205 results on '"Brewster, David"'
Search Results
2. Psychosocial Interventions at the End-of-Life
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Chew, Nicolle Marie, Ting, Ee Lynn, Kerr, Lucille, Brewster, David J., and Russo, Philip L.
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- 2023
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3. Haemophagocytic lymphohistiocytosis secondary to disseminated tuberculosis in a young adult with Crohn's disease.
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Visal Hean, Rattanak, Sheffield, David A., Herbert, Kirsten, and Brewster, David
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- 2023
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4. Haemophagocytic lymphohistiocytosis secondary to disseminated tuberculosis in a young adult with Crohn's disease.
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Hean, Rattanak Visal, Sheffield, David A, Herbert, Kirsten, and Brewster, David
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TB-HLH has poorer prognosis than tuberculosis without HLH, carrying an increased risk of haematogenous tuberculosis and tuberculous meningitis. Keywords: Tuberculosis; Inflammatory bowel diseases; Inflammation; Immunosuppression; Intensive care EN Tuberculosis Inflammatory bowel diseases Inflammation Immunosuppression Intensive care 350 352 3 10/17/23 20231002 NES 231002 Clinical record A 25-year-old male patient reported four weeks of chills, night sweats, weight loss and dyspnoea following one week in Bali, Indonesia, seven weeks prior. Tuberculosis risk is low with short term travel, but pre-travel counselling is important for patients taking TNF inhibitors, who are at elevated risk of acquiring active tuberculosis. [Extracted from the article]
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- 2023
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5. Haemophagocytic lymphohistiocytosis secondary to disseminated tuberculosis in a young adult with Crohn's disease
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Hean, Rattanak Visal, Sheffield, David A, Herbert, Kirsten, and Brewster, David
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- 2023
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6. Airway management in the intensive care unit.
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Edelman, Daniel and Brewster, David
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Airway management practices in the intensive care unit (ICU) are still evolving, evidenced by an increasing proliferation of guidelines and algorithms in recent years. Specific considerations relate to the out-of-theatre environment and the physiological state in this patient population. Airway management in ICU is ultimately a multifaceted process spanning team training, simulation, preassessment, preparation, positioning of the patient, equipment decisions, guidelines/algorithm adherence and most recently the consideration of the coronavirus disease (COVID-19) pandemic. The use of video laryngoscopy has increased, as have the practices of apnoeic oxygenation and the use of checklists. Emergency front-of-neck access (FONA) should be taught to all staff and standardized equipment made available. This article highlights the factors a multidisciplinary team must navigate when approaching airway management in the ICU. [ABSTRACT FROM AUTHOR]
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- 2022
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7. Confidence in airway management proficiency: a mixed methods study of intensive care specialists in Australia and New Zealand
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Shahab, Jordi, Begley, Jonathan L., Nickson, Christopher P., Simpson, Shannon, Ukor, Ida F., and Brewster, David J.
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Objective:To explore self-confidence, and the respective facilitators and barriers, among intensive care specialists in Australia and New Zealand in relation to airway management.
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- 2022
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8. The physiologically difficult airway: an emerging concept
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Myatra, Sheila Nainan, Divatia, Jigeeshu Vasishtha, and Brewster, David J.
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- 2022
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9. The utility of frailty indices in predicting the risk of health care associated infections: A systematic review.
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Cosentino, Carmela B., Mitchell, Brett G., Brewster, David J., and Russo, Philip L.
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• Significant heterogeneity exists in the frailty index used and health care associated infections (HAI) definitions. • Frail surgical patients appear to have an increased risk of developing HAIs. • Further research in health care settings, with a uniform frailty index is required. Health care associated infections (HAIs) are a major health concern associated with significant morbidity and mortality. The relationship between frailty, a syndrome often associated with older individuals, and HAIs has not been investigated. To determine if frailty scoring systems can assist in predicting the risk of developing HAIs in health care settings. A directed search was conducted across 4 databases (MEDLINE, Cochrane, Scopus, and CINAHL) for articles published between 1 January 1990 and 31 December 2019. All articles were screened for relevance to the research aims. The Newcastle-Ottawa Scale was utilised to assess the study quality and risk of bias. The literature search yielded 290 results, with 14 articles meeting the inclusion criteria. Significant heterogeneity was present across the studies with regards to the frailty index employed and HAI definitions. Most studies were conducted in an acute health care setting (n = 12), while 2 studies were conducted in nursing homes. Eight studies demonstrated that frail individuals were at an increased risk of developing HAIs, in both surgical (n = 5) and medical patient populations (n = 2). Two of the 3 validated frailty scoring systems employed across the studies, the Clinical Frailty Scale and the Frailty Index demonstrated this relationship. The results of this review demonstrate a potential association between frailty and the development of HAIs. [ABSTRACT FROM AUTHOR]
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- 2021
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10. Proper elements of Coxeter groups
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Balogh, József, Brewster, David, and Hodges, Reuven
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We extend the notion of proper elementsto all finite Coxeter groups. For all infinite families of finite Coxeter groups we prove that the probability a random element is propergoes to zero in the limit. This proves a conjecture of the third author and Alexander Yong regarding the proportion of Schubert varieties that are Levi spherical for all infinite families of Weyl groups. We also enumerate the proper elements in the exceptional Coxeter groups.
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- 2024
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11. Indian Ocean Strategic Futures: Re-examining Assumptions of Capability and Intent
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Tarapore, Arzan and Brewster, David
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- 2021
12. Airway management in the adult patient with COVID-19: High flow nasal oxygen or not? A summary of evidence and local expert opinion
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Lee, Sarah, Bradley, W Pierre L, Brewster, David J, Chahal, Rani, Poon, Laurence, Segal, Reny, Totonidis, Savas, Tsang, David, and Ng, Mark
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The use of high flow nasal oxygen in the care of COVID-19-positive adult patients remains an area of contention. Early guidelines have discouraged the use of high flow nasal oxygen therapy in this setting due to the risk of viral spread to healthcare workers. However, there is the need to balance the relative risks of increased aerosol generation and virus transmission to healthcare workers against the role high flow nasal oxygen has in reducing hypoxaemia when managing the airway in high-risk patients during intubation or sedation procedures. The authors of this article undertook a narrative review to present results from several recent papers. Surrogate outcome studies suggest that the risk of high flow nasal oxygen in dispersing aerosol-sized particles is probably not as great as first perceived. Smoke laser-visualisation experiments and particle counter studies suggest that the generation and dispersion of bio-aerosols via high flow nasal oxygen with flow rates up to 60 l/min is similar to standard oxygen therapies. The risk appears to be similar to oxygen supplementation via a Hudson mask at 15 l/min and significantly less than low flow nasal prong oxygen 1–5 l/min, nasal continuous positive airway pressure with ill-fitting masks, bilevel positive airway pressure, or from a coughing patient. However, given the limited safety data, we recommend a cautious approach. For intubation in the COVID-positive or suspected COVID-positive patient we support the use of high flow nasal oxygen to extend time to desaturation in the at-risk groups, which include the morbidly obese, those with predicted difficult airways and patients with significant hypoxaemia, ensuring well-fitted high flow nasal oxygen prongs with staff wearing full personal protective equipment. For sedation cases, we support the use of high flow nasal oxygen when there is an elevated risk of hypoxaemia (e.g. bariatric endoscopy or prone-positioned procedures), but recommend securing the airway with a cuffed endotracheal tube for the longer duration procedures when theatre staff remain in close proximity to the upper airway, or considering the use of a surgical mask to reduce the risk of exhaled particle dispersion.
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- 2021
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13. Emergency Front-of-Neck Airway Rescue Via the Cricothyroid Membrane: A High-Resolution Computed Tomography Study of Airway Anatomy in Adults
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Fennessy, Paul, Greco, Eugene, Gelber, Nicholas, Brewster, David J., and Reeves, John H.
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- 2021
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14. Laparotomy- and groin-associated complications are common after aortofemoral bypass and contribute to reintervention.
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DeCarlo, Charles, Boitano, Laura T., Schwartz, Samuel I., Lancaster, R. Todd, Conrad, Mark F., Eagleton, Matthew J., Brewster, David C., and Clouse, W. Darrin
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Despite endovascular advancements, aortofemoral bypass (AFB; aortounifemoral and aortobifemoral bypass) remains the most durable option for aortoiliac occlusive disease. Whereas AFB reduces vascular aortoiliac reintervention, the impact of laparotomy-associated and groin wound complications on morbidity and reintervention is unclear. The aim of this study was to establish the incidence of nonvascular complications after AFB and to determine their effect on reintervention. Institutional data for AFB (2000-2017) were queried. Primary end points included laparotomy-associated and groin wound complications. Total reintervention was defined as the composite outcome of reinterventions for laparotomy and groin wound complications and graft patency. Kaplan-Meier analysis estimated freedom from reintervention. Fine-Gray method for competing long-term risk determined predictors of laparotomy complications. Logistic regression, adjusting variability for patient-level clustering, determined predictors of wound complications. There were 553 limbs in 281 patients (272 aortobifemoral and 9 aortounifemoral bypasses; age, 67.6 ± 11.0 years; 50.5% female). Ninety (32%) patients had prior abdominal surgery, 3.2% had prior ventral hernia (VH) repair, 2.9% had untreated VH, and 0.7% had history of small bowel obstruction. The majority of patients underwent AFB for claudication (66.2%); 87.2% had TransAtlantic Inter-Society Consensus (TASC) D lesions, 31.4% required a suprarenal clamp or higher, 16.4% had concomitant renovisceral revascularization, and 6.4% were receiving anticoagulation. Sixty-seven (12.1%) limbs had redo femoral artery exposures, 32.4% required femoral outflow adjunct, and 1.8% had simultaneous lower extremity bypass. The 30-day mortality was 2.9%. During median follow-up of 5.3 years (interquartile range, 7.3 years), 21% had laparotomy complications (VH, 15.3%; small bowel obstruction, 7.5%; other, 2.1%), including 10.0% requiring operative intervention. Sixty-seven (12%) groins had a wound complication; 4.9% required intervention. Unadjusted 1-, 3-, and 5-year freedom from graft reintervention was 93.3% (95% confidence interval [CI], 90.1%-96.5%), 85.3% (80.7%-90.2%), and 79.6% (74.1%-85.5%), respectively. Freedom from total reintervention at 1 year, 3 years, and 5 years was 82.1% (95% CI, 77.4%-87.1%), 73.6% (68.0%-79.6%), and 65.1% (58.7%-72.2%). Predictors of laparotomy complications were untreated VH (P =.01) and hypertension (P =.01). Protective factors were thoracoabdominal approach (P <.01) and aortounifemoral bypass (P <.01). Predictors of wound complications included body mass index (per kg, 1.07; CI, 1.01-1.15; P =.018), anticoagulation (2.59; CI, 1.01-8.37; P =.049), and previous iliac stents (2.60; CI, 1.36-4.94; P =.004). Whereas AFB is a durable reconstruction with infrequent need for graft reintervention, laparotomy- and groin wound-associated complications contribute significantly to morbidity and reintervention after AFB. Predictive factors for laparotomy and groin wound complications should be considered in preoperative planning and selection of patients for AFB and in the discussion of outcomes. [ABSTRACT FROM AUTHOR]
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- 2020
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15. Use of point-of-care ultrasound during cardiac arrest in the intensive care unit: A cross-sectional survey
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West, David A., Killick, Caroline, Jones, Daryl, Tan, Li, Knott, Cameron, Brewster, David, Le Fevre, Philippe, Tiruvoipati, Ravindranath, Maiden, Matt, Al-Bassam, Wissam, Rechnitzer, Tom, Haydon, Tim, and Farley, K.J.
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There is growing interest in the use of point-of-care ultrasound during cardiac arrest, but few studies document its use in the intensive care unit.
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- 2024
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16. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group.
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Brewster, David J, Chrimes, Nicholas, Do, Thy BT, Fraser, Kirstin, Groombridge, Christopher J, Higgs, Andy, Humar, Matthew J, Leeuwenburg, Timothy J, McGloughlin, Steven, Newman, Fiona G, Nickson, Chris P, Rehak, Adam, Vokes, David, and Gatward, Jonathan J
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Introduction: This statement was planned on 11 March 2020 to provide clinical guidance and aid staff preparation for the coronavirus disease 2019 (COVID-19) pandemic in Australia and New Zealand. It has been widely endorsed by relevant specialty colleges and societies.Main Recommendations: Generic guidelines exist for the intubation of different patient groups, as do resources to facilitate airway rescue and transition to the "can't intubate, can't oxygenate" scenario. They should be followed where they do not contradict our specific recommendations for the COVID-19 patient group. Consideration should be given to using a checklist that has been specifically modified for the COVID-19 patient group. Early intubation should be considered to prevent the additional risk to staff of emergency intubation and to avoid prolonged use of high flow nasal oxygen or non-invasive ventilation. Significant institutional preparation is required to optimise staff and patient safety in preparing for the airway management of the COVID-19 patient group. The principles for airway management should be the same for all patients with COVID-19 (asymptomatic, mild or critically unwell). Safe, simple, familiar, reliable and robust practices should be adopted for all episodes of airway management for patients with COVID-19.Changes in Management AsA Result Of This Statement: Airway clinicians in Australia and New Zealand should now already be involved in regular intensive training for the airway management of the COVID-19 patient group. This training should focus on the principles of early intervention, meticulous planning, vigilant infection control, efficient processes, clear communication and standardised practice. [ABSTRACT FROM AUTHOR]- Published
- 2020
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17. Smartphone use and perceptions of their benefit and detriment within Australian anaesthetic practice
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Perkins, Emma J, Edelman, Daniel A, and Brewster, David J
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The primary aim of this study was to evaluate the perceptions of Australian anaesthetists in relation to smartphone use within anaesthetic practice. In particular, we aimed to assess the frequency of smartphone use, the types and number of smartphone applications used, how reliant anaesthetists perceive themselves to be on smartphones and whether they perceive them to be a factor that aids or distracts from their practice. Secondly, we assessed whether there is an association between the type, frequency, reliance and perceptions of smartphone use and the years of experience as an anaesthetist. A 24-item questionnaire addressing these questions was created and distributed to an email list of credentialled anaesthetists in Melbourne, Australia. A total of 113 consultant anaesthetists who practise at 55 hospitals in Melbourne completed the questionnaire. Our results suggest that the majority of anaesthetists are using smartphones regularly in their practice. About 74% of respondents agreed that they rely on their smartphone for their work. We found that respondents were more likely to rely on smartphones and consider them to aid patient safety than to consider them a distraction. This phenomenon was particularly apparent in those who had been a consultant anaesthetist for less than three years. Furthermore, those who had been a consultant anaesthetist for less than three years were more likely to have more smartphone apps relating to anaesthetics, use them more often and rely on them to a greater degree. Our results highlight the ubiquitous and perceived useful nature of smartphones in anaesthetic practice.
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- 2020
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18. Leadership in intensive care: A review
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Brewster, David J, Butt, Warwick W, Gordon, Lisi J, and Rees, Charlotte E
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An integrative review of the literature specific to leadership within the intensive care unit was planned to guide future research. Four databases were searched. Study selection was based on predetermined inclusion and exclusion criteria and a quality check was done. Data extraction and synthesis involved developing a preliminary thematic coding framework based on a sample of papers. The coding framework and all selected papers were entered into NVivo software. All papers were then coded to the previously identified themes. Themes were summarised and presented with illustrative quotes highlighting key findings. In total, 1102 relevant quotations were coded across the 28 included papers. Four themes pertaining to leadership were described and analysed: (a) leadership dimensions and discourses; (b) leadership experiences; (c) facilitators and/or barriers to leadership; and (d) leadership outcomes. The literature was found to focus on leader behaviours, as well as the leader dimensions of role allocation, clinical and communication skills and traditional hierarchies. Positive behaviours mentioned included good decision-making, staying calm under pressure and being approachable. Leadership experiences (and outcomes) are typically reported to be positive. Personal individual factors seem the biggest enablers and barriers to leadership within the intensive care unit. Training is considered to be a facilitator of leadership within the intensive care unit. This study highlights the current literature on leadership in intensive care medicine and provides a basis for future research on interventions to improve leadership in the intensive care unit.
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- 2020
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19. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID‐19 adult patient group
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Brewster, David J, Chrimes, Nicholas, Do, Thy BT, Fraser, Kirstin, Groombridge, Christopher J, Higgs, Andy, Humar, Matthew J, Leeuwenburg, Timothy J, McGloughlin, Steven, Newman, Fiona G, Nickson, Chris P, Rehak, Adam, Vokes, David, and Gatward, Jonathan J
- Abstract
This statement was planned on 11 March 2020 to provide clinical guidance and aid staff preparation for the coronavirus disease 2019 (COVID‐19) pandemic in Australia and New Zealand. It has been widely endorsed by relevant specialty colleges and societies. Generic guidelines exist for the intubation of different patient groups, as do resources to facilitate airway rescue and transition to the “can't intubate, can't oxygenate” scenario. They should be followed where they do not contradict our specific recommendations for the COVID‐19 patient group.Consideration should be given to using a checklist that has been specifically modified for the COVID‐19 patient group.Early intubation should be considered to prevent the additional risk to staff of emergency intubation and to avoid prolonged use of high flow nasal oxygen or non‐invasive ventilation.Significant institutional preparation is required to optimise staff and patient safety in preparing for the airway management of the COVID‐19 patient group.The principles for airway management should be the same for all patients with COVID‐19 (asymptomatic, mild or critically unwell).Safe, simple, familiar, reliable and robust practices should be adopted for all episodes of airway management for patients with COVID‐19. Airway clinicians in Australia and New Zealand should now already be involved in regular intensive training for the airway management of the COVID‐19 patient group. This training should focus on the principles of early intervention, meticulous planning, vigilant infection control, efficient processes, clear communication and standardised practice.
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- 2020
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20. Direct Solvothermal Synthesis of Phase-Pure Colloidal NiO Nanocrystals
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Brewster, David A., Bian, Yifeng, and Knowles, Kathryn E.
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Nickel(II) oxide (NiO) nanocrystals have potential applications in catalysis and photocatalysis and as precursors for nanostructured thin films of NiO used as photocathodes in p-type dye-sensitized solar cells. Previously reported methods for synthesizing NiO nanocrystals typically produce Ni(OH)2or Ni as an intermediate phase that is subsequently converted to NiO via calcination or oxidation. Here, we report a reproducible solvothermal method to access colloidal, monodisperse NiO nanocrystals of high optical quality from aminated nickel carboxylate precursor complexes in a single synthetic step at a low reaction temperature (180 °C). The use of a tertiary alcohol, such as tert-butanol or tert-amyl alcohol, as a solvent and the presence of amines and a trace amount of water are all necessary for the formation of NiO. The high optical quality of these nanocrystals combined with the reproducibility and scalability of the synthesis will enable future spectroscopic and reactivity studies of colloidal NiO nanocrystals in the context of their optoelectronic and catalytic applications.
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- 2020
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21. Operative Complexity and Prior Endovascular Intervention Negatively Impact Morbidity after Aortobifemoral Bypass in the Modern Era
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DeCarlo, Charles, Boitano, Laura T., Schwartz, Samuel I., Lancaster, R. Todd, Conrad, Mark F., Eagleton, Matthew J., Brewster, David C., and Clouse, W. Darrin
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Endovascular therapy is first-line treatment for aortoiliac occlusive disease. This shift has altered case volume, patient selection, and risk profile for aortobifemoral bypass (ABF). Given this, we sought to investigate factors influencing morbidity and mortality after ABF in the endovascular era.
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- 2020
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22. How long do nosocomial pathogens persist on inanimate surfaces: A scoping review
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Porter, Lucy, Sultan, Ola, Mitchell, Brett, Jenney, Adam, Kiernan, Martin, Brewster, David, and Russo, Philip
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- 2023
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23. A Critical Assessment of Indications of the National Prevalence of Illegal Drug Use in Japan
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Brewster, David
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Indications of the national prevalence of illegal drug use in Japan have largely been presented from two main sources: official police-recorded statistics and a national self-report survey. Their findings have been often used to support a representation of Japan as having relatively low levels of illegal drug use in comparison to other developed countries. However, the use and presentation of these sources has rarely considered in any meaningful way their nature and accuracy in revealing patterns of illegal drug use. As such, there is a tendency to uncritically accept and reproduce dominant patterns that may distort and disguise a more realistic understanding. This article critically examines these two sources, identifying a series of methodological issues that may contribute toward an underrepresentation of illegal drug use. In doing so, it also argues that a more critical social science–informed perspective may allow for these sources to be better utilized and situated within the cultural context in which they are produced and which they claim to represent.
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- 2018
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24. Diagnostic Routes and Time Intervals for Ovarian Cancer in Nine International Jurisdictions; Findings From the International Cancer Benchmarking Partnership (ICBP)
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Menon, Usha, Weller, David, Falborg, Alina Zalounina, Jensen, Henry, Butler, John, Barisic, Andriana, Knudsen, Anne Kari, Bergin, Rebecca J., Brewster, David H., Cairnduff, Victoria, Fourkala, Evangelia Ourania, Gavin, Anna T., Grunfeld, Eva, Harland, Elizabeth, Kalsi, Jatinderpal, Law, Rebecca-Jane, Lin, Yulan, Turner, Donna, Neal, Richard D., White, Victoria, Harrison, Samantha, Reguilon, Irene, Lynch, Charlotte, and Vedsted, Peter
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(Abstracted from Br J Cancer2022;127:844–854)Ovarian cancer (OC) is the gynecological malignancy with the highest mortality, partially attributable to the lack of effective screening for early-stage disease. Despite inadequate screening methods, there exists significant international variation in the proportion diagnosed at late stage and in OC survival across all stages.
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- 2022
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25. Investigation of the international comparability of population-based routine hospital data set derived comorbidity scores for patients with lung cancer
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Luchtenborg, Margreet, Morris, Eva J A, Tataru, Daniela, Coupland, Victoria H, Smith, Andrew, Milne, Roger L, te Marvelde, Luc, Baker, Deborah, Young, Jane, Turner, Donna, Nishri, Diane, Earle, Craig, Shack, Lorraine, Gavin, Anna, Fitzpatrick, Deirdre, Donnelly, Conan, Lin, Yulan, Møller, Bjørn, Brewster, David H, Deas, Andrew, Huws, Dyfed W, White, Ceri, Warlow, Janet, Rashbass, Jem, and Peake, Michael D
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IntroductionThe International Cancer Benchmarking Partnership (ICBP) identified significant international differences in lung cancer survival. Differing levels of comorbid disease across ICBP countries has been suggested as a potential explanation of this variation but, to date, no studies have quantified its impact. This study investigated whether comparable, robust comorbidity scores can be derived from the different routine population-based cancer data sets available in the ICBP jurisdictions and, if so, use them to quantify international variation in comorbidity and determine its influence on outcome.MethodsLinked population-based lung cancer registry and hospital discharge data sets were acquired from nine ICBP jurisdictions in Australia, Canada, Norway and the UK providing a study population of 233 981 individuals. For each person in this cohort Charlson, Elixhauser and inpatient bed day Comorbidity Scores were derived relating to the 4–36 months prior to their lung cancer diagnosis. The scores were then compared to assess their validity and feasibility of use in international survival comparisons.ResultsIt was feasible to generate the three comorbidity scores for each jurisdiction, which were found to have good content, face and concurrent validity. Predictive validity was limited and there was evidence that the reliability was questionable.ConclusionThe results presented here indicate that interjurisdictional comparability of recorded comorbidity was limited due to probable differences in coding and hospital admission practices in each area. Before the contribution of comorbidity on international differences in cancer survival can be investigated an internationally harmonised comorbidity index is required.
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- 2018
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26. Occult blood in faeces is associated with all-cause and non-colorectal cancer mortality
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Libby, Gillian, Fraser, Callum G, Carey, Frank A, Brewster, David H, and Steele, Robert J C
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ObjectiveAn association between detectable faecal haemoglobin (f-Hb) and both the risk of death from colorectal cancer (CRC) and all-cause mortality has been reported. We set out to confirm or refute this observation in a UK population and to explore the association between f-Hb, as indicated by a positive guaiac faecal occult blood test (gFOBT) result, and different causes of death.DesignAll individuals (134 192) who participated in gFOBT screening in Tayside, Scotland between 29/03/2000 and 29/03/2016 were studied by linking their test result (positive or negative) with mortality data from the National Records of Scotland database and following to 30/03/2016.ResultsThose with a positive test result (n=2714) had a higher risk of dying than those with a negative result, from CRC: HR 7.79 (95% CI 6.13 to 9.89), p<0.0001, (adjusted for, gender, age, deprivation quintile and medication that can cause bleeding) and all non-CRC causes: HR 1.58 (95% CI 1.45 to 1.73), p<0·0001.· In addition, f-Hb detectable by gFOBT was significantly associated with increased risk of dying from circulatory disease, respiratory disease, digestive diseases (excluding CRC), neuropsychological disease, blood and endocrine disease and non-CRC.ConclusionThe presence of detectable f-Hb is associated with increased risk of death from a wide range of causes.
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- 2018
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27. Retrograde stenting of proximal lesions with carotid endarterectomy increases risk.
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Clouse, W. Darrin, Ergul, Emel A., Cambria, Richard P., Brewster, David C., Kwolek, Christopher J., LaMuraglia, Glenn M., Patel, Virendra I., and Conrad, Mark F.
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Objective Concomitant carotid bifurcation and proximal ipsilateral arch branch disease is uncommon. A combined approach using carotid endarterectomy (CEA) with ipsilateral proximal endovascular (IPE) intervention (CEA+IPE) has been proposed as safe and durable, with similar results to isolated CEA. This study was conducted to identify diagnostic modalities and outcomes of this uncommon procedure at our institution. Methods Operative records were used to identify patients who underwent CEA+IPE between May 2003 and July 2014. Patients were excluded if they underwent open retrograde access for endovascular intervention only, without CEA. The primary end points were freedom from neurologic event and need for reintervention. Results Twenty-three patients (15 women [65%]) underwent CEA+IPE. Mean clinical follow-up was 44 ± 35 months. Average age was 69 ± 9 years. Most patients (22 [96%]) were taking a statin and at least one antiplatelet agent. Bilateral internal carotid stenosis (>50%) was present in 12 patients (52%), and eight (35%) were symptomatic. Seven patients (30%) had prior ipsilateral CEA. All patients underwent preoperative carotid duplex and axial imaging. Computed tomography angiography was the initial imaging assessment in 10 patients (43%). The proximal lesion was identified in 19 (83%) by blunted waveforms on carotid duplex. Most bifurcation operations were CEA with patch (20 [87%]), and 21 (91%) underwent the bifurcation procedure first, followed by IPE. All IPE included balloon-expandable stenting (22 of 23 [96%] bare-metal, 7 [30%] innominate artery, 16 [70%] left common carotid artery). Electroencephalographic changes occurred in two patients (9%). Shunting was used in three (13%). Three vessel dissections (13%) occurred at the IPE site; two required further stenting and one was complicated by stroke and death. There were two perioperative strokes (9%) and one death (4%). Mean imaging follow-up was 30.6. ± 27.2 months, with restenosis identified in five patients (23%; four bifurcation, one IPE in-stent). One patient required open reintervention with subclavian-carotid bypass at 13 months for recurrent transient ischemic attack. The 4-year actuarial survival was 85%. Stroke-free survival and freedom from reintervention were 80% and 90% at 36 months, respectively. Conclusions The stroke and death rate for CEA+IPE is higher than that of isolated CEA at our institution. Duplex findings can suggest proximal stenosis; however, confirmation with physical examination in conjunction with axial imaging are integral. This combined treatment strategy should be reserved for those with evident hemodynamically significant proximal stenosis and approached with caution in asymptomatic patients. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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28. Universal Solid-Phase Reversible Sample-Prep for Concurrent Proteome and N-Glycome Characterization.
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Hui Zhou, Morley, Samantha, Kostel, Stephen, Freeman, Michael R., Joshi, Vivek, Brewster, David, and Lee, Richard S.
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- 2016
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29. Potential role for extracorporeal membrane oxygenation cardiopulmonary resuscitation (E-CPR) during in-hospital cardiac arrest in Australia: A nested cohort study
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Pound, G., Eastwood, G.M., Jones, D., Hodgson, C.L., Jones, Daryl, Hodgson, Carol, Eastwood, Glenn, Pound, Gemma, Higgins, Lisa, Hilton, Andrew, Bellomo, Rinaldo, Board, Jasmin, Martin, Emma-Leah, Orosz, Judit, Udy, Andrew, Marsh, Phil, Young, Helen, Peck, Leah, Simpson, Shannon, Brewster, David, Gupta, Sachin, Green, Cameron, Gough, Maimoonbe, Richards, Brent, Wells, Lucy, Gattas, David, Coakley, Jennifer, Buhr, Heidi, Fennessy, Gerard, Bates, Sam, and Mulder, John
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This study aims to evaluate the characteristics and outcomes of patients who fulfilled extracorporeal membrane oxygenation cardiopulmonary resuscitation (E-CPR) selection criteria during in-hospital cardiac arrest (IHCA).
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- 2023
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30. Interval cancers in a national colorectal cancer screening programme
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Steele, Robert JC, Stanners, Greig, Lang, Jaroslaw, Brewster, David H, Carey, Francis A, and Fraser, Callum G
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Background Little is known about interval cancers (ICs) in colorectal cancer (CRC) screening.Objective The purpose of this study was to identify IC characteristics and compare these with screen-detected cancers (SCs) and cancers in non-participants (NPCs) over the same time period.Design This was an observational study done in the first round of the Scottish Bowel Screening Programme. All individuals (772,790), aged 50–74 years, invited to participate between 1 January 2007 and 31 May 2009 were studied by linking their screening records with confirmed CRC records in the Scottish Cancer Registry (SCR). Characteristics of SC, IC and NPC were determined.Results There were 555 SCs, 502 ICs and 922 NPCs. SCs were at an earlier stage than ICs and NPCs (33.9% Dukes’ A as against 18.7% in IC and 11.3% in NPC), screening preferentially detected cancers in males (64.7% as against 52.8% in IC and 59.7% in NPC): this was independent of a different cancer site distribution in males and females. SC in the colon were less advanced than IC, but not in the rectum.Conclusion ICs account for 47.5% of the CRCs in the screened population, indicating approximately 50% screening test sensitivity: guaiac faecal occult blood testing (gFOBT) sensitivity is less for women than for men and gFOBT screening may not be effective for rectal cancer.
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- 2016
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31. Interval cancers in a national colorectal cancer screening programme
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Steele, Robert JC, Stanners, Greig, Lang, Jaroslaw, Brewster, David H, Carey, Francis A, and Fraser, Callum G
- Abstract
Little is known about interval cancers (ICs) in colorectal cancer (CRC) screening. The purpose of this study was to identify IC characteristics and compare these with screen-detected cancers (SCs) and cancers in non-participants (NPCs) over the same time period. This was an observational study done in the first round of the Scottish Bowel Screening Programme. All individuals (772,790), aged 50–74 years, invited to participate between 1 January 2007 and 31 May 2009 were studied by linking their screening records with confirmed CRC records in the Scottish Cancer Registry (SCR). Characteristics of SC, IC and NPC were determined. There were 555 SCs, 502 ICs and 922 NPCs. SCs were at an earlier stage than ICs and NPCs (33.9% Dukes’ A as against 18.7% in IC and 11.3% in NPC), screening preferentially detected cancers in males (64.7% as against 52.8% in IC and 59.7% in NPC): this was independent of a different cancer site distribution in males and females. SC in the colon were less advanced than IC, but not in the rectum. ICs account for 47.5% of the CRCs in the screened population, indicating approximately 50% screening test sensitivity: guaiac faecal occult blood testing (gFOBT) sensitivity is less for women than for men and gFOBT screening may not be effective for rectal cancer.
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- 2016
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32. Universal Solid-Phase Reversible Sample-Prep for Concurrent Proteome and N-Glycome Characterization
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Zhou, Hui, Morley, Samantha, Kostel, Stephen, Freeman, Michael R., Joshi, Vivek, Brewster, David, and Lee, Richard S.
- Abstract
We describe a novel solid-phase reversible sample-prep (SRS) platform that enables rapid sample preparation for concurrent proteome and N-glycome characterization for nearly all protein samples. SRS utilizes a uniquely functionalized, silica-based bead that has strong affinity toward proteins with minimal to no affinity for peptides and other small molecules. By leveraging this inherent size difference between proteins and peptides, SRS permits high-capacity binding of proteins, rapid removal of small molecules (detergents, metabolites, salts, peptides, etc.), extensive manipulation including enzymatic and chemical treatments on bead-bound proteins, and easy recovery of N-glycans and peptides. SRS was evaluated in a wide range of samples including glycoproteins, cell lysate, murine tissues, and human urine. SRS was also coupled to a quantitative strategy to investigate the differences between DU145 prostate cancer cells and its DIAPH3-silenced counterpart. Previous studies suggested that DIAPH3 silencing in DU145 induced transition to an amoeboid phenotype that correlated with tumor progression and metastasis. In this pilot study we identified distinct proteomic and N-glycomic alterations between them. A metastasis-associated tyrosine kinase receptor ephrin-type-A receptor (EPHA2) was highly up-regulated in DIAPH3-silenced cells, indicating a possible connection between EPHA2 and DIAPH3. Moreover, distinct alterations in the N-glycome were identified, suggesting cross-links between DIAPH3 and glycosyltransferase networks.
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- 2016
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33. Worldwide Inverse Association between Gastric Cancer and Esophageal Adenocarcinoma Suggesting a Common Environmental Factor Exerting Opposing Effects
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Derakhshan, Mohammad H, Arnold, Melina, Brewster, David H, Going, James J, Mitchell, David R, Forman, David, and McColl, Kenneth E L
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Objectives:The incidence of esophageal adenocarcinoma (EAC) is increasing while adenocarcinoma of the stomach is decreasing. We have investigated whether the incidences of these two cancers and their time trends might be inversely related pointing to a common environmental factor exerting opposite effects on these cancers.Methods:For cross-sectional analyses data were abstracted from “Cancer Incidence in Five Continents” (CI5) Volume X and GLOBOCAN 2012. Relevant ICD-10 codes were used to locate esophageal and gastric cancers anatomically, and ICD-O codes for the histological diagnosis of EAC. For longitudinal analyses, age standardized rates (ASRs) of EAC and total gastric cancer (TGC) were extracted from CI5C-Plus.Results:Estimated (2012) ASRs were available for 51 countries and these showed significant negative correlations between EAC and both TGC (males: correlation coefficient (CC)=−0.38, P=0.006, females: CC=−0.41, P=0.003) and non-cardia gastric cancer rates (males: CC=−0.41, P=0.003 and females: CC=−0.43, P=0.005). Annual incidence trends were analyzed for 38 populations through 1989–2007 and showed significant decreases for TGC in 89% and increases for EAC in 66% of these, with no population showing a fall in the latter. Significant negative correlation between the incidence trends of the two cancers was observed in 27 of the 38 populations over the 19–50 years of available paired data. Super-imposition of the longitudinal and cross-sectional data indicated that populations with a current high incidence of EAC and low incidence of gastric cancer had previously resembled countries with a high incidence of gastric cancer and low incidence of EAC.Conclusions:The negative association between gastric cancer and EAC in both current incidences and time trends is consistent with a common environmental factor predisposing to one and protecting from the other.
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- 2016
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34. Policy for home or hospice as the preferred place of death from cancer: Scottish Health and Ethnicity Linkage Study population cohort shows challenges across all ethnic groups in Scotland
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Sharpe, Katharine H, Cezard, Genevieve, Bansal, Narinder, Bhopal, Raj S, and Brewster, David H
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BackgroundPlace of cancer death varies ethnically and internationally. Palliative care reviews highlight limited ability to demonstrate equal access due to incomplete or unreliable ethnicity data.AimTo establish place of cancer death by ethnicity and describe patient characteristics.DesignWe linked census, hospital episode and mortality data for 117 467 persons dying of cancer, 2001–2009. With White Scottish population as reference, prevalence ratios (PR), 95% CIs and p values of death in hospital, home or hospice adjusted for sex and age were calculated by ethnic group.ResultsWhite Scottish group and minority ethnic groups combined constituted 91% and 0.4% of cancer deaths, respectively. South Asian, Chinese and African Origin patients were youngest at death (66, 66 and 65.9 years). Compared with the Scottish White reference, the White Irish (1.15 (1.10 to 1.22), p<0.0001) and Other White British (1.07 (1.02 to 1.12), p=0.003) groups were more likely to die at home. Generally, affluent Scottish White patients were less likely to die in hospital and more likely to die at home or in a hospice regardless of socioeconomic indicator used.ConclusionsCancer deaths occur most often in hospital (52.3%) for all ethnic groups. Regardless of the socioeconomic indicator used, more affluent Scottish White patients were less likely to die in hospital; existing socioeconomic indicators detected no clear trend for the non-White population. Regardless of ethnic group, significant work is required to achieve more people dying at home or the setting of their choice.
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- 2015
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35. The Accuracy of Dermatology Network Physician Directories Posted by Medicare Advantage Health Plans in an Era of Narrow Networks
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Resneck, Jack S., Quiggle, Aaron, Liu, Michael, and Brewster, David W.
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IMPORTANCE: Insurers are increasingly deploying “narrow networks” with fewer contracted physicians both in health plans offered in new state exchanges under the Affordable Care Act and in Medicare Advantage (MA) plans, which are commercial alternatives offered to Medicare beneficiaries. Patients choosing health plans rely on the accuracy of network directories posted by insurers. The MA plans must meet network adequacy requirements, and inaccurate directories of participating physicians might prejudice those determinations. OBJECTIVE: To determine the accuracy of MA plan directories of participating dermatologists, and the appointment availability of listed physicians. DESIGN, SETTING, AND PARTICIPANTS: Scripted telephone calls were placed to every dermatologist listed in directories for the largest MA plans in 12 US metropolitan areas. The caller sought an appointment on behalf of his fictitious father who had severe itch for several months, asked whether the dermatologist accepted the relevant plan, and asked for the next available appointment date. MAIN OUTCOMES AND MEASURES: Appointment availability and wait time. RESULTS: Among 4754 total physician listings, 45.5% represented duplicates in the same plan directory. Among the remaining unique listings, 48.9% of physicians were reachable, accepted the listed plan, and offered an appointment for our fictitious patient. Many of the dermatologists listed had incorrect contact information, were deceased, retired, or had moved, were not accepting new patients, did not accept the insurance plan, or were subspecialized. The mean (range) wait time for appointments among the remaining listings was 45.5 (1-414) days. Both the accuracy of network directories and the appointment wait times varied substantially by health plan and metropolitan area. For 1 plan, our caller was unable to obtain an appointment with any listed dermatologist. CONCLUSIONS AND RELEVANCE: Medicare Advantage physician directories for dermatology in many areas substantially overestimate the number of in-network physicians available to treat patients with medical skin conditions. These inaccuracies occurred in areas with long appointment wait times and where plans are terminating selected physician contracts. This suggests a lack of capacity that would be exacerbated by further network narrowing. Accurate physician directories are essential for proper oversight of network adequacy, and for patients who rely on these listings to evaluate health plan options during open enrollment.
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- 2014
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36. Durability of open repair of juxtarenal abdominal aortic aneurysms.
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Tsai, Shirling, Conrad, Mark F., Patel, Virendra I., Kwolek, Christopher J., LaMuraglia, Glenn M., Brewster, David C., and Cambria, Richard P.
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AORTIC aneurysms ,ENDOVASCULAR surgery ,MULTIVARIATE analysis ,MEDICAL statistics ,THORACIC aneurysms ,RELATIVE medical risk ,HEALTH outcome assessment - Abstract
Objective: As branched/fenestrated endografts expand endovascular options for juxtarenal abdominal aortic aneurysms (JAAAs), long-term durability will be compared to that of open JAAA repair, which has not been documented in large contemporary series. The goal of this study was to assess the late clinical and anatomic outcomes after open JAAA repair. Methods: From July 2001 to December 2007, 199 patients underwent open elective JAAA repair, as defined by a need for suprarenal clamping. End points included perioperative and late survival, long-term follow-up of renal function, and freedom from graft-related complications. Factors predictive of survival were determined by multivariate analysis. Results: The mean patient age was 74 years, 71% were men, and 20% had baseline renal insufficiency (Cr >1.5). Thirty-seven renal artery bypasses, for anatomic necessity or ostial stenosis, were performed in 36 patients. Overall 30-day mortality was 2.5%. Four patients (2.0%) required early dialysis; one patient recovered by discharge. Two additional patients progressed to dialysis over long-term follow-up. There was one graft infection involving one limb of a bifurcated graft. Surveillance imaging was obtained in 101 patients (72% of survivors) at a mean follow-up of 41 ± 28 months. Renal artery occlusion occurred in four patients (3% of imaged renal arteries; one native/three grafts). Two patients (2.0%) had aneurysmal degeneration of the aorta either proximal or distal to the repaired segment, but there were no anastomotic pseudoaneurysms. Remote aneurysms were found in 29 patients (29% of imaged patients), 14 of whom had descending thoracic aneurysm or TAAA. Four patients underwent subsequent thoracic endovascular aneurysm repair (TEVAR). Actuarial survival was 74 ± 3.3% at 5 years. Negative predictors of survival included increasing age at the time of operation (relative risk [RR], 1.05; P = .01), steroid use (RR, 2.20; P = .001), and elevated preoperative creatinine (RR, 1.73; P = .02). Conclusions: Open JAAA repair yields excellent long-term anatomic durability and preserves renal function. Perioperative renal insufficiency occurs in 8.5% of patients, but few of them progress to dialysis. Graft-related complications are rare (2% at 40 months); however, axial imaging revealed descending thoracic aneurysms in 14% of imaged patients, making continued surveillance for remote aneurysms prudent. These data provide a benchmark against which fenestrated/branched endovascular aneurysm repair (EVAR) outcomes can be compared. [Copyright &y& Elsevier]
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- 2012
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37. Comparable mortality with open repair of complex and infrarenal aortic aneurysm.
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Patel, Virendra I., Lancaster, Robert T., Conrad, Mark F., LaMuraglia, Glenn M., Kwolek, Christopher J., Brewster, David C., and Cambria, Richard P.
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ABDOMINAL surgery ,ABDOMINAL aortic aneurysms ,OPERATIVE surgery ,MORTALITY ,SURGICAL complications ,COHORT analysis ,UNIVARIATE analysis ,HEALTH outcome assessment ,REGRESSION analysis - Abstract
Background: A consequence of endovascular aneurysm repair (EVAR) of anatomically straightforward infrarenal abdominal aortic aneurysm repair cohort (AAA) is that open aneurysm repair is more commonly performed for complex anatomy. Complex aneurysm repair with visceral vessel involvement (CAA) or combined aneurysm repair and visceral vessel reconstruction (VVR) has traditionally been considered to increase morbidity and mortality compared with repair of infrarenal AAA. This study evaluated contemporary outcomes of open abdominal aneurysm surgery, including AAA, CAA, and VVR using the National Surgical Quality Improvement Program (NSQIP) database. Methods: The NSQIP Participant Use File was queried by CPT code to identify patients undergoing AAA, CAA, and VVR (2005-2008). Comparative analysis of clinical features, technical details and 30-day outcomes was performed using univariate methods. Logistic regression analysis was used to identify predictors of morbidity and mortality. Results: A total of 2820 patients underwent AAA and 592 CAA. Renal insufficiency (ie, creatinine >1.4 mg/dL) rates were similar in AAA and CAA patients, however, more frequent in patients with VVR (51% vs 31% [no bypass]; P < .01). CAA was less likely to be performed urgently (6.3% vs 9.1%; P < .05) and was associated with increased operative time (254 ± 100 vs 224 ± 93; P < .01) compared with AAA. Univariate analysis showed that CAA did not increase mortality (5.7% vs 5.1%; P = .5). CAA slightly increased overall complications (32% vs 27%; P = .01) compared with AAA. 73 (2.5%) AAA and 84 (12%) CAA patients had simultaneous VVR and these patients exhibited a trend toward increased mortality (8.9% vs 5.2%; P = .07). VVR increased complications (43% (VVR) vs 26% [no bypass]; P < .01), including ventilation >48 hours (21% [VVR] vs 12% [no bypass]; P < .01), renal failure (7.6% [VVR] vs 4.1% [no bypass]; P = .04), and sepsis (13% [VVR] vs 6.3% ([no bypass]; P < .01). Multivariate analysis demonstrated that CAA (odds ratio [OR], 1.3 [95% confidence interval (CI), 1.1-1.6]; P = .01) and VVR (OR, 2.2 [95% CI, 1.8-3.6]; P < .01) increased the odds of any complication. Independent predictors of mortality included dependent functional status (OR, 3.6 [95% CI, 2.3-5.4]; P < .01), elevated pre-op creatinine (OR, 2.9 [95% CI, 2.2-4.0]; P < .01), type II diabetes (OR, 1.6 [95% CI, 1.05-2.4]; P = .03), and age (OR, 1.06 [95% CI, 1.03-1.08]; P < .01). Neither CAA (OR, 1.2 [95% CI, 0.84-1.8]; P = .3) nor VVR (OR, 1.6 [95% CI, 0.89-2.9]; P = .11) were associated with increased mortality compared with AAA. Conclusion: In contemporary practice the migration of open repair to increasingly complex cases has been achieved with 30-day mortality essentially equivalent to open repair of infrarenal AAA. Patients who require VVR do sustain increased complications, in particular renal failure. These data also emphasize the importance of baseline renal insufficiency in clinical decision making. CAA and VVR are associated with increased morbidity in comparison to AAA repair; however, both procedures can be safely performed in patients without increased risk of operative mortality. [Copyright &y& Elsevier]
- Published
- 2011
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38. Continued favorable results with open surgical repair of type IV thoracoabdominal aortic aneurysms.
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Patel, Virendra I., Ergul, Emel, Conrad, Mark F., Cambria, Matthew, LaMuraglia, Glenn M., Kwolek, Christopher J., Brewster, David C., and Cambria, Richard P.
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AORTA surgery ,AORTIC aneurysms ,ISCHEMIA ,SPINAL cord diseases ,MORTALITY ,CHRONIC kidney failure ,SURGICAL complications ,HEALTH outcome assessment - Abstract
Objectives: Type IV thoracoabdominal aortic aneurysm (TAAA) repair, despite low risk of spinal cord ischemia (SCI), is reported to have significant morbidity and mortality. This has led some to apply adjuncts (eg, extracorporeal circulation) used in more extensive TAAA repair or to consider alternative approaches, such as hybrid operations. We have used a consistent, simplified surgical approach to type IV TAAA, and the goal of the present study is to review experience over 2 decades with such treatment and to identify correlates of surgical morbidity. Methods: All type IV repairs at Massachusetts General Hospital from January 1989 through September 2009 were evaluated for clinical features, technical operative details, and 30-day outcomes. Logistic regression identified predictors of morbidity. Survival was assessed using Kaplan-Meier analysis. Results: A total of 179 patients underwent type IV repair, with elective repair in 156 (87%) and urgent in 23 (13%). The clamp-and-sew technique was used for all operations, with routine hypothermic renal perfusion. Clinical features were age 73 ± 8 years, coronary artery disease in 89 (50%), and creatinine level >1.8 mg/dL defining chronic renal insufficiency (CRI) in 32 (18%). Operative reconstruction in 166 (93%) consisted of one beveled proximal anastomosis incorporating the descending thoracic aorta, celiac, superior mesenteric artery, and right renal arteries origins (mean visceral clamp time, 36 ± 12 minutes) and a side-arm graft to the left renal artery. Technical details included previous abdominal aortic aneurysm (AAA) repair in 52 (29%), operative time of 290 ± 90 min, estimated blood loss of 2.7 ± 1.4 L, and splenectomy in 57 (32%). The 30-day outcomes were death in 5 (2.8%), myocardial infarction in 6 (3.4%), hemodialysis in 5 (2.8%), and any degree of SCI in 4 (2.2%). Regression analysis identified a history of CRI as an independent predictor of postoperative complication or death (odds ratio, 3.4; 95% confidence interval, 1.4-8). Survival rates at 1, 5, and 10 years were 89% ± 2%, 62% ± 4%, and 36% ± 5%, respectively. Conclusions: A simplified operative approach for type IV TAAA repair is associated with favorable perioperative results. These data refute the need for surgical adjuncts commonly applied in more extensive TAAA and indicate that the hybrid operation is an illogical posture. CRI should figure prominently in clinical decision making. Long-term survival equates that observed after routine AAA repair. [Copyright &y& Elsevier]
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- 2011
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39. Preoperative variables predict persistent type 2 endoleak after endovascular aneurysm repair.
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Abularrage, Christopher J., Crawford, Robert S., Conrad, Mark F., Lee, Hang, Kwolek, Christopher J., Brewster, David C., Cambria, Richard P., and LaMuraglia, Glenn M.
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ANEURYSMS ,SURGERY ,ENDOVASCULAR surgery ,TOMOGRAPHY ,PREOPERATIVE period ,LUMBOSACRAL region ,HEALTH risk assessment - Abstract
Objective: Persistent type 2 endoleaks (PT2, present ≥6 months) after endovascular aneurysm repair (EVAR) are associated with adverse outcomes. This study evaluated the preoperative risk factors and natural history of PT2 in order to define a population at high risk. Methods: From January 1999 to December 2007, 595 of 832 EVAR patients had long-term computed tomography follow-up and comprised the study cohort. Preoperative anatomic and clinical variables were correlated with PT2 using Cox regression. Composite hazard ratios (HRs) were constructed with clusters of high-risk preoperative variables. Primary end points, including spontaneous resolution, sac enlargement >5 mm, and freedom from reintervention, were evaluated using Kaplan-Meier analysis. Results: There were 136 PT2 patients (23%) with a median follow-up of 34.8 months (range, 6.4-121.2 months). Positive predictive factors included patent inferior mesenteric artery (IMA; HR, 4.00; 95% confidence interval [CI], 1.62-9.90; P = .003), increasing number of patent lumbar arteries (HR, 1.24; 95% CI, 1.10-1.41; P = .0006), increasing age (HR, 1.04; 95% CI, 1.01-1.06; P = .005), and increasing luminal diameter on CT-contrast opacified lumen (HR, 1.03; 95% CI, 1.02-1.05; P = .0001). During follow-up, spontaneous PT2 resolution occurred in 34 patients (25%), sac diameter remained stable in 63 (46%), and rupture occurred in 2 (1.5%). Kaplan-Meier analysis estimated that 35.2% ± 5.6% (95% CI, 23.8%-46.2%) of PT2 resolve spontaneously at 5 years after the index procedure. Freedom from sac enlargement >5 mm was 54.6% ± 7.2% (95% CI, 40.6%-69.4%) at 5 years. Fifty-nine reinterventions were performed in 39 patients with PT2. Freedom from reintervention was 67.3% ± 5.0% (95% CI, 57.0%-77.0%) at 5 years. The combination of a patent IMA and one risk factor of more than six patent lumbar arteries, maximum luminal diameter >30 mm, or age >70 years increased the odds of PT2 approximately ninefold. The combination of a patent IMA and any two risk factors increased the odds of PT2 approximately 18-fold. Conclusions: Several readily identifiable preoperative variables are associated with PT2 whose natural history was benign in but 35% of patients. On the basis of the composite high-risk HRs, there is accordingly a cohort of patients in whom perioperative interventions to preclude PT2 should be considered. [Copyright &y& Elsevier]
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- 2010
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40. SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: Executive summary.
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Chaikof, Elliot L., Brewster, David C., Dalman, Ronald L., Makaroun, Michel S., Illig, Karl A., Sicard, Gregorio A., Timaran, Carlos H., Upchurch, Gilbert R., and Veith, Frank J.
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- 2009
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41. Aortic remodeling after endovascular repair of acute complicated type B aortic dissection.
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Conrad, Mark F., Crawford, Robert S., Kwolek, Christopher J., Brewster, David C., Brady, Thomas J., and Cambria, Richard P.
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THORACIC arteries ,ENDOVASCULAR surgery ,AORTIC dissection ,THROMBOSIS ,TOMOGRAPHY ,SURGICAL complications ,ORGAN rupture ,ANALYSIS of variance ,THERAPEUTICS - Abstract
Objective: The role of thoracic endovascular aortic repair (TEVAR) in the management of acute type B aortic dissection remains undefined. Entry tear coverage during the acute phase is an appealing method to treat acute complications, and by inducing false lumen thrombosis, might also prevent late aneurysm formation. This study evaluated structural changes by serial computed tomography (CT) in the thoracic aorta after TEVAR performed for acute complicated aortic dissection. Methods: Between August 2005 and October 2007, 33 patients with complicated acute type B aortic dissection were treated with TEVAR (19 from a prospective industry sponsored trial, 14 from our institution). CT images obtained preprocedurally (PP), at 1 month (1M), and 1 year (1Y) were evaluated for each patient. Four patients with no postprocedural imaging were excluded. The largest diameters of the thoracic aorta, dissection true lumen, and false lumen were recorded at each time point. Canges in total aortic and true and false lumen diameters were evaluated using a mixed effect analysis of variance model of repeated measures. Results: The average age was 58 years (range, 38-87 years); 26 (81%) were male. Indications for TEVAR included malperfusion syndrome in 17 (53%), refractory hypertension in 14 (44%), impending rupture in 12 (28%), and refractory pain in 14 (44%); 19 (59%) had more than one indication. The average length of aorta covered was 19.5 cm (range, 10-29.3 cm). The maximum aortic diameter decreased over time (P = .04) and averaged 39.9 (PP), 41.3 (1M), and 34.8 mm (1Y). The true lumen diameter increased over time (P = .02) and averaged 23.7 (PP), 29.0 (1M), and 31.1 mm (1Y). The false lumen diameter decreased (P = .046) and averaged 19.5 (PP), 12.1 (1M), and 9.6 mm (1Y). Partial or complete thrombosis of the false lumen along the stented segment of aorta was recorded in 87% (PP), 93% (1M), and 88% (1Y). Conclusions: TEVAR of acute complicated aortic dissection appears to promote early aortic remodeling. Nearly 90% of patients maintained at least partial false lumen thrombosis at 1 year. Because continued false lumen patency correlates strongly with late aneurysm formation, such favorable remodeling is considered a surrogate for prevention of late aneurysm, but longer follow-up is required. [Copyright &y& Elsevier]
- Published
- 2009
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42. Secondary Intervention After Endovascular Abdominal Aortic Aneurysm Repair.
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Conrad, Mark F., Adams, Andrew B., Guest, Julie M., Paruchuri, Vikram, Brewster, David C., LaMuraglia, Glenn M., and Cambria, Richard P.
- Abstract
Endovascular Abdominal Aortic Aneurysm Repair (EVAR) has been criticized because of the need for frequent secondary interventions (2ndINT) to maintain effective abdominal aortic aneurysm (AAA) exclusion. The study goal is to detail such interventions and determine their effect on clinical outcomes.From January 1997 to December 2007, 832 patients underwent EVAR. Those requiring 2ndINT were stratified according to the indications and specific nature of 2ndINT and treatment. Study endpoints included freedom from 2ndINT, aneurysm-related and overall survival.There were 91 (11%) patients who underwent 131 2ndINT (mean follow-up 35 months). No demographic features (age, gender, etc) predicted the need for 2ndINT. Actuarial 5-year freedom from 2ndINT was 80%. Indications for 2ndINT included: sac rupture 5 (4%), graft migration/ type I endoleak 37 (28%), persistent type II endoleak 40 (38%), endotension with sac growth 5 (4%), and limb occlusion/kinking 24 (18%). The majority of 2ndINT were accomplished with an endovascular approach (76%) with a >80% initial success rate for all indications except type II endoleak in which the initial intervention was successful only 34% of the time. Initial 2ndINT were successful in 62% and 35 (38%) patients underwent more than one 2ndINT. Multivariate predictors of 2ndINT were AAA sac size >5.5cm (OR = 2.1, P = 0.004), and preprocedure coil embolization (hypogastric or inferior mesenteric artery) (OR = 2.1, P = 0.008). The actuarial survival was 70% at 5 years and the aneurysm-related survival was 97.5% with no difference in either parameter in patients who underwent 2ndINT compared with those who did not.Although 2ndINT are common after EVAR, most were addressed through an endovascular approach; technical success thereof varies widely with the specific indication for 2ndINT. Secondary intervention did not adversely affect aneurysm-related or overall actuarial 5-year survival. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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43. Endovascular stenting of a penetrating axillary artery injury in a 14-year-old with 1-year follow-up.
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Chang, Henry L., Patel, Virendra I., Brewster, David C., and Masiakos, Peter T.
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TREATMENT of children's injuries ,ENDOVASCULAR surgery ,SURGICAL stents ,TOMOGRAPHY ,ANGIOGRAPHY ,VASCULAR grafts ,DISEASES in teenagers - Abstract
Abstract: In the management of pediatric trauma, certain principles that are practiced in children who have sustained injuries more commonly seen in adults are extrapolated from the adult trauma literature. The increased use of computer tomography angiograms in the diagnosis of penetrating vascular trauma and endovascular therapy in treating vascular trauma in the adult population is being extended to the pediatric population. We present a case of a 14-year-old male with an axillary artery injury that was diagnosed by computer tomography angiogram and treated with an endovascular Stent graft with 1-year follow-up. [Copyright &y& Elsevier]
- Published
- 2009
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44. Outcomes following endovascular abdominal aortic aneurysm repair (EVAR): An anatomic and device-specific analysis.
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Abbruzzese, Thomas A., Kwolek, Christopher J., Brewster, David C., Chung, Thomas K., Kang, Jeanwan, Conrad, Mark F., LaMuraglia, Glenn M., and Cambria, Richard P.
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AORTIC aneurysms ,CARDIOVASCULAR diseases ,MORTALITY ,BLOOD coagulation - Abstract
Objective: We performed a device-specific comparison of long-term outcomes following endovascular abdominal aortic aneurysm repair (EVAR) to determine the effect(s) of device type on early and late clinical outcomes. In addition, the impact of performing EVAR both within and outside of specific instructions for use (IFU) for each device was examined. Methods: Between January 8, 1999 and December 31, 2005, 565 patients underwent EVAR utilizing one of three commercially available stent graft devices. Study outcomes included perioperative (≤30 days) mortality, intraoperative technical complications and need for adjunctive procedures, aneurysm rupture, aneurysm-related mortality, conversion to open repair, reintervention, development and/or resolution of endoleak, device related adverse events (migration, thrombosis, or kinking), and a combined endpoint of any graft-related adverse event (GRAE). Study outcomes were correlated by aneurysm morphology that was within or outside of the recommended device IFU. χ
2 and Kaplan Meier methods were used for analysis. Results: Grafts implanted included 177 Cook Zenith (CZ, 31%), 111 Gore Excluder (GE, 20%), and 277 Medtronic AneuRx (MA, 49%); 39.3% of grafts were placed outside of at least one IFU parameter. Mean follow-up was 30 ± 21 months and was shorter for CZ (20 months CZ vs 35 and 31 months for GE and MA, respectively; P < .001). Overall actuarial 5-year freedom from aneurysm-related death, reintervention, and GRAE was similar among devices. CZ had a lower number of graft migration events (0 CZ vs 1 GE and 9 MA); however, there was no difference between devices on actuarial analysis. Combined GRAE was lowest for CZ (29% CZ, 35% GE, and 43% MA; P = .01). Graft placement outside of IFU was associated with similar 5-year freedom from aneurysm-related death, migration, and reintervention (P > .05), but a lower freedom from GRAE (74% outside IFU vs 86% within IFU; P = .021), likely related to a higher incidence of graft thrombosis (2.3% outside IFU vs 0.3% within IFU; P = .026). The differences in outcome for grafts placed within vs outside IFU were not device-specific. Conclusion: EVAR performed with three commercially available devices provided similar clinically relevant outcomes at 5 years, although no graft migration occurred with a suprarenal fixation device. As anticipated, application outside of anatomically specific IFU variables had an incremental negative effect on late results, indicating that adherence to such IFU guidelines is appropriate clinical practice. [Copyright &y& Elsevier]- Published
- 2008
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45. Risk of Second Primary Cancer among Esophageal Cancer Patients: a Pooled Analysis of 13 Cancer Registries.
- Author
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Shu-Chun Chuang, Hashibe, Mia, Scelo, Ghislaine, Brewster, David H., Pukkala, Eero, Friis, Soren, Tracey, Elizabeth, Weiderpass, Elisabete, Hemminki, Kari, Tamaro, Sharon, Kee-Seng Chia, Pompe-Kirn, Vera, Kliewer, Erich V., Tonita, Jon M., Martos, Carmen, Jonasson, Jon G., Dresler, Carolyn M., Boffetta, Paolo, and Brennan, Paul
- Abstract
The article discusses the result of a study concerning the risk of second primary cancer among esophageal cancer patients. The researchers have observed associations of esophageal cancer with second primary head and neck cancers and lung cancer regardless of years of follow-up suggesting that common risk factors play a role in multiple tumor development.
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- 2008
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46. Long-term durability of open abdominal aortic aneurysm repair.
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Conrad, Mark F., Crawford, Robert S., Pedraza, Juan D., Brewster, David C., LaMuraglia, Glenn M., Corey, Michael, Abbara, Suhny, and Cambria, Richard P.
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VASCULAR surgery ,MEDICINE ,BIOLOGY ,MEDICAL sciences - Abstract
Objective: In multiple comparisons of open vs endovascular (EVAR) repair of abdominal aortic aneurysms, the prior assumption that open repair produced superior durability has been challenged by advocates of EVAR. Although focus on EVAR reintervention has been intense, few contemporary studies document late outcomes after open repair; this was the goal of this study. Methods: From January 1994 to December 1998 (chosen to ensure a minimum 5-year follow-up), 540 patients underwent elective open repair. Surveillance imaging (computed tomographic and magnetic resonance imaging scans) was obtained for 152 (57%) of the 269 patients who remained alive at a mean follow-up of 87 months. Study end points included freedom from graft-related interventions and aneurysm-related and overall survival (Kaplan-Meier test); factors predictive of these end points were determined by multivariate analysis. Results: The mean age at operation was 73 years. A total of 76% of patients were male; 11% had renal insufficiency (creatinine ≥1.5 mg/dL), and 13% had chronic obstructive pulmonary disease. The aortic cross-clamp position was suprarenal in 135 (25%) patients, and 284 (53%) of patients had bifurcated grafts placed. Operative mortality (30 days) was 3%, and the median length of hospital stay was 7 days. Postoperative complications occurred in 68 (13%) patients. Predictors of postoperative complications included a history of myocardial infarction (hazard ratio [HR], 2.0; P = .01) and renal insufficiency (HR, 2.5; P = .02). The mean follow-up for all patients was 87 months. Actuarial survival was 70.7% ± 2% and 44.3% ± 2.4% at 5 and 10 years, respectively. Negative predictors of long-term survival included advanced age (HR, 1.1; P < .001), history of myocardial infarction (HR, 1.37; P = .02), and renal insufficiency (HR, 1.5; P = .04). Freedom from graft-related reintervention was 98.2% ± 0.8% and 94.3% ± 3.4% at 5 and 10 years, respectively. There were 13 late graft-related complications in 11 (2%) patients (mean follow-up, 7.2 years). Findings included seven anastomotic pseudoaneurysms (five were repaired), four graft limb occlusions, and two graft infections. Aneurysms were identified in noncontiguous arterial segments in 68 (45%) of 152 patients, most of which involved the iliac arteries and required no treatment because of small size. Late aortic aneurysms proximal to the repair were identified in 24% of patients, and 29 (19%) patients had multiple late synchronous aneurysms. Conclusions: Open repair remains a safe and durable option for the management of abdominal aortic aneurysms, with an excellent associated 10-year survival in patients who undergo operation at 75 years of age or younger. In addition, the freedom from graft-related reintervention is superior to that of EVAR. Finally, continued surveillance after open repair is appropriate and should be directed toward the detection of other aneurysms. [Copyright &y& Elsevier]
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- 2007
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47. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes.
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Jones, John E., Atkins, Marvin D., Brewster, David C., Chung, Thomas K., Kwolek, Christopher J., LaMuraglia, Glenn M., Hodgman, Thomas M., and Cambria, Richard P.
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SYSTEM downtime ,BREAKDOWNS (Machinery) ,COMPUTER networks ,FAILURE analysis - Abstract
Objective: Type 2 endoleak occurs in up to 20% of patients after endovascular aneurysm repair (EVAR), but its long-term significance is debated. We reviewed our experience to evaluate late outcomes associated with type 2 endoleak. Methods: During the interval January 1994 to December 2005, 873 patients underwent EVAR. Computed tomography (CT) scan assessment was performed ≤1 month of the operation and at least annually thereafter. Sequential 6-month CT scan follow-up was adopted for those patients with persistent type 2 endoleaks, and reintervention was limited to those with sac enlargement >5 mm. Study end points included overall survival, aneurysm sac growth, reintervention rate, conversion to open repair, and abdominal aortic aneurysm (AAA) rupture. Preoperative variables and anatomic factors potentially associated with these endpoints were assessed using multivariate analysis. Results: We identified 164 (18.9%) patients with early (at the first follow-up CT scan) type 2 endoleaks. Mean follow-up was 32.6 months. In 131 (79.9%) early type 2 endoleaks, complete and permanent leak resolution occurred ≤6 months. Endoleaks persisted in 33 patients (3.8% of total patients; 20.1% of early type 2 endoleaks) for >6 months. Transient type 2 endoleak (those that resolved ≤6 months of EVAR) was not associated with adverse late outcomes. In contrast, persistent endoleak was associated with several adverse outcomes. AAA-related death was not significantly different between patients with and without a type 2 endoleak (P = .78). When evaluating patients with no early endoleak vs persistent endoleak, freedom from sac expansion at 1, 3, and 5 years was 99.2%, 97.6%, and 94.9% (no leak) vs 88.1%, 48.0%, and 28.0% (persistent) (P < .001). Patients with persistent endoleak were at increased risk for aneurysm sac growth vs patients without endoleak (odds ratio [OR], 25.9; 95% confidence interval [CI] 11.8 to 57.4; P < .001). Patients with a persistent endoleak also had a significantly increased rate of reintervention (OR, 19.0; 95% CI, 8.0 to 44.7); P < .001). Finally, aneurysm rupture occurred in 4 patients with type 2 endoleaks. Freedom from rupture at 1, 3, and 5 years for patients with a persistent type 2 endoleak was 96.8%, 96.8%, and 91.1% vs 99.8%, 98.5%, and 97.4% for patients without a type 2 endoleak. Multivariate analysis demonstrated persistent type 2 endoleak to be a significant predictor of aneurysm rupture (P = .03). Conclusions: Persistent type 2 endoleak is associated with an increased incidence of adverse outcomes, including aneurysm sac growth, the need for conversion to open repair, reintervention rate, and rupture. These data suggest that patients with persistent type 2 endoleak (>6 months) should be considered for more frequent follow-up or a more aggressive approach to reintervention. [Copyright &y& Elsevier]
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- 2007
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48. Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: A comparative experience.
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Atkins, Marvin D., Kwolek, Christopher J., LaMuraglia, Glenn M., Brewster, David C., Chung, Thomas K., and Cambria, Richard P.
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MYOCARDIAL revascularization ,CARDIAC surgery ,TRANSLUMINAL angioplasty ,ARTERIAL dilatation - Abstract
Introduction: Endovascular therapy (percutaneous transluminal angioplasty [PTA] with stenting) has been increasingly applied in patients with chronic mesenteric ischemia (CMI) to avoid morbidities associated with open repair (OR). The purpose of this study was to compare outcomes of PTA/Stent vs OR in patients with symptomatic CMI. Methods: During the interval of January 1991 to December 2005, 80 consecutive patients presenting with symptomatic CMI underwent elective revascularization. Patients with acute mesenteric ischemia or those with mesenteric revascularization performed as part of complex aneurysm repair were excluded. PTA/Stent (with stenting in 87%) was the initial procedure in 31 patients (42 vessels). OR was performed in 49 patients (88 vessels) and consisted of bypass grafting in 31 (63%), transaortic endarterectomy in 7 (14%), patch angioplasty in 4 (8%), or combined in 7 (15%). Mean follow-up was 15 months in the PTA/Stent group and 42 months in the OR cohort. Study end points included perioperative morbidity, mortality, late survival (Kaplan-Meier), and symptomatic and radiographic recurrence. Results: Baseline comorbidities, with the exception of heart disease (P = .025) and serum albumin <3.5 g/dL (P = .025), were similar between PTA/Stent and OR patients. The PTA/Stent group had fewer vessels revascularized (1.5 vs 1.8 vessels, P = .001). Hospital length of stay was less for the PTA/Stent group (5.6 vs 16.7 days, P = .001). No difference was noted in in-hospital major morbidity (4/31 vs 2/49, P = .23) or mortality (1/31 vs 1/49, P = .74). Actuarial survival at 2 years was similar between the groups (88% PTA/Stent vs 74% OR, P = .28). There was no difference in the incidence of symptomatic (7/31 [23%] vs 11/49 [22%], P =.98) or radiographic recurrence (10/31 [32%] vs 18/49 [37%], P =.40) between the two groups. Radiographic primary patency (58% vs 90%, P = .001) and primary assisted patency (65% vs 96%, P < .001) at 1 year were lower in the PTA/Stent group compared with OR. Five (16%) of 31 PTA/Stent patients compared with 11 (22%) of 49 OR patients required a second intervention on at least one index vessel at any time (P = .49). Conclusions: Symptomatic recurrence requiring reintervention is common (overall 16/80 [20%]) after open and endovascular treatment for CMI. PTA/Stent was associated with decreased primary patency, primary assisted patency, and the need for earlier reintervention. In-hospital mortality or major morbidity were similar in patients undergoing PTA/Stent and OR. These findings suggest that OR and PTA/Stent should be applied selectively in CMI patients in accordance with individual patient anatomic and comorbidity considerations. [Copyright &y& Elsevier]
- Published
- 2007
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49. Five-year report of a multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysms.
- Author
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Peterson, Brian G., Matsumura, Jon S., Brewster, David C., and Makaroun, Michel S.
- Subjects
MEDICAL research ,AORTIC aneurysms ,CLINICAL trials ,ENDOVASCULAR surgery - Abstract
Objective: Compare long-term results of endovascular treatment and standard open repair of abdominal aortic aneurysms in a multicenter, concurrent-controlled trial. Methods: 334 subjects were treated with standard open repair (control, n = 99) or the original EXCLUDER Bifurcated Endoprosthesis (test, n = 235). Five-year clinical evaluations and corelab radiographic results are analyzed. Results: Overall and aneurysm-related survival are similar. There have been ten open conversions, most frequently for enlarging sacs without endoleak. Two patients died after conversion. Including reinterventions and complications of reinterventions as adverse events, there is significant, persistent long-term reduction in major adverse events. At 5 years, corelab reported 0% limb narrowing, 0% trunk migration, 0% component (contralateral leg, aortic extender, and iliac extender) migration, 0% fracture, endoleak in 3% (2 type II/68), and aneurysm growth (>5 mm compared to baseline) in 38% (30/78) of the test group. There are no aneurysm ruptures in either test or control group. Conclusions: After 5 years follow-up, endovascular repair is a safer and effective treatment compared with open surgical repair for abdominal aortic aneurysms. Major adverse events are less frequent with the endograft despite the need for late reinterventions. Aneurysm expansion is observed in nearly two-fifths of patients but is not associated with endoleak or aneurysm rupture. Multicenter clinical trials are evaluating a newer version of this device designed to avoid this high rate of sac expansion. [Copyright &y& Elsevier]
- Published
- 2007
- Full Text
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50. Stent-graft versus open-surgical repair of the thoracic aorta: Mid-term results.
- Author
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Stone, David H., Brewster, David C., Kwolek, Christopher J., LaMuraglia, Glenn M., Conrad, Mark F., Chung, Thomas K., and Cambria, Richard P.
- Subjects
MORTALITY ,BLOOD circulation ,ARTERIES ,VASCULAR diseases - Abstract
Objective: Pivotal and comparative trial data are emerging for stent graft (SG) vs open repair of the thoracic aorta. We reviewed procedure-related perioperative morbidity, mortality, and mid-term outcomes in a contemporary series of patients treated with SG of the thoracic aorta. The data were compared with those of a patient cohort concurrently treated with open surgical repair confined to the descending aorta. Methods: A review of patients undergoing SG procedures and open surgery of the thoracic aorta from January 1, 1996, to November 30, 2005, was performed from a prospectively compiled database. Study end points included perioperative complications, late survival, freedom from reinterventions, and graft-related complications. Multivariate methods were used to assess variables potentially associated with study end points; late outcomes were compared with actuarial methods. Results: In 105 patients (mean age, 70 years; 66 male [62.9%]) SG repairs were done for 68 degenerative aneurysms (64.7%), 12 penetrating ulcers (11.4%), 15 pseudoaneurysms (14.3%), 9 traumatic tears (8.6%), and 1 acute dissection (0.9%). Mean follow-up was 22 months (range, 0 to 101 months). Eighty-nine (84.8%) SG patients were asymptomatic at presentation and underwent elective repair, whereas 16 (15.2%) presented with acute conditions and underwent urgent repair. Perioperative mortality was 7.6% (8/105), and actuarial survival at 48 months was 54% ± 7%. The perioperative mortality rate among SG patients treated for degenerative pathology was 10.4% (8/77). Seven (6.7%) of 105 patients experienced spinal cord ischemic complications, including 2 patients with transient paraparesis that resolved by the time of discharge. Reinterventions were performed in 10.5% of patients (11/105), with freedom from reintervention approaching 81% by 48 months. Over the same interval, 93 patients were treated with open-surgical repair for descending thoracic aneurysm (anastomosis cephalad to the celiac axis). Perioperative mortality in the open cohort was 15.1% (14/93; P = .09 vs SG repair), and the 48-month actuarial survival was 64% ± 6%. The incidence of spinal cord ischemic complications was 8.6% (8/93), including 4 patients with transient paraparesis (P = .44 vs SG repair). Nine patients (9.7%) required surgical reintervention during the follow-up period, with 48-month freedom from reintervention approaching 79% (P = .73 vs SG repair). Conclusions: Operative mortality was halved with SG, with similar late survival for both cohorts. Reinterventions were required at a nearly identical rate for open repair and SG, and both groups experienced similar rates of spinal cord ischemic complications. [Copyright &y& Elsevier]
- Published
- 2006
- Full Text
- View/download PDF
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