allows the maximum knee flexion in vivo after a posterior-cruciate-ligament (PCL)-retaining total knee arthroplasty. Using three-dimensional computer-aided design videofluoroscopy of deep squatting in 29 patients, we determined that in 72% of knees, direct impingement of the tibial insert posteriorly against the back of the femur was the factor responsible for blocking further flexion. In view of this finding we defined a new parameter termed the 'posterior condylar offset'. In 150 consecutive arthroplasties of the knee, the magnitude of posterior condylar offset was found to correlate with the final range of flexion.
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A portable, disposable device for patient-controlled epidural analgesia following Caesarean section: evaluation by patients and nurses. Aust N Z J Obstet Gynaecol 2001; 41:372-5. [PMID: 11787908 DOI: 10.1111/j.1479-828x.2001.tb01312.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Twenty patients undergoing elective Caesarean section were provided with a pethidine-primed disposable Go Medical epidural infuser for postoperative pain control. Patients and nurses evaluated the device by completing a questionnaire. The infuser delivered adequate analgesia, was easy to understand and use, provided the patients with control over their pain relief and allowed good mobility The nursing staff found the device easy to prime and understand, the only drawback being the occasional incidence of equipment failure. The patients expressed a high level of satisfaction with the device and all would use it again if offered the chance. We conclude that the Go Medical epidural infuser is a safe and effective device as used in the postnatal ward setting.
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