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1. Elevate to Alleviate – Evidence Based Vascular Nursing Study

Author

Ielapi N, Andreucci M, Bracale UM, Costa D, Bevacqua E, Giannotta N, Bevacqua MG, Serraino GF, Mastroroberto P, Provenzano M, and Serra R

Subjects
venous system, lower limb, circulation, leg elevation, hospital stay, vein symptoms, leg discomfort, Nursing, RT1-120
Abstract

Nicola Ielapi,1,2,&ast; Michele Andreucci,3,&ast; Umberto Marcello Bracale,4 Davide Costa,1,5 Egidio Bevacqua,6 Nicola Giannotta,1,6 Maria Grazia Bevacqua,7 Giuseppe Filiberto Serraino,7 Pasquale Mastroroberto,7 Michele Provenzano,6 Raffaele Serra1,6 1Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology” at the Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; 2Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy; 3Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; 4Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Naples, Italy; 5Department of Law, Economics and Sociology, University Magna Graecia of Catanzaro, Catanzaro, Italy; 6Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy; 7Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy&ast;These authors contributed equally to this workCorrespondence: Raffaele SerraDepartment of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy, Email rserra@unicz.itBackground: Venous return in the circulatory system of lower limbs results from the interaction of several mechanisms and reflects the balance between blood inflow and outflow. Blood outflow improves during the lying position especially with leg elevation both in patients with chronic venous disease (CVD) and in healthy subjects in sedentary settings with short-term immobilization. This study evaluated the level of comfort of hospital inpatients, without CVD, lying with a moderate leg elevation during hospital stay.Methods: This was a clinical trial examining 60 consecutive patients referred to vascular surgery, cardiac surgery, and nephrology units. After inclusion, patients were randomly assigned to two groups: A (leg elevation) in which patients were made to lie in the hospital bed with moderate elevation of the legs, and B (no leg elevation) in which patients were made to lie in the hospital bed without leg elevation.Results: The whole population consisted of 40 patients undergoing leg elevation (group A) and 20 without leg elevation (group B). During each day of hospitalization, measurements such as ankle and calf circumference, heart rate, blood pressure, and body temperature were collected. Subjective data such as perceived heaviness in the lower limbs, comfort perception and hours of sleep were also collected. In this study, patients of group A recorded a decrease in calf and ankle circumference (delta in ankle and calf circumference (difference between end of study visit and baseline visit) were significantly decreased in group A vs group B (p< 0.001 for both sides), and patients perceived less leg heaviness and even reported more leg comfort compared to patients of Group B (p< 0.001)). Among patients of group A, the bigger advantage in terms of comfort perception was recorded in patients with 15° leg elevation.Conclusion: Moderate leg elevation during hospital stay seems to effectively improve leg comfort in hospitalized patients.Keywords: venous system, lower limb, circulation, leg elevation, hospital stay, vein symptoms, leg discomfort

Published
2022

2. The Impact of Chronic Kidney Disease on Peripheral Artery Disease and Peripheral Revascularization

Author

Serra R, Bracale UM, Ielapi N, Del Guercio L, Di Taranto MD, Sodo M, Michael A, Faga T, Bevacqua E, Jiritano F, Serraino GF, Mastroroberto P, Provenzano M, and Andreucci M

Subjects
chronic kidney disease (ckd), peripheral artery disease (pad), eskd, amputations, albuminuria, Medicine (General), R5-920
Abstract

Raffaele Serra,1,2,&ast; Umberto Marcello Bracale,3,&ast; Nicola Ielapi,4 Luca Del Guercio,3 Maria Donata Di Taranto,5 Maurizio Sodo,3 Ashour Michael,6 Teresa Faga,6 Egidio Bevacqua,7 Federica Jiritano,7 Giuseppe Fliberto Serraino,7 Pasquale Mastroroberto,7 Michele Provenzano,8 Michele Andreucci6 1Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, Catanzaro, Italy; 2Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy; 3Department of Public Health, University of Naples “Federico II”, Naples, Italy; 4Department of Public Health and Infectious Disease, “Sapienza” University of Rome, Roma, 00185, Italy; 5Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Naples, Italy; 6Department of Health Sciences, “Magna Graecia” University, Catanzaro, Italy; 7Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, 88100, Italy; 8Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy&ast;These authors contributed equally to this workCorrespondence: Raffaele SerraDepartment of Surgical and Medical Sciences, Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, ItalyTel +39 09613647380Email rserra@unicz.itAbstract: Chronic kidney disease (CKD) is a clinical condition characterized by high morbidity and mortality. Globally, CKD is also increasing in prevalence and incidence. The two principal kidney measures namely estimated glomerular filtration rate (eGFR) and albuminuria have been found to be predictors of renal and cardiovascular (CV) endpoints including peripheral artery disease (PAD). The prevalence of PAD was increased in CKD patients and, particularly, in patients with more severe CKD stages. Despite the fact that revascularization strategies are suitable in CKD patients in similar fashion to non-CKD patients, few CKD patients underwent these procedures. In fact, if it is true that revascularization improves prognosis in PAD patients irrespective of baseline eGFR, it was also demonstrated that CKD patients, who underwent revascularization, were at higher risk for amputations, mortality, re-intervention and perioperative complications. With the present review article, we have examined the association between CKD, PAD and peripheral revascularization highlighting data about epidemiology, pathophysiologic mechanisms, and results from previous observational and intervention studies. We have also examined the future perspectives and challenges of research around the association between CKD and PAD.Keywords: chronic kidney disease, CKD, peripheral artery disease, PAD, ESKD, amputations, albuminuria

Published
2021

3. Barriers and Facilitators to Managing Social Care in the Digital Era Among Michigan Health Centers.

Author

PROVENZANO, ANTHONY M., SYED, FAIYAZ, PLATT, JODYN E., PIATT, GRETCHEN A., ACKERMAN, MARK S., BUYUKTUR, AYSE, and KLINKMAN, MICHAEL S.

Subjects
DIGITAL technology, MENTAL health services, INFORMATION technology, SOCIOTECHNICAL systems, INFORMATION superhighway
Abstract

Objectives: Health care organizations are taking a greater role in providing social care. Federally qualified health centers (FQHCs) lead these efforts, leveraging investments in technology to manage patient care and information. This study describes the challenges of meeting patient social needs and presents new opportunities for engaging in communitywide activities to address care and quality. Study Design: Sociotechnical systems theory was applied in qualitative research. Methods: Eleven of the 40 Michigan FQHCs were recruited into the study. Twenty-five semistructured interviews were conducted with practice leadership, clinicians, and staff to explore information technology and other resources used for managing social care. Analyses of the interviews were used to organize infrastructural and technological factors that emerged into key themes. Results: Interviews revealed that Michigan FQHCs participated in community-wide activities to develop value-based care practices and quality initiatives using shared data and technology. Study participants revealed that their community-level involvement facilitated improved data management, digital information sharing, and quality improvement efforts. Ultimately, however, limited housing services and inadequate behavioral health care created challenges in connecting patients with essential treatments and social supports. Conclusions: Developing information infrastructure and new technological capabilities to manage patient care and population health is necessary but insufficient. Major investments in both technology and human capital are critical to effectively provide social care and improve quality. Building on the evidence gained from FQHC partnerships and data activities offers public officials and health care leaders insight into the local resources and policy changes that are needed. [ABSTRACT FROM AUTHOR]

Published
2024
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4. Benefits, Challenges, Characteristics and Instructional Approaches in an El Sistema Inspired After-School String Program Developed as a University-School Partnership in the United States

Author

Hopkins, Michael, Provenzano, Anthony M., and Spencer, Michael S.

Abstract

The purpose of this study was to examine the benefits, challenges, program characteristics and instructional approaches of an El Sistema inspired (ESI) after-school string program developed as a university-school partnership. Case study methodology was used to examine the program. Fifth-grade students received 75 minutes of after-school instruction four days per week. Two graduate students in music performance and the elementary school orchestra/general music teacher were the program's lead teachers. Eight additional university students gave pull-out lessons. The program featured many "distinguishing characteristics" described in the ESI literature. The learning environment included large ensemble, sectional learning, and individual lessons. The repertoire learned was standard for American beginning string classes. Teachers provided rigorous expectations for the students to strive for excellence, a safe and supportive learning environment, flexible teaching, and peer-mentoring opportunities. Benefits included high levels of musical achievement, increased learning opportunities, perceived benefits of discipline, perseverance, positive attitude, and hard work. Instructional challenges included low attendance, curricular balance, and teacher collaboration. The intensity and frequency of instruction were found to be the source of most benefits and challenges reported by the participants.

Published
2017
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8. The relationship between uremic toxins and symptoms in older men and women with advanced chronic kidney disease

Author

Massy Z. A., Chesnaye N. C., Larabi I. A., Dekker F. W., Evans M., Caskey F. J., Torino C., Porto G., Szymczak M., Drechsler C., Wanner C., Jager K. J., Alvarez J. C., Schneider A., Torp A., Iwig B., Perras B., Marx C., Blaser C., Emde C., Krieter D., Fuchs D., Irmler E., Platen E., Schmidt-Gurtler H., Schlee H., Naujoks H., Schlee I., Casar S., Beige J., Rothele J., Mazur J., Hahn K., Blouin K., Neumeier K., Anding-Rost K., Schramm L., Hopf M., Wuttke N., Frischmuth N., Ichtiaris P., Kirste P., Schulz P., Aign S., Biribauer S., Manan S., Roser S., Heidenreich S., Palm S., Schwedler S., Delrieux S., Renker S., Schattel S., Stephan T., Schmiedeke T., Weinreich T., Leimbach T., Stovesand T., Bahner U., Seeger W., Cupisti A., Sagliocca A., Ferraro A., Mele A., Naticchia A., Cosaro A., Ranghino A., Stucchi A., Pignataro A., De Blasio A., Pani A., Tsalouichos A., Bellasi A., Raffaele Di Iorio B., Butti A., Abaterusso C., Somma C., D'Alessandro C., Zullo C., Pozzi C., Bergamo D., Ciurlino D., Motta D., Russo D., Favaro E., Vigotti F., Ansali F., Conte F., Cianciotta F., Giacchino F., Cappellaio F., Pizzarelli F., Greco G., Bigatti G., Marinangeli G., Cabiddu G., Fumagalli G., Caloro G., Piccoli G., Capasso G., Gambaro G., Tognarelli G., Bonforte G., Conte G., Toscano G., Del Rosso G., Capizzi I., Baragetti I., Oldrizzi L., Gesualdo L., Biancone L., Magnano M., Ricardi M., Di Bari M., Laudato M., Luisa Sirico M., Ferraresi M., Provenzano M., Malaguti M., Palmieri N., Murrone P., Cirillo P., Dattolo P., Acampora P., Nigro R., Boero R., Scarpioni R., Sicoli R., Malandra R., Savoldi S., Bertoli S., Borrelli S., Maxia S., Maffei S., Mangano S., Cicchetti T., Rappa T., Palazzo V., De Simone W., Schrander A., Van Dam B., Siegert C., Gaillard C., Beerenhout C., Verburgh C., Janmaat C., Hoogeveen E., Hoorn E., Boots J., Boom H., Eijgenraam J. -W., Kooman J., Rotmans J., Vogt L., Raasveld M., Vervloet M., Van Buren M., Van Diepen M., Leurs P., Voskamp P., Blankestijn P., Van Esch S., Boorsma S., Berger S., Konings C., Aydin Z., Musiala A., Szymczak A., Olczyk E., Augustyniak-Bartosik H., Miskowiec-Wisniewska I., Manitius J., Pondel J., Jedrzejak K., Nowanska K., Nowak L., Durlik M., Dorota S., Nieszporek T., Heleniak Z., Jonsson A., Blom A. -L., Rogland B., Wallquist C., Vargas D., Dimeny E., Sundelin F., Uhlin F., Welander G., Bascaran Hernandez I., Grontoft K. -C., Stendahl M., Svensson M., Heimburger O., Kashioulis P., Melander S., Almquist T., Jensen U., Woodman A., McKeever A., Ullah A., McLaren B., Harron C., Barrett C., O'Toole C., Summersgill C., Geddes C., Glowski D., McGlynn D., Sands D., Roy G., Hirst G., King H., McNally H., Masri-Senghor H., Murtagh H., Rayner H., Turner J., Wilcox J., Berdeprado J., Wong J., Banda J., Jones K., Haydock L., Wilkinson L., Carmody M., Weetman M., Joinson M., Dutton M., Matthews M., Morgan N., Bleakley N., Cockwell P., Roderick P., Mason P., Kalra P., Sajith R., Chapman S., Navjee S., Crosbie S., Brown S., Tickle S., Mathavakkannan S., Kuan Y., Massy, Z. A., Chesnaye, N. C., Larabi, I. A., Dekker, F. W., Evans, M., Caskey, F. J., Torino, C., Porto, G., Szymczak, M., Drechsler, C., Wanner, C., Jager, K. J., Alvarez, J. C., Schneider, A., Torp, A., Iwig, B., Perras, B., Marx, C., Blaser, C., Emde, C., Krieter, D., Fuchs, D., Irmler, E., Platen, E., Schmidt-Gurtler, H., Schlee, H., Naujoks, H., Schlee, I., Casar, S., Beige, J., Rothele, J., Mazur, J., Hahn, K., Blouin, K., Neumeier, K., Anding-Rost, K., Schramm, L., Hopf, M., Wuttke, N., Frischmuth, N., Ichtiaris, P., Kirste, P., Schulz, P., Aign, S., Biribauer, S., Manan, S., Roser, S., Heidenreich, S., Palm, S., Schwedler, S., Delrieux, S., Renker, S., Schattel, S., Stephan, T., Schmiedeke, T., Weinreich, T., Leimbach, T., Stovesand, T., Bahner, U., Seeger, W., Cupisti, A., Sagliocca, A., Ferraro, A., Mele, A., Naticchia, A., Cosaro, A., Ranghino, A., Stucchi, A., Pignataro, A., De Blasio, A., Pani, A., Tsalouichos, A., Bellasi, A., Raffaele Di Iorio, B., Butti, A., Abaterusso, C., Somma, C., D'Alessandro, C., Zullo, C., Pozzi, C., Bergamo, D., Ciurlino, D., Motta, D., Russo, D., Favaro, E., Vigotti, F., Ansali, F., Conte, F., Cianciotta, F., Giacchino, F., Cappellaio, F., Pizzarelli, F., Greco, G., Bigatti, G., Marinangeli, G., Cabiddu, G., Fumagalli, G., Caloro, G., Piccoli, G., Capasso, G., Gambaro, G., Tognarelli, G., Bonforte, G., Conte, G., Toscano, G., Del Rosso, G., Capizzi, I., Baragetti, I., Oldrizzi, L., Gesualdo, L., Biancone, L., Magnano, M., Ricardi, M., Di Bari, M., Laudato, M., Luisa Sirico, M., Ferraresi, M., Provenzano, M., Malaguti, M., Palmieri, N., Murrone, P., Cirillo, P., Dattolo, P., Acampora, P., Nigro, R., Boero, R., Scarpioni, R., Sicoli, R., Malandra, R., Savoldi, S., Bertoli, S., Borrelli, S., Maxia, S., Maffei, S., Mangano, S., Cicchetti, T., Rappa, T., Palazzo, V., De Simone, W., Schrander, A., Van Dam, B., Siegert, C., Gaillard, C., Beerenhout, C., Verburgh, C., Janmaat, C., Hoogeveen, E., Hoorn, E., Boots, J., Boom, H., Eijgenraam, J. -W., Kooman, J., Rotmans, J., Vogt, L., Raasveld, M., Vervloet, M., Van Buren, M., Van Diepen, M., Leurs, P., Voskamp, P., Blankestijn, P., Van Esch, S., Boorsma, S., Berger, S., Konings, C., Aydin, Z., Musiala, A., Szymczak, A., Olczyk, E., Augustyniak-Bartosik, H., Miskowiec-Wisniewska, I., Manitius, J., Pondel, J., Jedrzejak, K., Nowanska, K., Nowak, L., Durlik, M., Dorota, S., Nieszporek, T., Heleniak, Z., Jonsson, A., Blom, A. -L., Rogland, B., Wallquist, C., Vargas, D., Dimeny, E., Sundelin, F., Uhlin, F., Welander, G., Bascaran Hernandez, I., Grontoft, K. -C., Stendahl, M., Svensson, M., Heimburger, O., Kashioulis, P., Melander, S., Almquist, T., Jensen, U., Woodman, A., Mckeever, A., Ullah, A., Mclaren, B., Harron, C., Barrett, C., O'Toole, C., Summersgill, C., Geddes, C., Glowski, D., Mcglynn, D., Sands, D., Roy, G., Hirst, G., King, H., Mcnally, H., Masri-Senghor, H., Murtagh, H., Rayner, H., Turner, J., Wilcox, J., Berdeprado, J., Wong, J., Banda, J., Jones, K., Haydock, L., Wilkinson, L., Carmody, M., Weetman, M., Joinson, M., Dutton, M., Matthews, M., Morgan, N., Bleakley, N., Cockwell, P., Roderick, P., Mason, P., Kalra, P., Sajith, R., Chapman, S., Navjee, S., Crosbie, S., Brown, S., Tickle, S., Mathavakkannan, S., Kuan, Y., Nephrology, ACS - Diabetes & metabolism, Medical Informatics, APH - Methodology, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, APH - Health Behaviors & Chronic Diseases, and ACS - Pulmonary hypertension & thrombosis

Subjects
Transplantation, Nephrology, uremic toxins, CKD, symptoms, symptom, elderly
Abstract

Background Patients with stage 4/5 chronic kidney disease (CKD) suffer from various symptoms. The retention of uremic solutes is thought to be associated with those symptoms. However, there are relatively few rigorous studies on the potential links between uremic toxins and symptoms in patients with CKD. Methods The EQUAL study is an ongoing observational cohort study of non-dialyzed patients with stage 4/5 CKD. EQUAL patients from Germany, Poland, Sweden and the UK were included in the present study (n = 795). Data and symptom self-report questionnaires were collected between April 2012 and September 2020. Baseline uric acid and parathyroid hormone and 10 uremic toxins were quantified. We tested the association between uremic toxins and symptoms and adjusted P-values for multiple testing. Results Symptoms were more frequent in women than in men with stage 4/5 CKD, while levels of various uremic toxins were higher in men. Only trimethylamine N-oxide (TMAO; positive association with fatigue), p-cresyl sulfate (PCS) with constipation and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (negative association with shortness of breath) demonstrated moderately strong associations with symptoms in adjusted analyses. The association of phenylacetylglutamine with shortness of breath was consistent in both sexes, although it only reached statistical significance in the full population. In contrast, TMAO (fatigue) and PCS and phenylacetylglutamine (constipation) were only associated with symptoms in men, who presented higher serum levels than women. Conclusion Only a limited number of toxins were associated with symptoms in persons with stage 4/5 CKD. Other uremic toxins, uremia-related factors or psychosocial factors not yet explored might contribute to symptom burden.

Published
2022
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10. Omics in chronic kidney disease: Focus on prognosis and prediction

Author

Provenzano, M, Serra, R, Garofalo, C, Michael, A, Crugliano, G, Battaglia, Y, Ielapi, N, Bracale, U, Faga, T, Capitoli, G, Galimberti, S, Andreucci, M, Provenzano M., Serra R., Garofalo C., Michael A., Crugliano G., Battaglia Y., Ielapi N., Bracale U. M., Faga T., Capitoli G., Galimberti S., Andreucci M., Provenzano, M, Serra, R, Garofalo, C, Michael, A, Crugliano, G, Battaglia, Y, Ielapi, N, Bracale, U, Faga, T, Capitoli, G, Galimberti, S, Andreucci, M, Provenzano M., Serra R., Garofalo C., Michael A., Crugliano G., Battaglia Y., Ielapi N., Bracale U. M., Faga T., Capitoli G., Galimberti S., and Andreucci M.

Abstract

Chronic kidney disease (CKD) patients are characterized by a high residual risk for cardiovascular (CV) events and CKD progression. This has prompted the implementation of new prognostic and predictive biomarkers with the aim of mitigating this risk. The ‘omics’ techniques, namely genomics, proteomics, metabolomics, and transcriptomics, are excellent candidates to provide a better understanding of pathophysiologic mechanisms of disease in CKD, to improve risk stratification of patients with respect to future cardiovascular events, and to identify CKD patients who are likely to respond to a treatment. Following such a strategy, a reliable risk of future events for a particular patient may be calculated and consequently the patient would also benefit from the best available treatment based on their risk profile. Moreover, a further step forward can be represented by the aggregation of multiple omics information by combining different techniques and/or different biological samples. This has already been shown to yield additional information by revealing with more accuracy the exact individual pathway of disease.

Published
2022

11. Risk of end-stage kidney disease in kidney transplant recipients versus patients with native chronic kidney disease: multicentre unmatched and propensity-score matched analyses

Author

De Nicola, L., Serra, R., Provenzano, M., Minutolo, R., Michael, A., Ielapi, N., Federico, S., Carrano, R., Bellizzi, V., Garofalo, C., Iodice, C., Borrelli, S., Grandaliano, Giuseppe, Stallone, G., Gesualdo, L., Chiodini, P., Andreucci, M., Grandaliano G. (ORCID:0000-0003-1213-2177), De Nicola, L., Serra, R., Provenzano, M., Minutolo, R., Michael, A., Ielapi, N., Federico, S., Carrano, R., Bellizzi, V., Garofalo, C., Iodice, C., Borrelli, S., Grandaliano, Giuseppe, Stallone, G., Gesualdo, L., Chiodini, P., Andreucci, M., and Grandaliano G. (ORCID:0000-0003-1213-2177)

Abstract

Background: In kidney transplant recipients (KTR), the end-stage kidney disease (ESKD) risk dependent on the risk factors acting in native chronic kidney disease (CKD) remains undefined. Methods: We compared risk and determinants of ESKD between 757 adult KTR and 1940 patients with native CKD before and after propensity-score (PS) analysis matched for unmodifiable risk factors [(age, sex, diabetes, cardiovascular disease and estimated glomerular filtration rate (eGFR)]. Results: In unmatched cohorts, eGFR was lower in CKD versus KTR (45.9 ± 11.3 versus 59.2 ± 13.4 mL/min/1.73 m2, P < 0.001). During a median follow-up of 5.4 years, the unadjusted cumulative incidence of ESKD was consistently lower in unmatched KTR versus CKD. Conversely, in PS-matched analysis, the risk of ESKD in KTR was 78% lower versus CKD at 1 year of follow-up while progressively increased over time resulting similar to that of native CKD patients after 5 years and 2.3-fold higher than that observed in CKD at 10 years. R2 analysis in unmatched patients showed that the proportion of the outcome variance explained by traditional ESKD determinants was smaller in KTR versus native CKD (31% versus 70%). After PS matching, the risk of ESKD [hazard ratio (HR), 95% confidence interval (95% CI)] was significantly associated with systolic blood pressure (1.02, 1.01-1.02), phosphorus (1.31, 1.05-1.64), 24-h proteinuria (1.11, 1.05-1.17) and haemoglobin (0.85, 0.78-0.93) irrespective of KTR status. Similar data were obtained after matching also for modifiable risk factors. Conclusions: In KTR, when compared with matched native CKD patients, the risk of ESKD is lower in the first 5 years and higher later on. Traditional determinants of ESKD account for one-third of the variability of time-to-graft failure.

Published
2023

15. Factors influencing delayed discharge after day-surgery laparoscopic cholecystectomy: the DeDiLaCo study protocol.

Author

CILLARA, N., FRANSVEA, P., SECHI, R., CICALÒ, E., SOTGIU, G., PROVENZANO, M., POILLUCCI, G., AGNES, A., and PODDA, M.

Abstract

OBJECTIVE: Laparoscopic cholecystectomy (LC) is the gold standard for most benign gallbladder diseases. Early discharge (<24 hours) has the same outcomes as longer (>24 hours) hospital stay. Nevertheless, the rate of delayed discharge >24 hours range from 4.6% to 37%. The primary endpoint of this Italian nationwide study is to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge >24 hours and identify potential limiting factors of early discharge. Results from these analyses will be used to select patients who can be safely discharged on the same day after surgery. Secondary endpoints will be to evaluate the patient's quality of life (QoL), assess the direct health costs associated with late discharge, and quantify the patient's involvement in the treatment process. PATIENTS AND METHODS: This prospective, observational study was conducted following a resident-led model and the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. All patients were treated according to the local hospital protocol and received routine care as standard therapy. RESULTS: We expected to obtain the enrollment of at least 500 patients based on an assumed difference in discharge delay between the reference and the recruitable population of 6% and the identification of factors related to discharge failure within 24 h. Early discharge after LC leads to advantages both in terms of clinical outcomes and quality of life of the patient, and it is highly effective in terms of health costs and shortening the waiting list. However, clinical reality differs from the results of randomized studies by a complex series of non-objectionable real-world data influencing treatment plans. Therefore, we expected to identify independent predictors and factors of failure of early discharge. CONCLUSIONS: Clinical reality often differs from randomized trial results. In Italy, the vast majority of delayed discharges after LC may not be related to surgery and can be prevented both with logistical reorganization and with a readjustment of the trust reimbursement policies. [ABSTRACT FROM AUTHOR]

Published
2023

16. Investigating a Rapid and Safe Outpatient Pediatric Screening Protocol

Author

Park, Dawn M., primary, Landeck, Bruce F., additional, Burkett, Dale A., additional, Friesen, Richard M., additional, Villavicencio, Karrie L., additional, Patel, Sonali S., additional, Kirby, K. Scott, additional, Hoefener, Brittany E., additional, Gau, Casey M., additional, Provenzano, Lindsay M., additional, and Younoszai, Adel K., additional

Published
2022
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19. Design of a Smart Car Park with PV generation and BESS for Grid-on and Grid-off Operation. The SMARTEP Project

Author

Barberi A., Beccali M., Bonomolo M., Favuzza S., Lo Brano V., Musca R., Provenzano C. M., Zizzo G., Barberi A., Beccali M., Bonomolo M., Favuzza S., Lo Brano V., Musca R., Provenzano C.M., and Zizzo G.

Subjects
storage, Settore ING-IND/33 - Sistemi Elettrici Per L'Energia, Batteries, smart parking, Settore ING-IND/11 - Fisica Tecnica Ambientale, electric vehicle, EVH
Abstract

The paper presents the design state of a smart car park shelter for electric vehicle in the campus of the University of Palermo. The car park is supplied by the main grid and by a 40 kW photovoltaic system and is equipped with a Li-ion battery storage system with capacity 42 kWh. The hybrid plant is designed in order to operate both in connection with the main grid and in stand-alone mode, supplying, in this case, all car park's loads and providing one recharge to an electric vehicle. Moreover, the energy storage system and, eventually, the battery of one or more cars with V2G technologies, can be managed for providing ancillary services to the grid. In the paper, the design of the system and the choice of all components is presented. Finally, the environmental impact of the diffusion of such installations on the energy system is discussed.

Published
2022
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20. 603-P: Qualitative Results from an African-American Church–Based Diabetes Self-Management Support Program

Author

JACLYNN M. HAWKINS, ANTHONY M. PROVENZANO, ROBIN NWANKWO, MARTHA M. FUNNELL, KATHERINE A. KLOSS, DIANA HALL, and GRETCHEN PIATT

Subjects
Endocrinology, Diabetes and Metabolism, Internal Medicine
Abstract

Diabetes-related health disparities, especially for African Americans (AA) , underscore the need for effective, culturally tailored approaches to promote and sustain diabetes self-management support (DSMS) over time. The Praise study, a cluster randomized hybrid type II implementation trial recruited 21 AA churches, 28 peer leaders, 21 parish nurses, and 371 participants (100% AA, 73.8% female, 64±11.3 years of age) to determine the effectiveness of three DSMS approaches [Parish Nurse (PN) + Peer Leader (PL) DSMS vs. PN DSMS vs. PL DSMS], in comparison to enhanced usual care in improving and sustaining A1c and diabetes distress. Monthly DSMS groups were independently planned and facilitated by 28 trained PLs (100% African American, 18% male) and 14 trained PNs. A post-trial qualitative process evaluation was conducted to evaluate DSMS and ongoing support. Five focus groups were held (n=30) . Individual semi-structured interviews were completed with PLs and PNs (N=7) . Data were analyzed using the Rapid Analysis Process to generate themes from transcripts. Most participants were motivated to enroll in the Praise study to learn more about how to manage their diabetes. Others stated that poor health status (such as high A1C) and a need for accountability motivated them to join. PN and PL were driven to serve in these roles by a desire to educate and support other members of their community with diabetes in a structured format. Few concerns about the study were reported; however, the amount of time commitment was a common topic. Some participants encountered significant technology difficulties with attending remote sessions and a host of other issues related to the pandemic. Suggested improvements included: 1) clear study expectations from the start; 2) integrating exercise, and meal prep; and 3) using of social media for recruitment. AAs with T2D are motivated to engage in ongoing DSMS facilitated by PLs and PNs in church-settings. Improvements in training and support of PLs is needed. Disclosure J.M.Hawkins: None. A.M.Provenzano: None. R.Nwankwo: Advisory Panel; WW (Weight Watchers) . M.M.Funnell: n/a. K.A.Kloss: None. D.Hall: None. G.Piatt: None.

Published
2022
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22. Stress Management through Written Emotional Disclosure Improves Academic Performance among College Students with Physical Symptoms.

Author

Lumley, Mark A. and Provenzano, Kimberly M.

Abstract

Tests whether writing about stressful events improves grade point averages (GPAs) and whether decreases in writing-induced negative mood from the first to last day of writing predicts GPA improvements. Results reveal that writing about general life stress leads to improved academic functioning, particularly among those who become less distressed over writing days. (Contains 42 references, 2 tables, and 2 figures.) (GCP)

Published
2003

23. Burnout and Emotional Well-Being among Nephrology Fellows: A National Online Survey

Author

Kurtis A. Pivert, Michael J. Choi, Laura C. Plantinga, Bernard G. Jaar, Sandeep Soman, Anthony M Provenzano, Varun Agrawal, and Khaled Abdel-Kader

Subjects
Adult, Male, medicine.medical_specialty, education, 030204 cardiovascular system & hematology, Burnout, Psychological Distress, Special Article, 03 medical and health sciences, Social support, Sex Factors, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, Depersonalization, Odds Ratio, Humans, Medicine, 030212 general & internal medicine, Emotional exhaustion, Burnout, Professional, Depression (differential diagnoses), Response rate (survey), Depression, business.industry, Internship and Residency, General Medicine, Odds ratio, United States, Emotional well-being, Cross-Sectional Studies, Logistic Models, Nephrology, Family medicine, Female, medicine.symptom, business
Abstract

Background Physician burnout and emotional distress are associated with work dissatisfaction and provision of suboptimal patient care. Little is known about burnout among nephrology fellows. Methods Validated items on burnout, depressive symptoms, and well being were included in the American Society of Nephrology annual survey emailed to US nephrology fellows in May to June 2018. Burnout was defined as an affirmative response to two single-item questions of experiencing emotional exhaustion or depersonalization. Results Responses from 347 of 808 eligible first- and second-year adult nephrology fellows were examined (response rate=42.9%). Most fellows were aged 30-34 years (56.8%), male (62.0%), married or partnered (72.6%), international medical graduates (62.5%), and pursuing a clinical nephrology fellowship (87.0%). Emotional exhaustion and depersonalization were reported by 28.0% and 14.4% of the fellows, respectively, with an overall burnout prevalence of 30.0%. Most fellows indicated having strong program leadership (75.2%), positive work-life balance (69.2%), presence of social support (89.3%), and career satisfaction (73.2%); 44.7% reported a disruptive work environment and 35.4% reported depressive symptoms. Multivariable logistic regression revealed a statistically significant association between female gender (odds ratio [OR], 1.90; 95% confidence interval [95% CI], 1.09 to 3.32), poor work-life balance (OR, 3.97; 95% CI, 2.22 to 7.07), or a disruptive work environment (OR, 2.63; 95% CI, 1.48 to 4.66) and burnout. Conclusions About one third of US nephrology fellows surveyed reported experiencing burnout and depressive symptoms. Further exploration of burnout-especially that reported by female physicians, as well as burnout associated with poor work-life balance or a disruptive work environment-is warranted to develop targeted efforts that may enhance the educational experience and emotional well being of nephrology fellows.

Published
2020
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24. New-onset anemia and associated risk of ESKD and death in non-dialysis CKD patients: A multicohort observational study

Author

Minutolo, R., Provenzano, M., Chiodini, P., Borrelli, S., Garofalo, C., Andreucci, M., Liberti, M. E., Bellizzi, V., Conte, G., De Nicola, L., Zamboli, P., Iodice, F. C., Signoriello, S., Gallo, C., Cianciaruso, B., Pota, A., Nappi, F., Avella, F., Di Iorio, B. R., Cestaro, R., Martignetti, V., Morrone, L., Lupo, A., Abaterusso, C., Donadio, C., Bonomini, M., Sirolli, V., Casino, F., Lopez, T., Detomaso, F., Giannattasio, M., Virgilio, M., Tarantino, G., Cristofano, C., Tuccillo, S., Chimienti, S., Petrarulo, F., Giancaspro, V., Strippoli, M., Laraia, E., Gallucci, M., Gigante, B., Lodeserto, C., Santese, D., Montanaro, A., Giordano, R., Caglioti, A., Fuiano, G., Zoccali, C., Caridi, G., Postorino, M., Savica, V., Monardo, P., Bellinghieri, G., Santoro, D., Castellino, P., Rapisarda, F., Fatuzzo, P., Messina, A., Dal Canton, A., Esposito, V., Formica, M., Segoloni, G., Gallieni, M., Locatelli, F., Tarchini, R., Meneghel, G., Oldrizzi, L., Cossu, M., Di Giulio, S., Malaguti, M., Pizzarelli, F., Quintaliani, G., Pisani, A., Bonofiglio, R., Grandaliano, Giuseppe, Russo, D., Di Micco, L., Torraca, S., Sabbatini, M., Grandaliano G. (ORCID:0000-0003-1213-2177), Minutolo, R., Provenzano, M., Chiodini, P., Borrelli, S., Garofalo, C., Andreucci, M., Liberti, M. E., Bellizzi, V., Conte, G., De Nicola, L., Zamboli, P., Iodice, F. C., Signoriello, S., Gallo, C., Cianciaruso, B., Pota, A., Nappi, F., Avella, F., Di Iorio, B. R., Cestaro, R., Martignetti, V., Morrone, L., Lupo, A., Abaterusso, C., Donadio, C., Bonomini, M., Sirolli, V., Casino, F., Lopez, T., Detomaso, F., Giannattasio, M., Virgilio, M., Tarantino, G., Cristofano, C., Tuccillo, S., Chimienti, S., Petrarulo, F., Giancaspro, V., Strippoli, M., Laraia, E., Gallucci, M., Gigante, B., Lodeserto, C., Santese, D., Montanaro, A., Giordano, R., Caglioti, A., Fuiano, G., Zoccali, C., Caridi, G., Postorino, M., Savica, V., Monardo, P., Bellinghieri, G., Santoro, D., Castellino, P., Rapisarda, F., Fatuzzo, P., Messina, A., Dal Canton, A., Esposito, V., Formica, M., Segoloni, G., Gallieni, M., Locatelli, F., Tarchini, R., Meneghel, G., Oldrizzi, L., Cossu, M., Di Giulio, S., Malaguti, M., Pizzarelli, F., Quintaliani, G., Pisani, A., Bonofiglio, R., Grandaliano, Giuseppe, Russo, D., Di Micco, L., Torraca, S., Sabbatini, M., and Grandaliano G. (ORCID:0000-0003-1213-2177)

Abstract

Background: Anemia is a common complication of chronic kidney disease (CKD), but its incidence in nephrology settings is poorly investigated. Similarly, the risks of adverse outcomes associated with new-onset anemia are not known. Methods: We performed a pooled analysis of three observational cohort studies including 1031 non-anemic CKD patients with eGFR <60 mL/min/1.73 m2 regularly followed in renal clinics. We estimated the incidence of mild anemia (hemoglobin 11-12 g/dL in women and 11-13 g/dL in men) and severe anemia (hemoglobin <11 g/dL or use of erythropoiesis-stimulating agents) during a 3-year follow-up period. Thereafter we estimated the risk of end-stage kidney disease (ESKD) and all-cause death associated with new-onset mild and severe anemia. Results: The mean age was 63 ± 14 years, 60% were men and 20% had diabetes. The mean estimated glomerular filtration rate (eGFR) was 37 ± 13 mL/min/1.73 m2 and the median proteinuria was 0.4 g/day [interquartile range (IQR) 0.1-1.1]. The incidence of mild and severe anemia was 13.7/100 patients-year and 6.2/100 patients-year, respectively. Basal predictors of either mild or severe anemia were diabetes, lower hemoglobin, higher serum phosphate, eGFR <30 mL/min/1.73 m2 and proteinuria >0.50 g/day. Male sex, moderate CKD (eGFR 30-44 mL/min/1.73 m2) and moderate proteinuria (0.15-0.50 g/day) predicted only mild anemia. The incidence of anemia increased progressively with CKD stages (from 8.77 to 76.59/100 patients-year) and the proteinuria category (from 13.99 to 25.02/100 patients-year). During a median follow-up of 3.1 years, 232 patients reached ESKD and 135 died. Compared with non-anemic patients, mild anemia was associated with a higher adjusted risk of ESKD {hazard ratio [HR] 1.42 [95% confidence interval (CI) 1.02-1.98]} and all-cause death [HR 1.55 (95% CI 1.04-2.32)]. Severe anemia was associated with an even higher risk of ESKD [HR 1.73 (95% CI 1.20-2.51)] and death [HR 1.83 (95% CI 1.05-3.19)].

Published
2022

25. No additional benefit of prescribing a very low-protein diet in patients with advanced chronic kidney disease under regular nephrology care: a pragmatic, randomized, controlled trial

Author

Bellizzi, V., Signoriello, S., Minutolo, R., Di Iorio, B., Nazzaro, P., Garofalo, C., Calella, P., Chiodini, P., De Nicola, L., Torraca, S., Mascia, S., Conte, G., Iorio, B. D., De Simone, W., Zito, B., De Blasio, A., Micco, L. D., Provenzano, M., Gesualdo, L., Manno, C., Pastore, A., Querques, M., Coppola, S., Guastaferro, P., Bellizzi, Vincenzo, Signoriello, Simona, Minutolo, Roberto, Di Iorio, Biagio, Nazzaro, Paola, Garofalo, Carlo, Calella, Patrizia, Chiodini, Paolo, and De Nicola, Luca

Subjects
CKD, ESRD, body composition, chronic kidney disease, ketoanalogues, low protein diet, nutrition, randomized controlled trials, renal death, renal diet, Nutrition and Dietetics, ketoanalog, Medicine (miscellaneous), ketoanalogue, death, randomized controlled trial
Abstract

Background Whether a very low-protein diet supplemented with ketoanalogues (sVLPD), compared with a standard low-protein diet (LPD), improves outcomes in patients with chronic kidney disease (CKD) under stable nephrology care is undefined. Objectives To compare the effectiveness of sVLPD compared with LPD in patients regularly seen in tertiary nephrology care. Methods Participants were patients with CKD stages 4-5, followed for at least 6 mo, randomly allocated to receive sVLPD or LPD [0.35 or 0.60 g/kg ideal body weight (IBW)/d, respectively], stratified by center and CKD stage. The primary outcome was time to renal death, defined as the first event between end-stage renal disease (ESRD) and all-cause mortality; secondary outcomes were the single components of the primary outcome, cardiovascular outcome, and nutritional status. Results We analyzed 223 patients (sVLPD, n = 107; LPD, n = 116). Mean age was 64 y, 61% were male, and 35% had diabetes. Median protein intake (PI), which was 0.8 g/kg IBW/d at baseline in both groups, was 0.83 and 0.60 g/kg IBW/d in LPD and sVLPD, respectively, during the trial with a large decrease only in sVLPD (P = 0.011). During a median of 74.2 mo, we recorded 180 renal deaths (141 dialysis and 39 deaths before dialysis). Risk of renal death did not differ in sVLPD compared with LPD (HR: 1.17; 95% CI: 0.88, 1.57; P = 0.28). No difference was observed for ESRD (HR: 1.12; 95% CI: 0.81, 1.56; P = 0.51), mortality (HR: 0.95; 95% CI: 0.62, 1.45; P = 0.82), or time to fatal/nonfatal cardiovascular events (P = 0.2, log-rank test). After 36 mo, still active patients were 45 in sVLPD and 56 in LPD. No change of nutritional status emerged during the study in any arm. Conclusions This long-term pragmatic trial found that in patients with CKD under stable nephrology care, adherence to protein restriction is low. Prescribing sVLPD compared with standard LPD is safe but does not provide additional advantage to the kidney or patient survival.

Published
2022

26. Harnessing the potential of metalloproteinases in extracellular vesicles: a window of opportunity for aneurysm management - Metalloproteinasi e vescicole extracellulari: una finestra di opportunità per la gestione degli aneurismi

Author

Iaccino, E, Andreucci, M, Provenzano, M, Raimondo, F, Pitto, M, Fortunato, G, Di Taranto, MD, Serraino, FG, Mastroroberto, P, Bracale, UM, Serra, R, Iaccino, E, Andreucci, M, Provenzano, M, Raimondo, F, Pitto, M, Fortunato, G, Di Taranto, M, Serraino, F, Mastroroberto, P, Bracale, U, and Serra, R

Subjects
BIO/12 - BIOCHIMICA CLINICA E BIOLOGIA MOLECOLARE CLINICA, aneurismi, vescicole extracellulari, esosomi
Abstract

An aortic aneurysm is a ruinous condition that compromises the aortic wall. If inaccurately monitored, it could evolve in an extensive dilatation of the vessel and eventually in the aorta's devastating rupture with low survival rates. The recent attempts to increase clinical remission and disease clearance have only partially alleviated the disease-related poor prognosis. Indeed, aortic aneurysm events annually increase their impact on the National Health Systems of industrialized countries. In recent years, liquid biopsy tests have gained attention as a valuable alternative to traditional diagnostics. Classified as small extracellular vesicles of endosomal origin, exosomes are 30-150 nm diameter vesicles, which are physiologically produced by all cell types and secreted through an exocytosis process in blood, urine, cerebrospinal fluid, and other body fluids. Representing the molecular footprint of the cells of origin, exosomes have been recently considered to design a reliable liquid biopsy for non-invasive monitoring of disease evolution and a valuable tool to monitor the therapy response. Metalloproteinases have been reported as specific markers of aortic aneurysm in terms of disease staging and progression. Of interest, it has been demonstrated a specular metalloproteinase expression in the extracellular vesicles of patients, thus constituting a personal "barcode" of disease progression. This evidence could potentially allow the definition of innovative liquid biopsy approaches for monitoring the disease together with a comprehensive aortic aneurysm-derived exosomes molecular characterization and trapping.

Published
2021

27. Harnessing the potential of metalloproteinases in extracellular vesicles: a window of opportunity for aneurysm management

Author

Iaccino E., Andreucci M., Provenzano M., Raimondo F., Pitto M., Fortunato G., Di Taranto M. D., Serraino F. G., Mastroroberto P., Bracale U. M., Serra R., Iaccino, E., Andreucci, M., Provenzano, M., Raimondo, F., Pitto, M., Fortunato, G., Di Taranto, M. D., Serraino, F. G., Mastroroberto, P., Bracale, U. M., and Serra, R.

Abstract

An aortic aneurysm is a ruinous condition that compromises the aortic wall. If inaccurately monitored, it could evolve in an extensive dilatation of the vessel and eventually in the aorta's devastating rupture with low survival rates. The recent attempts to increase clinical remission and disease clearance have only partially alleviated the disease-related poor prognosis. Indeed, aortic aneurysm events annually increase their impact on the National Health Systems of industrialized countries. In recent years, liquid biopsy tests have gained attention as a valuable alternative to traditional diagnostics. Classified as small extracellular vesicles of endosomal origin, exosomes are 30-150 nm diameter vesicles, which are physiologically produced by all cell types and secreted through an exocytosis process in blood, urine, cerebrospinal fluid, and other body fluids. Representing the molecular footprint of the cells of origin, exosomes have been recently considered to design a reliable liquid biopsy for non-invasive monitoring of disease evolution and a valuable tool to monitor the therapy response. Metalloproteinases have been reported as specific markers of aortic aneurysm in terms of disease staging and progression. Of interest, it has been demonstrated a specular metalloproteinase expression in the extracellular vesicles of patients, thus constituting a personal "barcode" of disease progression. This evidence could potentially allow the definition of innovative liquid biopsy approaches for monitoring the disease together with a comprehensive aortic aneurysm-derived exosomes molecular characterization and trapping.

Published
2021

28. POS-255 EFFECT OF DAPAGLIFLOZIN ON BLOOD PRESSURE IN PATIENTS WITH CKD: A PRE-SPECIFIED ANALYSIS FROM DAPA-CKD

Author

Provenzano, M., primary, Toto, R.D., additional, Vart, P., additional, Umanath, K., additional, Luis Górriz, J., additional, Mark, P.B., additional, Mann, J.F.E., additional, Chertow, G.M., additional, McMurray, J.J.V., additional, Correa-Rotter, R., additional, Rossing, P., additional, Langkilde, A.M., additional, Stefánsson, B.V., additional, Wheeler, D.C., additional, and Lambers Heerspink, H., additional

Published
2022
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29. POS-202 DAPAGLIFLOZIN IN PATIENTS WITH CHRONIC KIDNEY DISEASE TREATED WITH MINERALOCORTICOID RECEPTOR ANTAGONISTS: PRE-SPECIFIED ANALYSIS OF THE DAPA-CKD TRIAL

Author

Provenzano, M., primary, Jongs, N., additional, Stefánsson, B.V., additional, Chertow, G.M., additional, Langkilde, A.M., additional, McMurray, J.J., additional, Correa-Rotter, R., additional, Rossing, P., additional, Sjöström, C.D., additional, Toto, R.D., additional, Wheeler, D.C., additional, and Lambers Heerspink, H., additional

Published
2022
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31. Investigating a Rapid and Safe Outpatient Pediatric Screening Protocol

Author

Dawn M. Park, Bruce F. Landeck, Dale A. Burkett, Richard M. Friesen, Karrie L. Villavicencio, Sonali S. Patel, K. Scott Kirby, Brittany E. Hoefener, Casey M. Gau, Lindsay M. Provenzano, and Adel K. Younoszai

Subjects
Outpatients, Ambulatory Care, Humans, Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine, Child
Published
2021

32. 62-OR: Fostering Sustainability through Diabetes Self-Management Support in African-American Churches: Results of the Praise Diabetes Project

Author

Jaclynn Hawkins, Katherine A. Kloss, Robin Nwankwo, Gretchen A. Piatt, Diana Hall, Anthony M. Provenzano, and Martha M. Funnell

Subjects
American diabetes association, African american, business.industry, Endocrinology, Diabetes and Metabolism, media_common.quotation_subject, Mean age, Diabetes self management, medicine.disease, Distress, Diabetes mellitus, Internal Medicine, medicine, Cluster randomised controlled trial, Praise, business, media_common, Demography
Abstract

A gap exists between diabetes self-management education (DSME), DSMS practices, and the infrastructure needed to foster sustainability of improved outcomes, particularly in low-resource communities. We determined the relative effectiveness of 3 parallel DSMS approaches in improving A1c and diabetes distress (DD). Moderate DD was 2.0-2.9 and high DD was ≥ 3.0. 370 individuals [mean age: 64.6 years, 74% female, 100% African American (AA), mean A1c: 7.7%±1.9, 22.8% with moderate DD] from 21 AA churches in southeast Michigan and northwestern Ohio, took part in a cluster randomized trial from 2016-2020. Data were collected at baseline, 6, 9, 21, and 33 months. Churches were randomized to one of three DSMS approaches [Parish Nurse (PN) + Peer Leader (PL) DSMS (n=123), PL DSMS (n=127), or PN DSMS (n=109)]. Twenty-one PNs and 28 PLs were trained to facilitate DSMS at each church. Sustained reduction in A1c was observed in all groups (PNPL: -0.2%, p=0.68; PN: -0.2%, p=0.13). PL had borderline statistically significant reductions (-0.3%, p=0.08). The proportion of participants with A1c < 7% also improved over time in each group (PNPL: 57.3 vs. 60.7%, p=0.21; PL: 57.3 vs. 62.7%, p=0.44; PN: 40.9 vs. 44.1%, p=0.66), but not significantly. Of those who achieved A1c < 7% following DSME (9-month follow-up), 81.3% of participants, across all groups, sustained the goal at 33 months. PN had the most participants with sustained glycemic control (PNPL: 81.6%, PL: 76.7%, PN: 86.9%). Significant improvements in mean DD scores were observed from baseline to 33 months in all groups (PNPL: 2.1 vs. 1.8, p=0.05; PL: 2.0 vs. 1.7, p=0.004). Moreover, there was a 50% reduction in the proportion of participants with moderate DD in PL (31.7% vs. 12.2%) and PN (27.5% vs. 15%) and severe DD in PN (10% vs. 5%). Varied approaches to DSMS within the context of existing community infrastructures (AA churches) fostered the sustainability of improvements in diabetes-related outcomes. Disclosure G. Piatt: None. A. M. Provenzano: None. R. Nwankwo: None. D. Hall: None. K. A. Kloss: None. J. M. Hawkins: None. M. M. Funnell: Other Relationship; Self; American Diabetes Association. Funding National Institutes of Health (R01DK103733)

Published
2021
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34. [Role of proteinuria in clinical research: for each old-answer, a new key-question.]

Author

Provenzano M., Garofalo C., Chiodini P., Mancuso C., Barbato E., Nicola L. D., Andreucci M., Provenzano, M., Garofalo, C., Chiodini, P., Mancuso, C., Barbato, E., Nicola, L. D., and Andreucci, M.

Subjects
urogenital system, Prognosi, urologic and male genital diseases, Cardiovascular risk, Prognosis, female genital diseases and pregnancy complications, End-stage-kidney-disease, Proteinuria, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Risk Factors, Chronic kidney disease, Albuminuria, Humans, Kidney Failure, Chronic, Kidney Diseases
Abstract

The presence of proteinuria, i.e. an abnormal amount of proteins in the urine is a well documented cardiovascular (CV) and renal risk factor either in the general population or in high-risk populations such as patients with type 2 diabetes, previous CV disease and patients under regular nephrology care. Indeed, the increase in proteinuria levels, even if of small entity, is associated to a faster decline in renal function over time, increased risk of End-Stage-Kidney-Disease and CV mortality. The deleterious effect of proteinuria on the kidney is attributable to the primitive glomerular damage as well as to the direct toxicity the proteinuria exerts on the tubule-interstitium. In addition, the more general association with the increased CV risk can be explained by the evidence that proteinuria can be considered a marker of systemic and renal endothelial damage. A reduction in proteinuria over time (a 30% decrease after 6 months of treatment in proteinuria is considered acceptable) as response to antihypertensive or antiproteinuric drugs protects against the development of all mentioned endpoints. Further studies are needed to better clarify: What is the normal value of proteinuria excretion, how many measures should be done during follow-up to truely assess the risk of future outcomes, what is the exact prognostic role of proteinuria.

Published
2020

35. The Role of Prognostic and Predictive Biomarkers for Assessing Cardiovascular Risk in Chronic Kidney Disease Patients

Author

Provenzano M, Andreucci M, De Nicola L, Garofalo C, Battaglia Y, Borrelli S, Gagliardi I, Faga T, Michael A, Mastroroberto P, Serraino GF, Licastro N, Ielapi N, Serra R., Provenzano, M, Andreucci, M, De Nicola, L, Garofalo, C, Battaglia, Y, Borrelli, S, Gagliardi, I, Faga, T, Michael, A, Mastroroberto, P, Serraino, Gf, Licastro, N, Ielapi N, and Serra, R.

Published
2020

37. Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study

Author

Kamarajah, S. K. Nepogodiev, D. Bekele, A. Cecconello, I. and Evans, R. P. T. Guner, A. Gossage, J. A. Harustiak, T. and Hodson, J. Isik, A. Kidane, B. Leon-Takahashi, A. M. and Mahendran, H. A. Negoi, I. Okonta, K. E. Rosero, G. and Sayyed, R. H. Singh, P. Takeda, F. R. van Hillegersberg, R. and Vohra, R. S. White, R. E. Griffiths, E. A. Alderson, D. and Bundred, J. Evans, R. P. T. Gossage, J. Griffiths, E. A. and Jefferies, B. Kamarajah, S. K. McKay, S. Mohamed, I. and Nepogodiev, D. Siaw-Acheampong, K. Singh, P. van Hillegersberg, R. Vohra, R. Wanigasooriya, K. Whitehouse, T. and Gjata, A. Moreno, J. I. Takeda, F. R. Kidane, B. and Guevara, Castro R. Harustiak, T. Bekele, A. Kechagias, A. and Gockel, I. Kennedy, A. Da Roit, A. Bagajevas, A. and Azagra, J. S. Mahendran, H. A. Mejia-Fernandez, L. and Wijnhoven, B. P. L. El Kafsi, J. Sayyed, R. H. Sousa, M. and Sampaio, A. S. Negoi, I. Blanco, R. Wallner, B. and Schneider, P. M. Hsu, P. K. Isik, A. Gananadha, S. and Wills, V. Devadas, M. Duong, C. Talbot, M. Hii, M. W. and Jacobs, R. Andreollo, N. A. Johnston, B. Darling, G. and Isaza-Restrepo, A. Rosero, G. Arias-Amezquita, F. Raptis, D. and Gaedcke, J. Reim, D. Izbicki, J. Egberts, J. H. and Dikinis, S. Kjaer, D. W. Larsen, M. H. Achiam, M. P. and Saarnio, J. Theodorou, D. Liakakos, T. Korkolis, D. P. and Robb, W. B. Collins, C. Murphy, T. Reynolds, J. Tonini, V. Migliore, M. Bonavina, L. Valmasoni, M. Bardini, R. and Weindelmayer, J. Terashima, M. White, R. E. Alghunaim, E. Elhadi, M. Leon-Takahashi, A. M. Medina-Franco, H. and Lau, P. C. Okonta, K. E. Heisterkamp, J. Rosman, C. van Hillegersberg, R. Beban, G. Babor, R. Gordon, A. and Rossaak, J. I. Pal, K. M. I. Qureshi, A. U. Naqi, S. A. and Syed, A. A. Barbosa, J. Vicente, C. S. Leite, J. Freire, J. Casaca, R. Costa, R. C. T. Scurtu, R. R. Mogoanta, S. S. Bolca, C. Constantinoiu, S. Sekhniaidze, D. Bjelovic, M. So, J. B. Y. Gacevski, G. Loureiro, C. Pera, M. and Bianchi, A. Moreno, Gijon M. Martin Fernandez, J. Carrera, M. S. Trugeda Vallve-Bernal, M. Pascual, M. A. Citores and Elmahi, S. Halldestam, I. Hedberg, J. Monig, S. and Gutknecht, S. Tez, M. Guner, A. Tirnaksiz, M. B. Colak, E. Sevinc, B. Hindmarsh, A. Khan, I. Khoo, D. Byrom, R. Gokhale, J. Wilkerson, P. Jain, P. Chan, D. and Robertson, K. Iftikhar, S. Skipworth, R. Forshaw, M. and Higgs, S. Gossage, J. Nijjar, R. Viswanath, Y. K. S. and Turner, P. Dexter, S. Boddy, A. Allum, W. H. Oglesby, S. and Cheong, E. Beardsmore, D. Vohra, R. Maynard, N. and Berrisford, R. Mercer, S. Puigt, S. Melhadot, R. Kelty, C. Underwood, T. Dawas, K. Lewis, W. Al-Bahrani, A. and Bryce, G. Thomas, M. Arndt, A. T. Palazzo, F. Meguid, R. A. Fergusson, J. Beenen, E. Mosse, C. Salim, J. and Cheah, S. Wright, T. Cerdeira, M. P. McQuillan, P. and Richardson, M. Liem, H. Spillane, J. Yacob, M. Albadawi, F. Thorpe, T. Dingle, A. Cabalag, C. Loi, K. Fisher, O. M. Ward, S. Read, M. Johnson, M. Bassari, R. Bui, H. Cecconello, I. Sallum, R. A. A. da Rocha, J. R. M. and Lopes, L. R. Tercioti, Jr., V. Coelho, J. D. Ferrer, J. A. P. Buduhan, G. Tan, L. Srinathan, S. Shea, P. Yeung, J. Allison, F. Carroll, P. Vargas-Barato, F. Gonzalez, F. Ortega, J. Nino-Torres, L. Beltran-Garcia, T. C. and Castilla, L. Pineda, M. Bastidas, A. Gomez-Mayorga, J. and Cortes, N. Cetares, C. Caceres, S. Duarte, S. Pazdro, A. and Snajdauf, M. Faltova, H. Sevcikova, M. Mortensen, P. B. and Katballe, N. Ingemann, T. Morten, B. Kruhlikava, I. and Ainswort, A. P. Stilling, N. M. Eckardt, J. Holm, J. and Thorsteinsson, M. Siemsen, M. Brandt, B. Nega, B. and Teferra, E. Tizazu, A. Kauppila, J. H. Koivukangas, V. and Merilainen, S. Gruetzmann, R. Krautz, C. Weber, G. and Golcher, H. Emons, G. Azizian, A. Ebeling, M. Niebisch, S. Kreuser, N. Albanese, G. Hesse, J. Volovnik, L. and Boecher, U. Reeh, M. Triantafyllou, S. Schizas, D. and Michalinos, A. Mpali, E. Mpoura, M. Charalabopoulos, A. and Manatakis, D. K. Balalis, D. Bolger, J. Baban, C. and Mastrosimone, A. McAnena, O. Quinn, A. Suilleabhain, C. B. O. Hennessy, M. M. Ivanovski, I. Khizer, H. Ravi, N. and Donlon, N. Cervellera, M. Vaccari, S. Bianchini, S. and Sartarelli, L. Asti, E. Bernardi, D. Merigliano, S. and Provenzano, L. Scarpa, M. Saadeh, L. Salmaso, B. De Manzoni, G. Giacopuzzi, S. La Mendola, R. De Pasqual, C. A. and Tsubosa, Y. Niihara, M. Irino, T. Makuuchi, R. and Ishii, K. Mwachiro, M. Fekadu, A. Odera, A. Mwachiro, E. and AlShehab, D. Ahmed, H. A. Shebani, A. O. Elhadi, A. and Elnagar, F. A. Elnagar, H. F. Makkai-Popa, S. T. Wong, L. F. and Tan, Y. R. Thannimalai, S. Ho, C. A. Pang, W. S. and Tan, J. H. Basave, H. N. L. Cortes-Gonzalez, R. Lagarde, S. M. van Lanschot, J. J. B. Cords, C. Jansen, W. A. and Martijnse, I. Matthijsen, R. Bouwense, S. Klarenbeek, B. and Verstegen, M. van Workum, F. Ruurda, J. P. van der Sluis, P. C. de Maat, M. Evenett, N. Johnston, P. Patel, R. and MacCormick, A. Young, M. Smith, B. Ekwunife, C. Memon, A. H. Shaikh, K. Wajid, A. Khalil, N. Haris, M. and Mirza, Z. U. Qudus, S. B. A. Sarwar, M. Z. Shehzadi, A. and Raza, A. Jhanzaib, M. H. Farmanali, J. Zakir, Z. and Shakeel, O. Nasir, I. Khattak, S. Baig, M. Noor, M. A. and Ahmed, H. H. Naeem, A. Pinho, A. C. da Silva, R. and Bernardes, A. Campos, J. C. Matos, H. Braga, T. and Monteiro, C. Ramos, P. Cabral, F. Gomes, M. P. Martins, P. C. Correia, A. M. Videira, J. F. Ciuce, C. Drasovean, R. Apostu, R. Ciuce, C. Paitici, S. Racu, A. E. and Obleaga, C. V. Beuran, M. Stoica, B. Ciubotaru, C. and Negoita, V. Cordos, I. Birla, R. D. Predescu, D. Hoara, P. A. Tomsa, R. Shneider, V. Agasiev, M. Ganjara, I. and Gunjic, D. Veselinovic, M. Babic, T. Chin, T. S. and Shabbir, A. Kim, G. Crnjac, A. Samo, H. Del Val, I. Diez and Leturio, S. Ramon, J. M. Dal Cero, M. Rifa, S. Rico, M. Pomar, A. Pagan Corcoles, J. A. Martinez Miravalles, J. L. Rodicio Pais, S. A. Turienzo, S. A. Alvarezt, L. S. and Alvarez, L. S. Campos, P. V. Rendo, A. G. Garcia, S. S. and Santos, E. P. G. Martinez, E. T. Fernandez, Diaz Mj Magadan, Alvarez C. Concepcion, Martin V. Diaz, Lopez C. Rosat, Rodrigo A. Perez, Sanchez L. E. Bailon, Cuadrado M. Tinoco, Carrasco C. Bhojwani, E. Choolani Sanchez, D. P. Ahmed, M. E. Dzhendov, T. Lindberg, F. Rutegard, M. Sundbom, M. and Mickael, C. Colucci, N. Schnider, A. Er, S. Kurnaz, E. Turkyilmaz, S. Turkyilmaz, A. Yildirim, R. Baki, B. E. Akkapulu, N. Karahan, O. Damburaci, N. Hardwickt, R. and Safranek, P. Sujendran, V. Bennett, J. Afzal, Z. and Shrotri, M. Chan, B. Exarchou, K. Gilbert, T. Amalesh, T. Mukherjee, D. Mukherjee, S. Wiggins, T. H. Kennedy, R. McCain, S. Harris, A. Dobson, G. Davies, N. and Wilson, I. Mayo, D. Bennett, D. Young, R. Manby, P. and Blencowe, N. Schiller, M. Byrne, B. Mitton, D. Wong, V. and Elshaer, A. Cowen, M. Menon, V. Tan, L. C. and McLaughlin, E. Koshy, R. Sharp, C. Brewer, H. Das, N. and Cox, M. Al Khyatt, W. Worku, D. Iqbal, R. Walls, L. and McGregor, R. Fullarton, G. Macdonald, A. MacKay, C. and Craig, C. Dwerryhouse, S. Hornby, S. Jaunoo, S. Wadley, M. Baker, C. Saad, M. Kelly, M. Davies, A. Di Maggio, F. McKay, S. Mistry, P. Singhal, R. Tucker, O. and Kapoulas, S. Powell-Brett, S. Davis, P. Bromley, G. and Watson, L. Verma, R. Ward, J. Shetty, V. Ball, C. and Pursnani, K. Sarela, A. Sue, Ling H. Mehta, S. Hayden, J. To, N. Palser, T. Hunter, D. Supramaniam, K. and Butt, Z. Ahmed, A. Kumar, S. Chaudry, A. Moussa, O. and Kordzadeh, A. Lorenzi, B. Wilson, M. Patil, P. Noaman, I. Willem, J. Bouras, G. Evans, R. Singh, M. and Warrilow, H. Ahmad, A. Tewari, N. Yanni, F. Couch, J. and Theophilidou, E. Reilly, J. J. Singh, P. van Boxel, Gijs and Akbari, K. Zanotti, D. Sgromo, B. Sanders, G. and Wheatley, T. Ariyarathenam, A. Reece-Smith, A. Humphreys, L. and Choh, C. Carter, N. Knight, B. Pucher, P. and Athanasiou, A. Mohamed, I. Tan, B. Abdulrahman, M. and Vickers, J. Akhtar, K. Chaparala, R. Brown, R. Alasmar, M. M. A. Ackroyd, R. Patel, K. Tamhankar, A. Wyman, A. and Walker, R. Grace, B. Abbassi, N. Slim, N. Ioannidi, L. Blackshaw, G. Havard, T. Escofet, X. Powell, A. and Owera, A. Rashid, F. Jambulingam, P. Padickakudi, J. and Ben-Younes, H. Mccormack, K. Makey, I. A. Karush, M. K. and Seder, C. W. Liptay, M. J. Chmielewski, G. Rosato, E. L. and Berger, A. C. Zheng, R. Okolo, E. Singh, A. Scott, C. D. and Weyant, M. J. Mitchell, J. D. Oesophago-Gastric Anastomotic

Abstract

Background: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III-V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC. Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Published
2021

38. Postoperative outcomes in oesophagectomy with trainee involvement

Author

Evans, R. P. T. Hodson, J. Kamarajah, S. K. Griffiths, E. A. and Singh, P. Alderson, D. Bundred, J. Gossage, J. and Jefferies, B. McKay, S. Mohamed, I Nepogodiev, D. and Siaw-Acheampong, K. van Hillegersberg, R. Vohra, R. and Wanigasooriya, K. Whitehouse, T. Gjata, A. Moreno, I, J. and Takeda, F. R. Kidane, B. Castro, R. Guevara Harustiak, T. and Bekele, A. Kechagias, A. Gockel, I Kennedy, A. Da Roit, A. Bagajevas, A. Azagra, J. S. Mahendran, H. A. and Mejia-Fernandez, L. Wijnhoven, B. P. L. El Kafsi, J. Sayyed, R. H. Sousa, M. Sampaio, A. S. Negoi, I Blanco, R. and Wallner, B. Schneider, P. M. Hsu, P. K. Isik, A. and Gananadha, S. Wills, V Devadas, M. Duong, C. Talbot, M. and Hii, M. W. Jacobs, R. Andreollo, N. A. Johnston, B. and Darling, G. Isaza-Restrepo, A. Rosero, G. Arias-Amezquita, F. Raptis, D. Gaedcke, J. Reim, D. Izbicki, J. and Egberts, J. H. Dikinis, S. Kjaer, D. W. Larsen, M. H. and Achiam, M. P. Saarnio, J. Theodorou, D. Liakakos, T. and Korkolis, D. P. Robb, W. B. Collins, C. Murphy, T. and Reynolds, J. Tonini, V Migliore, M. Bonavina, L. and Valmasoni, M. Bardini, R. Weindelmayer, J. Terashima, M. and White, R. E. Alghunaim, E. Elhadi, M. Leon-Takahashi, A. M. and Medina-Franco, H. Lau, P. C. Okonta, K. E. Heisterkamp, J. Rosman, C. Beban, G. Babor, R. Gordon, A. and Rossaak, I, J. Pal, I, K. M. Qureshi, A. U. Naqi, S. A. and Syed, A. A. Barbosa, J. Vicente, C. S. Leite, J. Freire, J. Casaca, R. Costa, R. C. T. Scurtu, R. R. Mogoanta, S. S. Bolca, C. Constantinoiu, S. Sekhniaidze, D. So, J. B. Y. Gacvski, G. Loureiro, C. Pera, M. Bianchi, A. and Gijon, M. Moreno Fernandez, J. Martin Carrera, M. S. Trugeda and Vallve-Bernal, M. Pascual, M. A. Citores Elmahi, S. and Halldestam, I Hedberg, J. Monig, S. Gutknecht, S. Tez, M. Guner, A. Tirnaksiz, T. B. Colak, E. Sevinc, B. and Hindmarsh, A. Khan, I Khoo, D. Byrom, R. Gokhale, J. and Wilkerson, P. Jain, P. Chan, D. Robertson, K. Iftikhar, S. Skipworth, R. Forshaw, M. Higgs, S. Nijjar, R. and Viswanath, Y. K. S. Turner, P. Dexter, S. Boddy, A. and Allum, W. H. Oglesby, S. Cheong, E. Beardsmore, D. and Maynard, N. Berrisford, R. Mercer, S. Puig, S. Melhado, R. Kelty, C. Underwood, T. Dawas, K. Lewis, W. and Al-Bahrani, A. Bryce, G. Thomas, M. Arndt, A. T. and Palazzo, F. Meguid, R. A. Fergusson, J. Beenen, E. and Mosse, C. Salim, J. Cheah, S. Wright, T. Cerdeira, M. P. and McQuillan, P. Richardson, M. Liem, H. Spillane, J. and Yacob, M. Albadawi, F. Thorpe, T. Dingle, A. Cabalag, C. and Loi, K. Fisher, O. M. Ward, S. Read, M. Johnson, M. and Bassari, R. Bui, H. Cecconello, I Sallum, R. A. A. and da Rocha, J. R. M. Lopes, L. R. Tercioti, Jr., V. Coelho, J. D. S. Ferrer, J. A. P. Buduhan, G. Tan, L. Srinathan, S. and Shea, P. Yeung, J. Allison, F. Carroll, P. and Vargas-Barato, F. Gonzalez, F. Ortega, J. Nino-Torres, L. and Beltran-Garcia, T. C. Castilla, L. Pineda, M. Bastidas, A. Gomez-Mayorga, J. Cortes, N. Cetares, C. Caceres, S. and Duarte, S. Pazdro, A. Snajdauf, M. Faltova, H. and Sevcikova, M. Mortensen, P. B. Katballe, N. Ingemann, T. and Morten, B. Kruhlikava, I Ainswort, A. P. Stilling, N. M. and Eckardt, J. Holm, J. Thorsteinsson, M. Siemsen, M. and Brandt, B. Nega, B. Teferra, E. Tizazu, A. Kauppila, J. S. Koivukangas, V Merilainen, S. Gruetzmann, R. Krautz, C. Weber, G. Golcher, H. Emons, G. Azizian, A. and Ebeling, M. Niebisch, S. Kreuser, N. Albanese, G. Hesse, J. Volovnik, L. Boecher, U. Reeh, M. Triantafyllou, S. and Schizas, D. Michalinos, A. Baili, E. Mpoura, M. and Charalabopoulos, A. Manatakis, D. K. Balalis, D. Bolger, J. and Baban, C. Mastrosimone, A. McAnena, O. Quinn, A. and Suilleabhain, C. B. O. Hennessy, M. M. Ivanovski, I. Khizer, H. Ravi, N. Donlon, N. Cervellera, M. Vaccari, S. and Bianchini, S. Sartarelli, L. Asti, E. Bernardi, D. and Merigliano, S. Provenzano, L. Scarpa, M. Saadeh, L. and Salmaso, B. De Manzoni, G. Giacopuzzi, S. La Mendola, R. and De Pasqual, C. A. Tsubosa, Y. Niihara, M. Irino, T. and Makuuchi, R. Ishii, K. Mwachiro, M. Fekadu, A. Odera, A. and Mwachiro, E. AlShehab, D. Ahmed, H. A. Shebani, A. O. and Elhadi, A. Elnagar, F. A. Elnagar, H. F. Makkai-Popa, S. T. Wong, L. F. Yunrong, T. Thanninalai, S. Aik, H. C. and Soon, P. W. Huei, T. J. Basave, H. N. L. and Cortes-Gonzalez, R. Lagarde, S. M. van Lanschot, J. J. B. and Cords, C. Jansen, W. A. Martijnse, I Matthijsen, R. and Bouwense, S. Klarenbeek, B. Verstegen, M. van Workum, F. and Ruurda, J. P. van der Veen, A. van den Berg, J. W. Evenett, N. Johnston, P. Patel, R. MacCormick, A. Young, M. and Smith, B. Ekwunife, C. Memon, A. H. Shaikh, K. Wajid, A. and Khalil, N. Haris, M. Mirza, Z. U. Qudus, S. B. A. and Sarwar, M. Z. Shehzadi, A. Raza, A. Jhanzaib, M. H. and Farmanali, J. Zakir, Z. Shakeel, O. Nasir, I Khattak, S. and Baig, M. Noor, M. A. Ahmed, H. H. Naeem, A. Pinho, A. C. da Silva, R. Bernardes, A. Campos, J. C. Matos, H. and Braga, T. Monteiro, C. Ramos, P. Cabral, F. Gomes, M. P. Martins, P. C. Correia, A. M. Videira, J. F. and Ciuce, C. Drasovean, R. Apostu, R. Paitici, S. Racu, A. E. Obleaga, V, C. Beuran, M. Stoica, B. Ciubotaru, C. and Negoita, V Cordos, I Birla, R. D. Predescu, D. and Hoara, P. A. Tomsa, R. Shneider, V Agasiev, M. Ganjara, I Gunjic, D. Veselinovic, M. Babic, T. Chin, T. S. and Shabbir, A. Kim, G. Crnjac, A. Samo, H. del Val, I. Diez and Leturio, S. Ramon, J. M. Dal Cero, M. Rifa, S. Rico, M. Pomar, A. Pagan Corcoles, J. A. Martinez Miravalles, J. L. Rodicio Pais, S. A. Turienzo, S. A. Alvarez, L. S. and Campos, V, P. Rendo, A. G. Garcia, S. S. Santos, E. P. G. and Martinez, E. T. Diaz, M. J. Fernandez Alvarez, C. Magadan and Martin, V. Concepcion Lopez, C. Diaz Rodrigo, A. Rosat and Sanchez, L. E. Perez Cuadrado, M. Bailon Carrasco, C. Tinoco and Bhojwani, E. Choolani Sanchez, D. P. Ahmed, M. E. Dzhendov, T. Lindberg, F. Rutegard, M. Sundbom, M. Mickael, C. and Colucci, N. Schnider, A. Er, S. Kurnaz, E. Turkyilmaz, S. Turkyilmaz, A. Yildirim, R. Baki, B. E. Akkapulu, N. and Karahan, O. Damburaci, N. Hardwick, R. Safranek, P. and Sujendran, V Bennett, J. Afzal, Z. Shrotri, M. Chan, B. and Exarchou, K. Gilbert, T. Amalesh, T. Mukherjee, D. and Mukherjee, S. Wiggins, T. H. Kennedy, R. McCain, S. and Harris, A. Dobson, G. Davies, N. Wilson, I Mayo, D. and Bennett, D. Young, R. Manby, P. Blencowe, N. Schiller, M. Byrne, B. Mitton, D. Wong, V Elshaer, A. Cowen, M. Menon, V Tan, L. C. McLaughlin, E. Koshy, R. and Sharp, C. Brewer, H. Das, N. Cox, M. Al Khyatt, W. and Worku, D. Iqbal, R. Walls, L. McGregor, R. Fullarton, G. and Macdonald, A. MacKay, C. Craig, C. Dwerryhouse, S. and Hornby, S. Jaunoo, S. Wadley, M. Baker, C. Saad, M. and Kelly, M. Davies, A. Di Maggio, F. Mistry, P. Singhal, R. Tucker, O. Kapoulas, S. Powell-Brett, S. Davis, P. and Bromley, G. Watson, L. Verma, R. Ward, J. Shetty, V and Ball, C. Pursnani, K. Sarela, A. Ling, H. Sue Mehta, S. Hayden, J. To, N. Palser, T. Hunter, D. and Supramaniam, K. Butt, Z. Ahmed, A. Kumar, S. Chaudry, A. and Moussa, O. Kordzadeh, A. Patil, P. Noaman, I Willem, J. Bouras, G. Evans, R. Singh, M. Warrilow, H. and Ahmad, A. Tewari, N. Yanni, F. Couch, J. Theophilidou, E. Reilly, J. J. van Boxel, G. Akbari, K. Zanotti, D. and Sgromo, B. Sanders, G. Wheatley, T. Ariyarathenam, A. and Reece-Smith, A. Humphreys, L. Choh, C. Carter, N. and Knight, B. Pucher, P. Athanasiou, A. Tan, B. and Abdulrahman, M. Vickers, J. Akhtar, K. Chaparala, R. and Brown, R. Alasmar, M. M. A. Ackroyd, R. Patel, K. and Tamhankar, A. Wyman, A. Walker, R. Grace, B. Abbassi, N. and Slim, N. Ioannidi, L. Blackshaw, G. Havard, T. and Escofet, X. Powell, A. Owera, A. Rashid, F. Jambulingam, P. Padickakudi, J. Ben-Younes, H. McCormack, K. Makey, I. A. Karush, M. K. Seder, C. W. Liptay, M. J. and Chmielewski, G. Rosato, E. L. Berger, A. C. Zheng, R. and Okolo, E. Singh, A. Scott, C. D. Weyant, M. J. Mitchell, J. D. West Midlands Res Collaborative

Abstract

Background The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. Methods Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. Results Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). Conclusion Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on perioperative outcomes in the international multicentre Oesophago-Gastric Anastomosis Audit (OGAA). Analysis of 2232 oesophagectomies has shown that trainee involvement did not negatively impact perioperative outcomes.

Published
2021

40. The Influence of Caregiving on the Relation Between Marital Status and Psychological Health in a Grandparent Sample

Author

Melanie Stearns, Angela M Provenzano, and Danielle K. Nadorff

Subjects
Adult, Male, Aging, Sample (statistics), 050105 experimental psychology, Psychological health, 03 medical and health sciences, Social support, 0302 clinical medicine, Sex Factors, Surveys and Questionnaires, Developmental and Educational Psychology, Humans, 0501 psychology and cognitive sciences, 030212 general & internal medicine, Depression (differential diagnoses), Aged, Aged, 80 and over, Psychiatric Status Rating Scales, Marital Status, Depression, 05 social sciences, Significant difference, Grandparent, Middle Aged, United States, Grandparents, Caregivers, Spouse, Marital status, Female, Geriatrics and Gerontology, Psychology, Clinical psychology
Abstract

Grandparent caregivers report poorer psychological and physical health, but relationship status has been shown to influence burden. The current study investigated depressive symptoms of 3288 grandparents who completed the third wave of the National Survey of Families and Households. The study found that those who are unmarried were more likely to be grandparent caregivers, and female participants reported higher depressive symptoms. Marital status and caregiving status were comparable predictors of depression, but marital status did not buffer the effects of caregiving status on depression. Caregiving status accounted for a significant amount of depressive symptom variance for depression, comparable to marital status and gender. There was a significant difference in depressive symptoms of married and unmarried grandparent non-caregivers but with a significantly lower baseline depression rate than grandparent caregivers. Future research should examine whether making social support options available to unmarried grandparent caregivers who lack informal support from a spouse may improve outcomes.

Published
2020

41. Who is a Jew?

Author

Winner, Lauren F., Provenzano, Thomas M., Bruney, Craig, Wolowelskyevin, Joel B., Williams, Jon, and Soloveichik, Meir

Abstract

To the Editor: I appreciate Meir Soloveichik's sensitive discussion of my memoir, Girl Meets God, but I am slightly puzzled by his professed puzzlement about whether I--as a convert to […]

Published
2006

43. 677P The Splice Index as a prognostic biomarker of strength and function in myotonic dystrophy type 1.

Author

Provenzano, M., Ikegami, K., Bates, K., Hartman, J., Jones, A., Butler, A., Berggren, K., Hung, M., Kiefer, M., Thornton, C., Johnson, N., and Hale, M.

Subjects
*MUSCLE strength measurement, *MUSCLE weakness, *MYOTONIA atrophica, *RNA splicing, *TIBIALIS anterior
Abstract

Myotonic dystrophy type 1 (DM1) is caused by a CTG repeat expansion in DMPK that leads to global dysregulation of RNA splicing and subsequent multisystemic symptomatic presentation. The gradual decline in physical function of DM1 individuals necessitates large participant numbers or extended trial durations when using motor function tests to demonstrate significant benefit of disease-modifying interventions. In this setting a biomarker capable of measuring the association between RNA mis-splicing and muscle weakness with prognostic utility would be useful for evaluating early indications of functional response or selection of appropriate participants at trial enrollment. We evaluated a 22-event composite measure of RNA mis-splicing called the Splice Index (SI) as a potential biomarker of muscle weakness in DM1. A total of 46 adults with DM1 provided baseline tibialis anterior muscle biopsies along with measurements of muscle strength, functional mobility, and myotonia, the hallmark symptom of DM1. A subset of 34 participants provided 3-month biopsies and measurements to assess longitudinal stability of the SI. The SI was derived using muscle RNA and a streamlined, easy to deploy, amplicon sequencing methodology to derive percent exon inclusion (PSI) values with high resolution. Individuals were then scored on a linear scale based on the average of a normalized PSI for all 22 splicing events. The SI demonstrated significant associations with ankle dorsiflexion (ADF) (Pearson r = -0.697) and other indicators of muscle function, including 10-meter run/fast walk and hand grip strength. These correlations were primarily driven by strong individual associations of CACNA1S and CLCN1 with all outcome measures. Mis-splicing of these two events is linked to both myotonia and muscle weakness in DM1 models. In a timepoint mismatch analysis we observed a significantly stronger correlation of baseline SI to 3-month ADF (r = -0.78) indicating that RNA mis-splicing as captured by the SI may be predictive of future performance. Linear regression modeling revealed that the combination of baseline ADF and SI was highly predictive of strength at 3 months in our cohort (adjusted R2 = 0.83). Importantly, while the SI exhibited reliability in cross-sectional comparisons between baseline and 3-months, asymmetric variation in SI dynamics within mild and moderately affected participant subgroups may affect this reliability. Overall, the SI is a reliable biomarker that accurately captures associations with physical strength and functional mobility in DM1 adults. Early analyses also suggest its potential value to predict future function. The SI can sensitively detect changes in mis-splicing over 3-months, which may be more dynamic than expected given the slow clinical progression of DM1. Collectively, our validation underscores this biomarker's utility for assessment of disease severity/progression and potential stratification of individuals for trial enrollment. [ABSTRACT FROM AUTHOR]

Published
2024
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