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Voelker R. The Promise and Pitfalls of AI in the Complex World of Diagnosis, Treatment, and Disease Management. JAMA 2023; 330:1416-1419. [PMID: 37755919 DOI: 10.1001/jama.2023.19180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
In this Medical News article, Ida Sim, MD, PhD, a primary care physician and computational precision health expert at the University of California, San Francisco, discusses the ramifications of using AI technologies in patient care.
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Zhou N, Wang L, Almirall D. Estimating tree-based dynamic treatment regimes using observational data with restricted treatment sequences. Biometrics 2023; 79:2260-2271. [PMID: 36063542 DOI: 10.1111/biom.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 08/16/2022] [Indexed: 11/29/2022]
Abstract
A dynamic treatment regime (DTR) is a sequence of decision rules that provide guidance on how to treat individuals based on their static and time-varying status. Existing observational data are often used to generate hypotheses about effective DTRs. A common challenge with observational data, however, is the need for analysts to consider "restrictions" on the treatment sequences. Such restrictions may be necessary for settings where (1) one or more treatment sequences that were offered to individuals when the data were collected are no longer considered viable in practice, (2) specific treatment sequences are no longer available, or (3) the scientific focus of the analysis concerns a specific type of treatment sequences (eg, "stepped-up" treatments). To address this challenge, we propose a restricted tree-based reinforcement learning (RT-RL) method that searches for an interpretable DTR with the maximum expected outcome, given a (set of) user-specified restriction(s), which specifies treatment options (at each stage) that ought not to be considered as part of the estimated tree-based DTR. In simulations, we evaluate the performance of RT-RL versus the standard approach of ignoring the partial data for individuals not following the (set of) restriction(s). The method is illustrated using an observational data set to estimate a two-stage stepped-up DTR for guiding the level of care placement for adolescents with substance use disorder.
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Affiliation(s)
- Nina Zhou
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Lu Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Astărăstoae V, Rogozea LM, Aron I, Botezat D. The New Mythology of the Body and the Transformation of the Therapeutic Space. Am J Ther 2023; 30:e439-e446. [PMID: 37713688 DOI: 10.1097/mjt.0000000000001661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
BACKGROUND The history of medicine has flowed in the wake of knowledge and social perceptions about the body and corporeality. There is no idea of health without reference to the notion of body (although "health" can have other meanings, figuratively). Considering the same history, the body was the subject of numerous segregations and categorizations due to which it was and is a "social object" and a "political object." In turn, the spatial and cultural framework was the environment and determinant of the medicine development which is not only a science but also an inter-human interactive practice. AREAS OF UNCERTAINTY In this article, we will analyze the current social (re)construction of the notions of body and space by referring to the technological and structural changes that are manifested in medicine and society and their ethical implications. DATA SOURCES A review of the specialized literature was performed in June-July 2023, using keywords like human enhancement, therapeutic enhancement, transhumanist medicine, ethics from PubMed, Scopus, Web of Science, and Google Scholar, and official documents issued at the international level (World Health Organization, European Commission). ETHICS AND THERAPEUTIC ADVANCES This literature review suggests that few practical solutions to human enhancement, both curative and preventive, whether cognitive or physical, have been approached entirely from an ethical point of view. The historical evolution of the concept of human enhancement has led to debates between "transhumanists" and "bioconservatives" depending on how they relate to the improvement of the human condition without or with reticence interventions to improve human capabilities being related to various interventions, from pharmacological, surgical ones to those in the field of genetics, nanomedicine, or cybernetics. In addition to the technical aspects, which are often the major concern of researchers and those applying new technologies, there are also ethical and legislative aspects, to better understand the impact that the dynamics and diffusion of these processes have on the evolution of the human species. CONCLUSIONS In interference with these technologies, the body is exposed to possibilities of change and evolution with colossal (expected) social impact that can change norms and values that have been stable for centuries. Social space and place are also proving to be "processes in the making'" for which we need to detect what developments are possible or have already imposed themselves as a trend in the social and medical world.
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Affiliation(s)
- Vasile Astărăstoae
- Faculty of Medicine, Grigore T Popa University of Medicine & Pharmacy, Iasi, Romania
| | - Liliana M Rogozea
- Basic, Preventive and Clinical Sciences Department, Transilvania University, Brasov, Romania; and
| | - Ioan Aron
- Law Department, Transilvania University, Brasov, Romania
| | - Doru Botezat
- Faculty of Medicine, Grigore T Popa University of Medicine & Pharmacy, Iasi, Romania
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Ribba B, Peck R, Hutchinson L, Bousnina I, Motti D. Digital Therapeutics as a New Therapeutic Modality: A Review from the Perspective of Clinical Pharmacology. Clin Pharmacol Ther 2023; 114:578-590. [PMID: 37392464 DOI: 10.1002/cpt.2989] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023]
Abstract
The promise of transforming digital technologies into treatments is what drives the development of digital therapeutics (DTx), generally known as software applications embedded within accessible technologies-such as smartphones-to treat, manage, or prevent a pathological condition. Whereas DTx solutions that successfully demonstrate effectiveness and safety could drastically improve the life of patients in multiple therapeutic areas, there is a general consensus that generating therapeutic evidence for DTx presents challenges and open questions. We believe there are three main areas where the application of clinical pharmacology principles from the drug development field could benefit DTx development: the characterization of the mechanism of action, the optimization of the intervention, and, finally, its dosing. We reviewed DTx studies to explore how the field is approaching these topics and to better characterize the challenges associated with them. This leads us to emphasize the role that the application of clinical pharmacology principles could play in the development of DTx and to advocate for a development approach that merges such principles from development of traditional therapeutics with important considerations from the highly attractive and fast-paced world of digital solutions.
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Affiliation(s)
- Benjamin Ribba
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Richard Peck
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Lucy Hutchinson
- Roche Information Solutions, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Imein Bousnina
- Genentech, A Member of the Roche Group, Washington, DC, USA
| | - Dario Motti
- Roche Information Solutions, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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van Kessel R, Roman-Urrestarazu A, Anderson M, Kyriopoulos I, Field S, Monti G, Reed SD, Pavlova M, Wharton G, Mossialos E. Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review. J Med Internet Res 2023; 25:e48000. [PMID: 37490322 PMCID: PMC10410406 DOI: 10.2196/48000] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. OBJECTIVE In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. METHODS A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. RESULTS We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. CONCLUSIONS The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.
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Affiliation(s)
- Robin van Kessel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of International Health, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Andres Roman-Urrestarazu
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Michael Anderson
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Ilias Kyriopoulos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Samantha Field
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Giovanni Monti
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, Netherlands
| | - George Wharton
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Elias Mossialos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Chan MS, Kowalik JC, Ashfield T, Pearson-Stuttard J. Improving health evaluations to capture wider value of therapeutics and incentivise innovation. Front Public Health 2023; 11:1119652. [PMID: 37064703 PMCID: PMC10102525 DOI: 10.3389/fpubh.2023.1119652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/07/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Mei Sum Chan
- Health Analytics, Lane Clark & Peacock LLP, London, United Kingdom
| | | | - Tom Ashfield
- UK Medical Affairs - Anti-infectives, Pfizer Ltd., Tadworth, United Kingdom
| | - Jonathan Pearson-Stuttard
- Health Analytics, Lane Clark & Peacock LLP, London, United Kingdom
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- *Correspondence: Jonathan Pearson-Stuttard
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Lang JH. [Developing micro and non-invasive procedures, practicing four-character of diagnosis and treatment]. Zhonghua Fu Chan Ke Za Zhi 2022; 57:241-243. [PMID: 35484654 DOI: 10.3760/cma.j.cn112141-20211214-00733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Goldenberg NA, Kittelson JM, Abshire TC, Bonaca M, Casella JF, Dale RA, Halperin JL, Hamblin F, Kessler CM, Manco-Johnson MJ, Sidonio RF, Spyropoulos AC, Steg PG, Turpie AGG, Schulman S. Effect of Anticoagulant Therapy for 6 Weeks vs 3 Months on Recurrence and Bleeding Events in Patients Younger Than 21 Years of Age With Provoked Venous Thromboembolism: The Kids-DOTT Randomized Clinical Trial. JAMA 2022; 327:129-137. [PMID: 35015038 PMCID: PMC8753509 DOI: 10.1001/jama.2021.23182] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Among patients younger than 21 years of age, the optimal duration of anticoagulant therapy for venous thromboembolism is unknown. OBJECTIVE To test the hypothesis that a 6-week duration of anticoagulant therapy for provoked venous thromboembolism is noninferior to a conventional 3-month therapy duration in patients younger than 21 years of age. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial involving 417 patients younger than 21 years of age with acute, provoked venous thromboembolism enrolled at 42 centers in 5 countries from 2008-2021. The main exclusions were severe anticoagulant deficiencies or prior venous thromboembolism. Patients without persistent antiphospholipid antibodies and whose thrombi were resolved or not completely occlusive upon repeat imaging at 6 weeks after diagnosis underwent randomization. The final visit for the primary end points occurred in January 2021. INTERVENTIONS Total duration for anticoagulant therapy of 6 weeks (n = 207) vs 3 months (n = 210) for provoked venous thromboembolism. MAIN OUTCOMES AND MEASURES The primary efficacy and safety end points were centrally adjudicated symptomatic recurrent venous thromboembolism and clinically relevant bleeding events within 1 year blinded to treatment group. The primary analysis was noninferiority in the per-protocol population. The noninferiority boundary incorporated a bivariate trade-off that included an absolute increase of 0% in symptomatic recurrent venous thromboembolism with an absolute risk reduction of 4% in clinically relevant bleeding events (1 of 3 points on the bivariate noninferiority boundary curve). RESULTS Among 417 randomized patients, 297 (median age, 8.3 [range, 0.04-20.9] years; 49% female) met criteria for the primary per-protocol population analysis. The Kaplan-Meier estimate for the 1-year cumulative incidence of the primary efficacy outcome was 0.66% (95% CI, 0%-1.95%) in the 6-week anticoagulant therapy group and 0.70% (95% CI, 0%-2.07%) in the 3-month anticoagulant therapy group, and for the primary safety outcome, the incidence was 0.65% (95% CI, 0%-1.91%) and 0.70% (95% CI, 0%-2.06%). Based on absolute risk differences in recurrent venous thromboembolism and clinically relevant bleeding events between groups, noninferiority was demonstrated. Adverse events occurred in 26% of patients in the 6-week anticoagulant therapy group and in 32% of patients in the 3-month anticoagulant therapy group; the most common adverse event was fever (1.9% and 3.4%, respectively). CONCLUSIONS AND RELEVANCE Among patients younger than 21 years of age with provoked venous thromboembolism, anticoagulant therapy for 6 weeks compared with 3 months met noninferiority criteria based on the trade-off between recurrent venous thromboembolism risk and bleeding risk. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00687882.
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Affiliation(s)
- Neil A. Goldenberg
- Institute for Clinical and Translational Research, Cancer and Blood Disorder Institute, and Heart Institute, Johns Hopkins All Children’s Hospital, St Petersburg, Florida
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - John M. Kittelson
- Department of Biostatistics, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- CPC Clinical Research, Aurora, Colorado
| | - Thomas C. Abshire
- Versiti Blood Research Institute and Department of Pediatrics and Medicine and Clinical and Translational Science Institute, Medical College of Wisconsin, Milwaukee
| | - Marc Bonaca
- CPC Clinical Research, Aurora, Colorado
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - James F. Casella
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Jonathan L. Halperin
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Frances Hamblin
- Institute for Clinical and Translational Research, Cancer and Blood Disorder Institute, and Heart Institute, Johns Hopkins All Children’s Hospital, St Petersburg, Florida
| | - Craig M. Kessler
- Lombardi Cancer Center, Department of Medicine, School of Medicine, Georgetown University, Washington, DC
| | - Marilyn J. Manco-Johnson
- Department of Pediatrics, School of Medicine, Children’s Hospital of Colorado, Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora
| | - Robert F. Sidonio
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Alex C. Spyropoulos
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell and Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - P. Gabriel Steg
- Université de Paris, AP-HP, Hôpital Bichat, French Alliance for Cardiovascular Trials and INSERM 1148, Paris, France
| | - Alexander G. G. Turpie
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sam Schulman
- Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
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Simon GE, Platt R, Watanabe JH, Bindman AB, John London A, Horberg M, Hernandez A, Califf RM. When Can We Rely on Real-World Evidence to Evaluate New Medical Treatments? Clin Pharmacol Ther 2022; 111:30-34. [PMID: 33895994 PMCID: PMC8251042 DOI: 10.1002/cpt.2253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022]
Abstract
Concerns regarding both the limited generalizability and the slow pace of traditional randomized trials have led to calls for greater use of real-world evidence (RWE) in the evaluation of new treatments or products. The RWE label has been used to refer to a variety of departures from the methods of traditional randomized controlled trials. Recognizing this complexity and potential confusion, the National Academies of Science, Engineering, and Medicine convened a series of workshops to clarify and address questions regarding the use of RWE to evaluate new medical treatments. Those workshops identified three specific dimensions in which RWE studies might differ from traditional clinical trials: use of real-world data (data extracted from health system records or data captured by mobile devices), delivery of real-world treatment (open-label treatments delivered in community settings by community practitioners), and real-world treatment assignment (including nonrandomized comparisons and variations on random assignment such as before-after or stepped-wedge designs). For any RWE study, decisions regarding each of these dimensions depends on the specific research question, characteristics of the potential study settings, and characteristics of the settings where study results would be applied.
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Affiliation(s)
| | - Richard Platt
- Harvard Pilgrim Health Care InstituteHarvard Medical School
| | | | | | - Alex John London
- Philosophy Department & Center for Ethics and PolicyCarnegie Mellon University
| | - Michael Horberg
- Kaiser Permanente Mid‐Atlantic Permanente Research InstituteMid‐Atlantic Permanente Medical Group
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Pope MK, Hall TS, Schirripa V, Radic P, Virdone S, Pieper KS, Le Heuzey JY, Jansky P, Fitzmaurice DA, Cappato R, Atar D, Camm AJ, Kakkar AK. Cardioversion in patients with newly diagnosed non-valvular atrial fibrillation: observational study using prospectively collected registry data. BMJ 2021; 375:e066450. [PMID: 34706884 PMCID: PMC8548918 DOI: 10.1136/bmj-2021-066450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the clinical outcomes of patients who underwent cardioversion compared with those who did not have cardioverson in a large dataset of patients with recent onset non-valvular atrial fibrillation. DESIGN Observational study using prospectively collected registry data (Global Anticoagulant Registry in the FIELD-AF-GARFIELD-AF). SETTING 1317 participating sites in 35 countries. PARTICIPANTS 52 057 patients aged 18 years and older with newly diagnosed atrial fibrillation (up to six weeks' duration) and at least one investigator determined stroke risk factor. MAIN OUTCOME MEASURES Comparisons were made between patients who received cardioversion and those who had no cardioversion at baseline, and between patients who received direct current cardioversion and those who had pharmacological cardioversion. Overlap propensity weighting with Cox proportional hazards models was used to evaluate the effect of cardioversion on clinical endpoints (all cause mortality, non-haemorrhagic stroke or systemic embolism, and major bleeding), adjusting for baseline risk and patient selection. RESULTS 44 201 patients were included in the analysis comparing cardioversion and no cardioversion, and of these, 6595 (14.9%) underwent cardioversion at baseline. The propensity score weighted hazard ratio for all cause mortality in the cardioversion group was 0.74 (95% confidence interval 0.63 to 0.86) from baseline to one year follow-up and 0.77 (0.64 to 0.93) from one year to two year follow-up. Of the 6595 patients who had cardioversion at baseline, 299 had a follow-up cardioversion more than 48 days after enrolment. 7175 patients were assessed in the analysis comparing type of cardioversion: 2427 (33.8%) received pharmacological cardioversion and 4748 (66.2%) had direct current cardioversion. During one year follow-up, event rates (per 100 patient years) for all cause mortality in patients who received direct current and pharmacological cardioversion were 1.36 (1.13 to 1.64) and 1.70 (1.35 to 2.14), respectively. CONCLUSION In this large dataset of patients with recent onset non-valvular atrial fibrillation, a small proportion were treated with cardioversion. Direct current cardioversion was performed twice as often as pharmacological cardioversion, and there appeared to be no major difference in outcome events for these two cardioversion modalities. For the overall cardioversion group, after adjustments for confounders, a significantly lower risk of mortality was found in patients who received early cardioversion compared with those who did not receive early cardioversion. STUDY REGISTRATION ClinicalTrials.gov NCT01090362.
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Affiliation(s)
- Marita Knudsen Pope
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Hamar Hospital, Innlandet Hospital Trust, Hamar, Norway
| | - Trygve S Hall
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | | | - Petra Radic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | - Jean-Yves Le Heuzey
- Department of Cardiology, Georges Pompidou Hospital, René Descartes University, Paris, France
| | - Petr Jansky
- Department of Cardiovascular Surgery, Motol University Hospital, Prague, Czech Republic
| | | | - Riccardo Cappato
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica Group, Sesto San Giovanni, Milan, Italy
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - A John Camm
- Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
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Tsunemi A, Uchida T, Kuroda K, Ikemoto Y, Ochiai A, Goto H, Sugiyama R, Satoh H, Itakura A, Watada H. Effect of thyroxine treatment on pregnancy outcomes in infertile Japanese women with TSH levels between 2.5 μIU/mL and the upper reference limit: a retrospective study. Endocr J 2021; 68:171-177. [PMID: 32999139 DOI: 10.1507/endocrj.ej20-0380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Recent randomized controlled studies have revealed that levothyroxine (LT4) treatment improves pregnancy outcomes only in infertile women with subclinical hypothyroidism who have thyroid autoantibodies (TAs), but not for those with high TSH levels within the normal range who have TAs. Here, we retrospectively investigated pregnancy outcomes in infertile Japanese women with 2.5 μIU/mL ≤ TSH < upper reference limit (URL). Between 2012 and 2018, 286 patients diagnosed with infertility were followed for more than 1 year at our institution. Among them, we included 106 patients with 2.5 μIU/mL ≤ TSH < URL. We divided these patients into four groups based on the combination of TA positivity and LT4 treatment status to assess the effects of LT4 treatment considering TA positivity on the incidence of pregnancy or miscarriage. In this study, we did not find any significant differences in the rates of pregnancy or miscarriage among the four groups (p = 0.81 and 0.52, respectively). In addition, logistic regression analysis showed that age and history of miscarriage were associated with the incidence of pregnancy, but presence of TAs and LT4 treatment status were not and that no variables examined were associated with the incidence of miscarriage. In summary, we were not able to demonstrate the benefit of LT4 treatment for pregnancy outcomes in Japanese euthyroid infertile women with 2.5 μIU/mL ≤ TSH < URL regardless of TA status in this study.
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Affiliation(s)
- Asako Tsunemi
- Department of Metabolism & Endocrinology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Toyoyoshi Uchida
- Department of Metabolism & Endocrinology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Keiji Kuroda
- Department of Obstetrics and Gynaecology, Juntendo University Graduate School, Tokyo 113-8421, Japan
- Centre for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan
| | - Yuko Ikemoto
- Department of Obstetrics and Gynaecology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Asako Ochiai
- Department of Obstetrics and Gynaecology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Hiromasa Goto
- Department of Metabolism & Endocrinology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Rikikazu Sugiyama
- Centre for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan
| | - Hiroaki Satoh
- Department of Metabolism & Endocrinology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynaecology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Hirotaka Watada
- Department of Metabolism & Endocrinology, Juntendo University Graduate School, Tokyo 113-8421, Japan
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Eggimann P, Matter M. [Not Available]. Rev Med Suisse 2020; 16:2017. [PMID: 33085265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Philippe Eggimann
- Président de la Société vaudoise de médecine, Président de la Société médicale de la Suisse romande, Chemin de Mornex 38, 1002 Lausanne
| | - Michel Matter
- Président de l'AMGe et vice-président de la FMH, Rue Micheli-du Crest 12, 1205 Genève
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Guo LN. Two Hats: When Family Asks for Medical Advice for the First Time. Acad Med 2020; 95:1297-1298. [PMID: 32101935 DOI: 10.1097/acm.0000000000003251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Lisa N Guo
- Fourth-year medical student, Harvard Medical School, Boston, Massachusetts;
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14
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Pourová M, Klocek A, Řiháček T, Čevelíček M. Therapeutic change mechanisms in adults with medically unexplained physical symptoms: A systematic review. J Psychosom Res 2020; 134:110124. [PMID: 32348898 DOI: 10.1016/j.jpsychores.2020.110124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although psychological treatments for patients suffering from medically unexplained physical symptoms (MUPS) show promising results, evidence for their effectiveness is still limited. The aim of this study was to review the existing empirical support for change mechanisms that explain treatment effect in terms of symptom intensity and symptom interference in the daily lives of patients. METHODS A systematic database search was conducted. Sixty-seven eligible studies were found, and change mechanism effects were extracted from them. The data were subjected to a systematic review. RESULTS Fifteen change mechanisms were identified. Those receiving the most consistent support included Increasing symptom acceptance, Development of coping strategies, and Positive treatment expectations, although the last mechanism was investigated in only two studies. Almost all mechanisms received support for at least one type of outcome, either at post-treatment or at follow-up. CONCLUSIONS Although some empirical support exists for many mechanisms, some of them have received only marginal attention in empirical studies. These limitations prevented us from deriving more definite conclusions.
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Affiliation(s)
- Martina Pourová
- Department of Psychology, Faculty of Social Studies, Masaryk University, Czech Republic.
| | - Adam Klocek
- Department of Psychology, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Michal Čevelíček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Czech Republic
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15
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Jennings WG. Special Issue: International Developmental/Life-Course Perspectives and Research on Sexual Offending and Offenders. Sex Abuse 2020; 32:371-374. [PMID: 32146877 DOI: 10.1177/1079063220910720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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16
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Dogan SN, Kazcı ZN, Kavuncu SB, Bayrak AH. Spontaneous external jugular vein pseudoaneurysm treated by thrombin injection: Case report and literature review. J Clin Ultrasound 2020; 48:294-297. [PMID: 31981367 DOI: 10.1002/jcu.22816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/22/2019] [Accepted: 01/16/2020] [Indexed: 06/10/2023]
Abstract
Although external jugular vein (EJV) aneurysms are infrequent, regardless of etiology, spontaneous pseudoaneurysms (PAs) are extremely rare and generally require surgery. We describe a case of spontaneous PA of the EJV, which was successfully treated by percutaneous thrombin injection.
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Affiliation(s)
- Sebahat N Dogan
- Department of Radiology, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeynep N Kazcı
- Department of Radiology, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Selen B Kavuncu
- Department of Radiology, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aylin H Bayrak
- Department of Radiology, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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17
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Poh C, Arora M, Ghuman S, Tuscano J. Belinostat in Relapsed/Refractory T-Cell Large Granular Lymphocyte Leukemia. Acta Haematol 2020; 144:95-99. [PMID: 32348994 DOI: 10.1159/000506918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/29/2020] [Indexed: 12/14/2022]
Abstract
T-cell large granular lymphocyte (LGL) leukemia is a rare indolent neoplasm primarily treated with immunosuppression. Few therapies and no consensus exist for the optimal treatment of T-cell LGL leukemia refractory to immunosuppressive therapy. Here, we report a case of relapsed/refractory T-cell LGL treated with belinostat. A 57-year-old male presented with lymphocytosis and anemia and was found to have T-cell LGL, requiring frequent packed red blood cell transfusions. He was initially treated with methotrexate with no response after 7 months. He was then switched to cyclosporine and cyclophosphamide and experienced transfusion independence for 42 months before disease relapse. He was then started on belinostat with noted subsequent transfusion independence for greater than 15 months to date and decreased disease involvement on bone marrow biopsy. To our knowledge, this is the first reported case of belinostat use in relapsed/refractory T-cell LGL leukemia which resulted in a durable clinical and biologic response.
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Affiliation(s)
- Christina Poh
- University of California Davis Comprehensive Cancer Center, Sacramento, California, USA,
| | - Mili Arora
- University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
- Veterans Administration, Northern California Healthcare System, Sacramento, California, USA
| | - Sudeep Ghuman
- Oroville Hospital Cancer & Infusion Center, Oroville, California, USA
| | - Joseph Tuscano
- University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
- Veterans Administration, Northern California Healthcare System, Sacramento, California, USA
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18
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Adorjan K, Pogarell O. [What needs to be considered in diagnostics and therapy]. MMW Fortschr Med 2020; 162:42-51. [PMID: 32221872 DOI: 10.1007/s15006-020-0005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Kristina Adorjan
- Institut für Psychiatrische Phänomik und Genomik (IPPG), Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Nussbaumstr. 7, D-80336, München, Deutschland.
| | - Oliver Pogarell
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Deutschland
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19
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Pietras CM, Power L, Slonim DK. aTEMPO: Pathway-Specific Temporal Anomalies for Precision Therapeutics. Pac Symp Biocomput 2020; 25:683-694. [PMID: 31797638 PMCID: PMC7664835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Dynamic processes are inherently important in disease, and identifying disease-related disruptions of normal dynamic processes can provide information about individual patients. We have previously characterized individuals' disease states via pathway-based anomalies in expression data, and we have identified disease-correlated disruption of predictable dynamic patterns by modeling a virtual time series in static data. Here we combine the two approaches, using an anomaly detection model and virtual time series to identify anomalous temporal processes in specific disease states. We demonstrate that this approach can informatively characterize individual patients, suggesting personalized therapeutic approaches.
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20
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Smink W, Sools AM, van der Zwaan JM, Wiegersma S, Veldkamp BP, Westerhof GJ. Towards text mining therapeutic change: A systematic review of text-based methods for Therapeutic Change Process Research. PLoS One 2019; 14:e0225703. [PMID: 31805093 PMCID: PMC6894756 DOI: 10.1371/journal.pone.0225703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 11/11/2019] [Indexed: 01/21/2023] Open
Abstract
Therapeutic Change Process Research (TCPR) connects within-therapeutic change processes to outcomes. The labour intensity of qualitative methods limit their use to small scale studies. Automated text-analyses (e.g. text mining) provide means for analysing large scale text patterns. We aimed to provide an overview of the frequently used qualitative text-based TCPR methods and assess the extent to which these methods are reliable and valid, and have potential for automation. We systematically reviewed PsycINFO, Scopus, and Web of Science to identify articles concerning change processes and text or language. We evaluated the reliability and validity based on replicability, the availability of code books, training data and inter-rater reliability, and evaluated the potential for automation based on the example- and rule-based approach. From 318 articles we identified four often used methods: Innovative Moments Coding Scheme, the Narrative Process Coding Scheme, Assimilation of Problematic Experiences Scale, and Conversation Analysis. The reliability and validity of the first three is sufficient to hold promise for automation. While some text features (content, grammar) lend themselves for automation through a rule-based approach, it should be possible to automate higher order constructs (e.g. schemas) when sufficient annotated data for an example-based approach are available.
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Affiliation(s)
- Wouter Smink
- Department of Psychology, Health & Technology, University of Twente, Enschede, Overijssel, The Netherlands
- Department of Research Methodology, Measurement & Data Analysis, University of Twente, Enschede, Overijssel, The Netherlands
| | - Anneke M. Sools
- Department of Research Methodology, Measurement & Data Analysis, University of Twente, Enschede, Overijssel, The Netherlands
| | | | - Sytske Wiegersma
- Department of Research Methodology, Measurement & Data Analysis, University of Twente, Enschede, Overijssel, The Netherlands
| | - Bernard P. Veldkamp
- Department of Research Methodology, Measurement & Data Analysis, University of Twente, Enschede, Overijssel, The Netherlands
| | - Gerben J. Westerhof
- Department of Psychology, Health & Technology, University of Twente, Enschede, Overijssel, The Netherlands
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Abstract
Theranostics or theragnostics are new terms which start to appear occasionally in publications from 2001 onwards, with a marked increase in references from 2011. In the last few years more than 1100 articles using this term were published each year. In 2011 the journal Theranostics was founded. This paper addresses the question of whether this new term is appropriate. The etymology of the term is analysed. A literature search for definitions of "theranostics" is carried out and the definitions examined as to whether they give grounds for justifying the use of a new term. The differences between diagnostics and therapy are explored. A broad and a narrow definition are found. According to the broad definition theranostics provides a closer relationship between diagnostics and therapy. According to the narrow definition diagnostics and therapy become a single intervention. On closer examination it turns out that in the narrow definition the diagnostics capacities are limited to monitoring. Neither the broad nor the narrow definition actually demonstrate a new concept in medicine. Rather, they describe the well-known practice of medical decision making. In this respect, the new term cannot be justified. The level of diagnostics is new (molecular/nano) but not the relationship between diagnostics and therapy. The term theranostics is misleading as it obscures the existing differences between diagnostics and therapy and wrongly insinuates that steps between diagnostics and therapy could be omitted.
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Affiliation(s)
- Urban Wiesing
- Institut für Ethik und Geschichte der Medizin, Gartenstr. 47, 72074, Tübingen, Germany.
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22
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Al-Gubory KH. Shedding light on fibered confocal fluorescence microscopy: Applications in biomedical imaging and therapies. J Biophotonics 2019; 12:e201900146. [PMID: 31343844 DOI: 10.1002/jbio.201900146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/20/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
Discoveries of major importance in life sciences and preclinical research are linked to the invention of microscopes that enable imaging of cells and their microstructures. Imaging technologies involving in vivo procedures using fluorescent dyes that permit labelling of cells have been developed over the last two decades. Fibered confocal fluorescence microscopy (FCFM) is an imaging technology equipped with fiber-optic probes to deliver light to organs and tissues of live animals. This enables not only in vivo detection of fluorescent signals and visualization of cells, but also the study of dynamic processes, such cell proliferation, apoptosis and angiogenesis, under physiological and pathological conditions. This will allow the diagnosis of diseased organs and tissues and the evaluation of the efficacy of new therapies in animal models of human diseases. The aim of this report is to shed light on FCFM and its potential medical applications and discusses some factors that compromise the reliability and reproducibility of monitoring biological processes by FCFM. This report also highlights the issues concerning animal experimentation and welfare, and the contributions of FCFM to the 3Rs principals, replacement, reduction and refinement.
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Affiliation(s)
- Kaïs H Al-Gubory
- National Institute for Agricultural Research, Department of Animal Physiology, Jouy-en-Josas, France
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23
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Affiliation(s)
- Tristan Cudennec
- Hôpitaux universitaires Paris Île-de-France Ouest, site Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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25
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Tanaka T, Hiramatsu K, Saito Y, Nosaka T, Takahashi K, Naito T, Ofuji K, Matsuda H, Ohtani M, Nemoto T, Suto H, Nakamoto Y. The Usefulness of Video Capsule Endoscopy in Evaluating Gastrointestinal Manifestations of Immunoglobulin A Vasculitis. Intern Med 2019; 58:1979-1985. [PMID: 30996162 PMCID: PMC6702007 DOI: 10.2169/internalmedicine.2097-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective Immunoglobulin (Ig) A vasculitis (IgAV) is a systemic vasculitis characterized by purpura and gastrointestinal involvement showing abdominal pain that usually occurs after the emergence of purpura. Criteria for evaluating gastrointestinal manifestations of IgAV are unavailable at present, so we conducted a study to investigate the usefulness of video capsule endoscopy (VCE) for detecting gastrointestinal manifestations of IgAV. Methods The clinical data of 10 patients who underwent VCE for IgAV at our hospital from 2012 to 2017 were collected. Nine patients underwent esophagogastroduodenoscopy, and five underwent colonoscopy. We compared the endoscopic severity determined by VCE to the findings of esophagogastroduodenoscopy and colonoscopy. Results The rates of positive findings of esophagogastroduodenoscopy, VCE, and colonoscopy were 56%, 100%, and 80%, respectively. In 70% of cases, the most severe gastrointestinal findings were detected by VCE. VCE was performed on average 16.8 days after the emergence of purpura, and in 8 of 10 patients, its result triggered the initiation of steroid therapy or the control of the steroid dose. Conclusion VCE is very useful for confirming gastrointestinal involvement in IgAV and may be used to determine the timing of steroid therapy initiation. We recommend performing VCE when IgAV is suspected in patients with gastrointestinal symptoms.
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Affiliation(s)
- Tomoko Tanaka
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Katsushi Hiramatsu
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Yasushi Saito
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Takuto Nosaka
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Kazuto Takahashi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Tatsushi Naito
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Kazuya Ofuji
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Hidetaka Matsuda
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Masahiro Ohtani
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Tomoyuki Nemoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Hiroyuki Suto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
- Department of Gastroenterology, Fukui Katsuyama General Hospital, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
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Affiliation(s)
- Amisha Ahuja
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nitin Kumar Ahuja
- Division of Gastroenterology, University of Pennsylvania, Philadelphia
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27
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Pulciani S, Nutile E. [Relationships between Medicine and Spirituality]. G Ital Nefrol 2019; 36:36-1-2019-13. [PMID: 30758158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This review aims at analysing the links between medicine and spirituality, two seemingly distant concepts. Medicine at its beginnings was imbued with rituals that invoked the intervention of supernatural powers, as man were unable to treat diseases and struggled to bear the suffering caused by them and the fragility of their own bodies. Today, in the post-genomic era, medicine has gained great benefits from new and extraordinary scientific and technological achievements, permitting sophisticated therapeutic and diagnostic approaches, which assure cures not previously possible. Even considering these great accomplishments in medicine and technology, it should be borne in mind that diseases not only induce bodily changes in sufferers, but also affect their emotional state and social interactions. Illness, especially when serious and in presence of a poor prognosis, raises profound questions around the meaning of life, affections, suffering and death. In the last few decades scientists, doctors, theologians, psychologists and others, in considering these questions, have emphasized the importance of spirituality as a relevant factor in the care of the sick and their illnesses. Drawing from some thoughts expressed in the book, "When the Breath Becomes Air," authored by the physician Paul Kalanithi, we claim that spirituality should be perceived as an important contributing factor in the therapeutic path. Our aim is to deepen the meaning of spirituality, differentiating it from religion, faith and mysticism, and to understand how it should be integrated with post-genomic medicine to enhance its positive aspects and effects.
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28
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Lorè F. [Evaluating the impact of regulation 2016/679 of the European Parliament]. G Ital Nefrol 2019; 36:36-1-2019-14. [PMID: 30758159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Affiliation(s)
- Christopher J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Allan S Detsky
- Institute of Health Policy, Management, and Evaluation and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - Eddy Fan
- Institute of Health Policy, Management, and Evaluation and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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Ceballos A, Prather R, Divo E, Kassab AJ, DeCampli WM. Patient-Specific Multi-Scale Model Analysis of Hemodynamics Following the Hybrid Norwood Procedure for Hypoplastic Left Heart Syndrome: Effects of Reverse Blalock-Taussig Shunt Diameter. Cardiovasc Eng Technol 2018; 10:136-154. [PMID: 30515683 DOI: 10.1007/s13239-018-00396-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/20/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The hybrid Norwood (HN) is a relatively new first stage palliative procedure for neonates with hypoplastic left heart syndrome, in which a sustainable uni-ventricular circulation is established in a less invasive manner than with the standard Norwood procedure. A computational multiscale model of the circulation following the HN procedure was used to obtain detailed hemodynamics. Implementation of a reverse-BT shunt (RBTS), a synthetic bypass from the main pulmonary to the innominate artery placed to counteract aortic arch stenosis, and its effects on local and global hemodynamics were studied. METHODS A post-op patient-derived anatomy of the HN procedure was utilized with varying degrees of distal arch obstruction, or stenosis, (nominal and 90% lumenal area reduction) and varying RBTS diameters (3.0, 3.5, 4.0 mm). A closed lumped parameter model (LPM) for the proximal and peripheral circulations was coupled to a 3D computational fluid dynamics (CFD) model in order to obtain converged flow fields for analysis. RESULTS CFD analyses of patient-derived anatomic configurations demonstrated consistent trends of vascular bed perfusion, vorticity, oscillatory shear index and wall shear stress levels. In the models with severe stenosis, implementation of the RBTS resulted in a restoration of arterial perfusion to near-nominal levels regardless of the shunt diameter. Shunt flow velocity, vorticity, and overall wall shear stress levels decreased with increasing shunt diameter, while shunt flow and systemic oxygen delivery increased with increased shunt diameter. In the absence of distal arch stenosis, large (4.0 mm) grafts may risk thrombosis due to low velocities and flow patterns. CONCLUSION Among the three graft sizes, the best option seems to be the 3.5 mm RBTS which provides a more organized flow similar to that of the 3.0 mm configuration with lower levels of wall shear stress. As such, in the setting of this study and for comparable HN physiologies our results suggest that: (1) the 4.0 mm shunt is a generous shunt diameter choice that may be problematic particularly when implemented prophylactically in the absence of stenosis, and (2) the 3.5 mm shunt may be a more suitable alternative since it exhibits more favorable hemodynamics at lower levels of wall shear stress.
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Affiliation(s)
- Andres Ceballos
- Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, USA
| | - Ray Prather
- Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, USA.
| | - Eduardo Divo
- Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Alain J Kassab
- Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, USA
| | - William M DeCampli
- The Heart Center, Arnold Palmer Hospital for Children, Orlando, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
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Blessmann J, Nguyen TPN, Bui TPA, Krumkamp R, Vo VT, Nguyen HL. Incidence of snakebites in 3 different geographic regions in Thua Thien Hue province, central Vietnam: Green pit vipers and cobras cause the majority of bites. Toxicon 2018; 156:61-65. [PMID: 30448540 DOI: 10.1016/j.toxicon.2018.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/31/2018] [Accepted: 11/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The annual incidence of snakebites in Vietnam is not known and only few publications about snakebite envenoming and medically relevant snakes can be found in English language literature. The present community-based surveys provide data on incidence of snakebites in three different geographic regions of Thua Thien Hue (TT Hue) province, central Vietnam and snake species responsible for bites in this region. METHODOLOGY/RESULTS The cross-sectional community based surveys were conducted from March to July 2017. Multistage cluster sampling was applied and snakebite incidence was calculated at 58 snakebites per 100,000 person-years for the entire province, and 172, 69 and 10 snakebites per 100,000 person-years in the mountainous, coastal and urban region of TT Hue province, respectively. Thirty-one snakebite victims interviewed during the surveys reported 18 (58%) green pit viper bites (Trimeresurus species), 5 (16%) cobra bites (Naja kaouthia, Naja siamensis), 2 (7%) krait bites (Bungarus candidus, Bungarus fasciatus), 2 (7%) red-necked keelback bites (Rhabdophis subminiatus) and 4 bites from unidentified snakes (13%). The outcome was favourable for 28 snakebite victims (90%), two (6%) had minor sequelae and one (3%) victim died after a Malayan krait bite. Two hundred and twenty-one snakebite patients were treated in 9 district hospitals and one central hospital in TT Hue between 2014 and 2016. Eighty green pit vipers (84%), 12 cobras (13%) and 3 kraits (3%) were responsible for bites in 95 patients where snake identification was documented. CONCLUSIONS Incidence of snakebites is surprisingly low in TT Hue province in central Vietnam in comparison to other regions in Asia, particularly to neighbouring Lao PDR. However, snakebites are still a significant health problem in the mountainous region and green pit vipers and cobras cause the vast majority of bites.
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Affiliation(s)
- Joerg Blessmann
- Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue, Viet Nam; Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
| | - Thanh Phuc Nhan Nguyen
- Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Thi Phuong Anh Bui
- Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Ralf Krumkamp
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany
| | - Van Thang Vo
- Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Hoang Lan Nguyen
- Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue, Viet Nam
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Rise N, Kristiansen J, Hvas AM, Grove EL, Würtz M, Neergaard-Petersen S, Kristensen SD. Effect of remote ischaemic conditioning on platelet aggregation and platelet turnover. J Thromb Thrombolysis 2018; 46:528-533. [PMID: 30168042 DOI: 10.1007/s11239-018-1728-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Remote ischaemic conditioning (RIC) is a new beneficial treatment for patients with ST-elevation myocardial infarction. RIC may inhibit thrombus formation and, therefore, we investigated whether RIC affects platelet aggregation and turnover. 30 healthy male volunteers were subjected to intervention on day 1 (sham intervention, no aspirin), day 2 (RIC, no aspirin), and day 16 (RIC, treated 7 days with aspirin 75 mg/day). RIC was performed as four cycles of 5 min interchangeable inflation and deflation using an automated cuff. Blood samples were collected 5 min before, as well as 5 and 45 min after RIC. Platelet aggregation was measured by Multiplate® using collagen (COLtest), adenosine diphosphate (ADPtest), and arachidonic acid (ASPItest) as agonists. Platelet turnover was evaluated by flow cytometry. Serum thromboxane B2 was determined by ELISA to confirm aspirin compliance. We found no significant change in platelet aggregation at visit 1 (COLtest: p = 0.32; ADPtest: p = 0.24; ASPItest: p = 0.07), visit 2, except for ADP-induced platelet aggregation evaluated 5 min after RIC (COLtest: p = 0.39; ADPtest: p = 0.02; ASPItest: p = 0.39), or visit 3 (COLtest: p = 0.48; ADPtest: p = 0.61; ASPItest: p = 0.90). Platelet turnover was not influenced by RIC, neither on nor off aspirin (all p-values > 0.07). (1) RIC did not affect platelet aggregation in healthy young men. (2) RIC did not affect platelet turnover in healthy young men. (3) Aspirin did not influence the effect of RIC on platelet aggregation and turnover. (4) Future studies exploring the effect of RIC on platelet aggregation and turnover in patients with ischaemic heart disease are warranted.
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Affiliation(s)
- Nina Rise
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Jacobina Kristiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
| | - Morten Würtz
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Søs Neergaard-Petersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark.
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Felder S, Mayrhofer T. Threshold analysis in the presence of both the diagnostic and the therapeutic risk. Eur J Health Econ 2018; 19:1019-1026. [PMID: 29280041 DOI: 10.1007/s10198-017-0951-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/13/2017] [Indexed: 06/07/2023]
Abstract
The well-established a priori probability of illness threshold in medical decision making, introduced by Pauker and Kassirer (N Engl J Med 293:229-234, 1975; N Engl J Med 302:1109-1117, 1980), involves the diagnostic risk only. We generalize the threshold analysis by adding the therapeutic risk, i.e., in accounting for the risk that a treatment might sometimes fail. We derive a priori probability of illness threshold as a function of the probability of successful treatment, as well as the inverted function, where the successful treatment probability threshold is a function of the a priori probability of illness. The thresholds in the general model are higher than those in the special cases where one of the two risks is absent. Applications show that the changes in the thresholds can be substantial. Our general model might explain empirical findings of much higher thresholds than the Pauker-Kassirer model suggests.
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Affiliation(s)
- Stefan Felder
- Department of Health Economics, Faculty of Business and Economics, University of Basel, Peter Merian-Weg 6, 4002, Basel, Switzerland.
- CINCH, Faculty of Business Administration and Economics, University of Duisburg-Essen, Essen, Germany.
| | - Thomas Mayrhofer
- Harvard Medical School and School of Business Studies, Massachusetts General Hospital, Stralsund University of Applied Sciences, Stralsund, Germany
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Wu M, Shu J. Multimodal Molecular Imaging: Current Status and Future Directions. Contrast Media Mol Imaging 2018; 2018:1382183. [PMID: 29967571 PMCID: PMC6008764 DOI: 10.1155/2018/1382183] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/11/2018] [Accepted: 05/10/2018] [Indexed: 12/12/2022]
Abstract
Molecular imaging has emerged at the end of the last century as an interdisciplinary method involving in vivo imaging and molecular biology aiming at identifying living biological processes at a cellular and molecular level in a noninvasive manner. It has a profound role in determining disease changes and facilitating drug research and development, thus creating new medical modalities to monitor human health. At present, a variety of different molecular imaging techniques have their advantages, disadvantages, and limitations. In order to overcome these shortcomings, researchers combine two or more detection techniques to create a new imaging mode, such as multimodal molecular imaging, to obtain a better result and more information regarding monitoring, diagnosis, and treatment. In this review, we first describe the classic molecular imaging technology and its key advantages, and then, we offer some of the latest multimodal molecular imaging modes. Finally, we summarize the great challenges, the future development, and the great potential in this field.
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Affiliation(s)
- Min Wu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Abstract
Dehydroepiandrosterone (DHEA) has been used to improve the pregnancy rate in women with diminished ovarian reserve(DOR) during in vitro fertilization. We aimed to validate the effects of DHEA and identify the possible mechanisms. We constructed a mice model with DOR and analyzed the hormone parameters and follicle counts. In vivo experiment, FSH and LH concentrations in the serum were significantly elevated in the DOR group. However, the FSH and LH concentrations were partially reversed in the DOR + DHEA group. The E2, AMH and INHB were down-regulated in the DOR group and reversed in the DOR + DHEA group. Our study supported evidences that DHEA might modulate the hormone receptors in the ovary and hormone secretions to the peripheral circulation to regulate the ovary reserve functions.
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Affiliation(s)
- Xiufeng Lin
- a Reproductive Medical Center, Department of Obstetrics and Gynecology , Nanfang Hospital, Southern Medical University , Guangzhou , China
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Jing Du
- a Reproductive Medical Center, Department of Obstetrics and Gynecology , Nanfang Hospital, Southern Medical University , Guangzhou , China
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Yan Du
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Riran Wu
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Xiaowu Fang
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Yuechan Liao
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Song Quan
- a Reproductive Medical Center, Department of Obstetrics and Gynecology , Nanfang Hospital, Southern Medical University , Guangzhou , China
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Jadvar H. The First Theranostic Conference at the American University of Beirut Medical Center. J Nucl Med 2018; 59:13N. [PMID: 29295944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
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Johnson AEW, Stone DJ, Celi LA, Pollard TJ. The MIMIC Code Repository: enabling reproducibility in critical care research. J Am Med Inform Assoc 2018; 25:32-39. [PMID: 29036464 PMCID: PMC6381763 DOI: 10.1093/jamia/ocx084] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/11/2017] [Accepted: 07/27/2017] [Indexed: 12/13/2022] Open
Abstract
Objective Lack of reproducibility in medical studies is a barrier to the generation of a robust knowledge base to support clinical decision-making. In this paper we outline the Medical Information Mart for Intensive Care (MIMIC) Code Repository, a centralized code base for generating reproducible studies on an openly available critical care dataset. Materials and Methods Code is provided to load the data into a relational structure, create extractions of the data, and reproduce entire analysis plans including research studies. Results Concepts extracted include severity of illness scores, comorbid status, administrative definitions of sepsis, physiologic criteria for sepsis, organ failure scores, treatment administration, and more. Executable documents are used for tutorials and reproduce published studies end-to-end, providing a template for future researchers to replicate. The repository's issue tracker enables community discussion about the data and concepts, allowing users to collaboratively improve the resource. Discussion The centralized repository provides a platform for users of the data to interact directly with the data generators, facilitating greater understanding of the data. It also provides a location for the community to collaborate on necessary concepts for research progress and share them with a larger audience. Consistent application of the same code for underlying concepts is a key step in ensuring that research studies on the MIMIC database are comparable and reproducible. Conclusion By providing open source code alongside the freely accessible MIMIC-III database, we enable end-to-end reproducible analysis of electronic health records.
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Affiliation(s)
| | - David J Stone
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Leo A Celi
- Massachusetts Institute of Technology, Cambridge, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tom J Pollard
- Massachusetts Institute of Technology, Cambridge, MA, USA
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Ludwin A, Nastri CO, Ludwin I, Martins WP. Hysterosalpingo-lidocaine-foam sonography combined with power Doppler imaging (HyLiFoSy-PD) in tubal patency assessment: 'flaming tube' sign. Ultrasound Obstet Gynecol 2017; 50:808-810. [PMID: 28133836 DOI: 10.1002/uog.17420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/12/2017] [Accepted: 01/20/2017] [Indexed: 06/06/2023]
Affiliation(s)
- A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - C O Nastri
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
| | - I Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - W P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
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Abstract
Construction of gene-gene interaction networks and potential pathways is a challenging and important problem in genomic research for complex diseases while estimating the dynamic changes of the temporal correlations and non-stationarity are the keys in this process. In this paper, we develop dynamic state space models with hierarchical Bayesian settings to tackle this challenge for inferring the dynamic profiles and genetic networks associated with disease treatments. We treat both the stochastic transition matrix and the observation matrix time-variant and include temporal correlation structures in the covariance matrix estimations in the multivariate Bayesian state space models. The unevenly spaced short time courses with unseen time points are treated as hidden state variables. Hierarchical Bayesian approaches with various prior and hyper-prior models with Monte Carlo Markov Chain and Gibbs sampling algorithms are used to estimate the model parameters and the hidden state variables. We apply the proposed Hierarchical Bayesian state space models to multiple tissues (liver, skeletal muscle, and kidney) Affymetrix time course data sets following corticosteroid (CS) drug administration. Both simulation and real data analysis results show that the genomic changes over time and gene-gene interaction in response to CS treatment can be well captured by the proposed models. The proposed dynamic Hierarchical Bayesian state space modeling approaches could be expanded and applied to other large scale genomic data, such as next generation sequence (NGS) combined with real time and time varying electronic health record (EHR) for more comprehensive and robust systematic and network based analysis in order to transform big biomedical data into predictions and diagnostics for precision medicine and personalized healthcare with better decision making and patient outcomes.
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Rajiv KR, Radhakrishnan A. Status epilepticus in pregnancy: Etiology, management, and clinical outcomes. Epilepsy Behav 2017; 76:114-119. [PMID: 28899640 DOI: 10.1016/j.yebeh.2017.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Status epilepticus (SE) in pregnancy carries significant risk to both mother and fetus. There is limited literature available on SE occurring in pregnancy world-over, with majority being from obstetric centers. METHODS All women who developed SE related to pregnancy (gestation, labor, or puerperium) between January 2000 and December 2016 were included in the study. Data were collected from our SE registry, maintained, and archived in the institute. The variables influencing the maternal and fetal outcome were compared using Student's t-test for continuous variables and Fisher's exact test for discrete variables. RESULTS During the 16-year study period, a total of 348 SE events were recorded in 294 patients. Among these, there were 138 women, of which 17 had SE related to pregnancy. The etiology of SE was remote symptomatic in two and acute symptomatic in 15 patients. The various causes detected after initial evaluation for acute symptomatic SE were eclampsia (n=4), posterior reversible encephalopathy syndrome due to various causes other than eclampsia (n=6), cortical venous thrombosis (n=3), subarachnoid hemorrhage (n=1), and NMDA receptor antibody-mediated encephalitis (n=1).13 of 17 women with SE (76%) had good outcome. Majority of the fetuses had good outcomes, i.e., Category 1 (n=9, 57%). Duration of intensive care unit stay (p=0.029) and Status Epilepticus Severity Score (p=0.0324) at admission, were found to be significantly associated with poor outcomes. CONCLUSION In any patient presenting with SE occurring in pregnancy, though eclampsia is presumed to be the most common overall cause; it is relevant to consider other etiologies such as posterior reversible encephalopathy syndrome, cortical venous thrombosis, and autoimmune encephalitis especially in cases presenting with refractory SE. Posterior reversible encephalopathy may occur in pregnancy due to diverse etiologies other than eclampsia.
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Affiliation(s)
- Keni Ravish Rajiv
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ashalatha Radhakrishnan
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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Mahmood E, Knio ZO, Mahmood F, Amir R, Shahul S, Mahmood B, Baribeau Y, Mueller A, Matyal R. Preoperative asymptomatic leukocytosis and postoperative outcome in cardiac surgery patients. PLoS One 2017; 12:e0182118. [PMID: 28873411 PMCID: PMC5584953 DOI: 10.1371/journal.pone.0182118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 07/12/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite showing a prognostic value in general surgical patients, preoperative asymptomatic elevated white blood cell (WBC) count is not considered a risk factor for cardiac surgery. Whereas there is sporadic evidence of its value as a preoperative risk marker, it has not been looked at methodically as a specific index of outcome during cardiac surgery. Using a national database we sought to determine the relationship between preoperative WBC count and postoperative outcome in cardiac surgical patients. METHODS Cardiac surgeries were extracted from the 2007-2013 American College of Surgeons National Surgical Quality Improvement Program database. Leukocytosis was defined by a preoperative WBC count greater than 11,000 cells/μL. A univariate analysis compared the incidence of adverse outcomes for patients with and without leukocytosis. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality. RESULTS Out of a total of 10,979 cardiac surgery patients 863 (7.8%) had preoperative leukocytosis. On univariate analysis, patients with leukocytosis experienced greater incidences of 30-day mortality, wound complications, and medical complications. Wound complications included surgical site infection as well as wound dehiscence. The medical complications included all other non-surgical causes of increased morbidity and infection leading to urinary tract infection, pneumonia, ventilator dependence, sepsis and septic shock. After stepwise model adjustment, leukocytosis was a strong predictor of medical complications (OR 1.22, 95% CI: 1.09-1.36, p = 0.002) with c-statistic of 0.667. However, after stepwise model adjustment leukocytosis was not a significant predictor of 30-day mortality and wound complications. CONCLUSION Preoperative leukocytosis is associated with adverse postoperative outcome after cardiac surgery and is an independent predictor of infection-related postoperative complications.
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Affiliation(s)
- Eitezaz Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ziyad O. Knio
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rabia Amir
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sajid Shahul
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bilal Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Albany Medical College, Albany, New York, United States of America
| | - Yanick Baribeau
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Evans DW, Lucas N, Kerry R. The form of causation in health, disease and intervention: biopsychosocial dispositionalism, conserved quantity transfers and dualist mechanistic chains. Med Health Care Philos 2017; 20:353-363. [PMID: 28124195 DOI: 10.1007/s11019-017-9753-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Causation is important when considering: how an organism maintains health; why disease arises in a healthy person; and, how one may intervene to change the course of a disease. This paper explores the form of causative relationships in health, disease and intervention, with particular regard to the pathological and biopsychosocial models. Consistent with the philosophical view of dispositionalism, we believe that objects are the fundamental relata of causation. By accepting the broad scope of the biopsychosocial model, we argue that psychological and social constructs be considered objects. We think that this 'biopsychosocial dispositionalism' offers the flexibility required to describe causation throughout health, disease and intervention pathways. When constructing mechanistic chains to describe causative pathways, we argue that an object will causally connect with others through actions; transfers of energy from one object to another, initiated by the manifestation of one or more dispositional property. Finally, our analysis of causative interactions utilises the concept that a common form of interaction exists between disease and intervention pathways. This common form will always be an object, but the mode of interaction will vary with each disease. We describe how intervention may act through objects being shared between converging mechanistic chains, or through the removal and/or insertion of objects in such chains. We believe that this analysis provides novel insight to the forms of causative transactions that can occur. In addition, we hope that the findings of this analysis represent the first step towards developing a framework for appraising the composition of mechanistic theories.
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Affiliation(s)
- David W Evans
- Research Centre, British School of Osteopathy, London, SE1 1JE, UK.
| | - Nicholas Lucas
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Roger Kerry
- Division of Physiotherapy Education and Department of Philosophy, University of Nottingham, Nottingham, UK
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Affiliation(s)
- Brian McKinstry
- Usher institute, Centre for Medical Informatics, University of Edinburgh, Number 9, Bioquarter, Edinburgh EH16 4UX, UK
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Papadopoulos K, Petrou PM, Michaelides D. Left Ventricular Noncompaction Cardiomyopathy Presenting with Heart Failure in a 35-Year-Old Man. Tex Heart Inst J 2017; 44:260-263. [PMID: 28878579 DOI: 10.14503/thij-15-5371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Isolated ventricular noncompaction, a rare genetic cardiomyopathy, is thought to be caused by the arrest of normal myocardial morphogenesis. It is characterized by prominent, excessive trabeculation in a ventricular wall segment and deep intertrabecular recesses perfused from the ventricular cavity. The condition can present with heart failure, systematic embolic events, and ventricular arrhythmias. Two-dimensional echocardiography is the typical diagnostic method. We report a case of heart failure in a 35-year-old man who presented with palpitations. Two-dimensional echocardiograms revealed left ventricular noncompaction, which markedly improved after standard heart failure therapy.
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Affiliation(s)
- Janet Woodcock
- From the Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Lisa M LaVange
- From the Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
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Affiliation(s)
- Shaurya Taran
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allan S Detsky
- Institute for Health Policy, Management, and Evaluation and Department of Medicine, University of Toronto, Toronto, Ontario, Canada; and Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
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Vallejo JR, Aparicio Mena AJ, González JA. Human urine-based therapeutics in Spain from the early 20th century to the present: a historical literature overview and a present-day case study. Acta Med Hist Adriat 2017; 15:73-108. [PMID: 28767264 DOI: 10.31952/amha.15.1.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Human urine is currently the subject of biomedical investigations as a potential therapeutic resource and it continues to be used in remedies in different cultures and societies, including the Spanish culture. In this study we gather etnomedical knowledge about urotherapy and determine their associated symbolisms in Spain. A literature overview and a case study were carried out to compile urine-based remedies and as a direct analysis of symbolic systems. Urotherapy is widespread in Spanish folk medicine. Among the 204 collected remedies, those related to treatment of diseases or skin conditions predominate (63%). Remedies have been reported for the treatment of skin diseases such as eczema, chloasma, alopecia, etc. to treat or alleviate burns, chilblains, wounds or skin chapping, and as a treatment of venomous bites. Most of the collected remedies have an associated naturalist symbolism, based on local traditions and the transmission of empirical initial knowledge. The use of urine in Spain is a result of the interaction of two types of practice: a local and traditional urotherapy, rural and with a utilitarian purpose, and a technical urotherapy, limited to an urban environment and a naturopathic medicine.
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Affiliation(s)
- José Ramón Vallejo
- Departamento de Terapéutica Médico-Quirúrgica, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain.
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Mikolaizak AS, Lord SR, Tiedemann A, Simpson P, Caplan GA, Bendall J, Howard K, Webster L, Payne N, Hamilton S, Lo J, Ramsay E, O'Rourke S, Roylance L, Close JC. A multidisciplinary intervention to prevent subsequent falls and health service use following fall-related paramedic care: a randomised controlled trial. Age Ageing 2017; 46:200-207. [PMID: 28399219 DOI: 10.1093/ageing/afw190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 10/14/2016] [Indexed: 01/04/2023] Open
Abstract
Background approximately 25% of older people who fall and receive paramedic care are not subsequently transported to an emergency department (ED). These people are at high risk of future falls, unplanned healthcare use and poor health outcomes. Objective to evaluate the impact of a fall-risk assessment and tailored fall prevention interventions among older community-dwellers not transported to ED following a fall on subsequent falls and health service use. Design, setting, participants Randomised controlled trial involving 221 non-transported older fallers from Sydney, Australia. Intervention the intervention targeted identified risk factors and used existing services to implement physiotherapy, occupational therapy, geriatric assessment, optometry and medication management interventions as appropriate. The control group received individualised written fall prevention advice. Measurements primary outcome measures were rates of falls and injurious falls. Secondary outcome measures were ambulance re-attendance, ED presentation, hospitalisation and quality of life over 12 months. Analysis was by intention-to-treat and per-protocol according to self-reported adherence using negative binominal regression and multivariate analysis. Results ITT analysis showed no significant difference between groups in subsequent falls, injurious falls and health service use. The per-protocol analyses revealed that the intervention participants who adhered to the recommended interventions had significantly lower rates of falls compared to non-adherers (IRR: 0.53 (95% CI : 0.32-0.87)). Conclusion a multidisciplinary intervention did not prevent falls in older people who received paramedic care but were not transported to ED. However the intervention was effective in those who adhered to the recommendations. Trial registration the trial is registered at the Australian New Zealand Clinical Trials Registry: ACTRN 12611000503921, 13/05/2011.
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Affiliation(s)
- A Stefanie Mikolaizak
- Falls Balance Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Stephen R Lord
- Falls Balance Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Anne Tiedemann
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Paul Simpson
- Western Sydney University, School of Science and Health, Campbelltown, New South Wales, Australia
| | - Gideon A Caplan
- Post Acute Care Services, Prince of Wales Hospital, Randwick, Sydney, New South Wales 2031, Australia
| | - Jason Bendall
- University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndell Webster
- Falls Balance Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Narelle Payne
- Falls Balance Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Sarah Hamilton
- Falls Balance Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Joanne Lo
- Falls Balance Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Elisabeth Ramsay
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Sandra O'Rourke
- Falls Balance Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Linda Roylance
- Falls Balance Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - J C Close
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
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McGary R, Franc J, Chui S, Kim CS, Boehm TK. Crown Lengthening Needs and Outcomes in Adults Attending a Predoctoral Clinic. J Calif Dent Assoc 2017; 45:73-80. [PMID: 29058855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this retrospective study of 5,536 patients admitted over four years at a predoctoral dental clinic for comprehensive care, general dentists identified crown lengthening needs in 584 patients and 760 teeth. Only 51 patients and 68 teeth actually received crown lengthening procedures. For the other cases, patients discontinued treatment or chose extraction or restoration without crown lengthening procedures. Teeth that received crown lengthening procedures were most likely restored and functioning for at least one year.
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