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991.
William D. Stoll Robert A. Mester James N. Fleming Joel M. Sirianni Joseph A. Abro Edward D. Colhoun David J. Taber Latha Hebbar 《Transplantation proceedings》2021,53(5):1665-1669
BackgroundLiver transplantation is a complex surgical procedure. The experience of the anesthesiologist, and its potential relationship to patient morbidity and mortality, is yet to be determined. We sought to explore this possible association using our institutional training patterns as the subject of study.MethodsThis is a single center retrospective analysis investigating the association of an anesthesiologist's experience with liver transplantation and its potential effect on early patient outcomes in adult liver transplant recipients from January 2010 to September 2016. Training of team members consisted of a 6-month period of clinical shadowing with a senior anesthesiologist and co-staffing 8 liver transplant procedures before solo staffing a liver transplant. Specifically, patient outcomes for the first 5 transplants after this training were investigated.ResultsThe only independent risk factor for early death or early graft loss was the amount of packed red blood cells administered during transplantation. With respect to secondary outcomes, the amount of packed red blood cells and hospitalization at the time of transplant were associated with the number of days on a ventilator, length of intensive care unit stay, and overall hospital length of stay.ConclusionsThe results of this study conclude that the training model currently in place for our new team members has no negative impact on patient outcomes after liver transplantation. 相似文献
992.
Gregory A Kline Lisa M Lix William D Leslie 《Journal of bone and mineral research》2021,36(8):1425-1431
The role of mid-treatment monitoring dual-energy X-ray absorptiometry–bone mineral density (DXA-BMD) for bisphosphonate-treated patients with osteoporosis remains unsettled. A common reason for such monitoring is to encourage ongoing medication adherence. We sought to determine if a DXA-BMD treatment monitoring test was associated with improved medication adherence and whether improved adherence after a DXA-BMD treatment monitoring test was associated with subsequent reduction in fracture rates. Using linked administrative databases within Manitoba, Canada, we performed a retrospective cohort study of women starting and continuing antiresorptive therapy in whom a mid-treatment DXA-BMD monitoring test was performed. From the provincial pharmacy database, we estimated medication adherence by calculating annual medication possession ratio (MPR) and determining the change in MPR with respect to change (stable/decrease) in the DXA-BMD monitoring test, in addition to fracture rates before and after the test. The cohort comprised 3418 women, 90.7% treated with oral bisphosphonate, with pharmacy data for the 3 years before and after the mid-treatment DXA-BMD. Median (interquartile range) MPR was 0.84 (0.49–0.99) in the year before DXA-BMD and 0.84 (0.48–0.99) in the year after DXA-BMD (p = 0.37). Among those whose DXA-BMD declined, MPR in the prior year was 0.54 (0.04–0.92) but improved to 0.70 (0.31–0.92) in the year after DXA-BMD (p < 0.001). Among those whose DXA-BMD monitoring test was stable/improved, the fracture rate before the monitoring DXA-BMD was 10.1 per 1000 person-years and in those whose DXA-BMD monitoring test showed a decrease, the rate was 23.7 per 1000 person-years (p < 0.001). Despite improved adherence in those with DXA-BMD decline, the post DXA-BMD fracture rate was 22.4 per 1000 person-years versus 12.9 per 1000 person-years in those who had stable DXA-BMD (p < 0.001). A mid-treatment DXA-BMD reassessment strategy may be useful to focus attention upon adherence, but for optimal fracture outcomes, treatment adherence should be specifically addressed at the commencement of therapy. © 2021 American Society for Bone and Mineral Research (ASBMR). 相似文献
993.
Daniel M. Green Mingjuan Wang Matthew Krasin DeoKumar Srivastava Songul Onder Dennis W. Jay Kirsten K. Ness William Greene Jennifer Q. Lanctot Kyla C. Shelton Liang Zhu Daniel A. Mulrooney Matthew J. Ehrhardt Andrew M. Davidoff Leslie L. Robison Melissa M. Hudson 《Journal of the American Society of Nephrology : JASN》2021,32(4):983
BackgroundSurvivors of childhood cancer may be at increased risk for treatment-related kidney dysfunction. Although associations with acute kidney toxicity are well described, evidence informing late kidney sequelae is less robust.MethodsTo define the prevalence of and risk factors for impaired kidney function among adult survivors of childhood cancer who had been diagnosed ≥10 years earlier, we evaluated kidney function (eGFR and proteinuria). We abstracted information from medical records about exposure to chemotherapeutic agents, surgery, and radiation treatment and evaluated the latter as the percentage of the total kidney volume treated with ≥5 Gy (V5), ≥10 Gy (V10), ≥15 Gy (V15), and ≥20 Gy (V20). We also used multivariable logistic regression models to assess demographic and clinical factors associated with impaired kidney function and Elastic Net to perform model selection for outcomes of kidney function.ResultsOf the 2753 survivors, 51.3% were men, and 82.5% were non-Hispanic White. Median age at diagnosis was 7.3 years (interquartile range [IQR], 3.3–13.2), and mean age was 31.4 years (IQR, 25.8–37.8) at evaluation. Time from diagnosis was 23.2 years (IQR, 17.6–29.7). Approximately 2.1% had stages 3–5 CKD. Older age at evaluation; grade ≥2 hypertension; increasing cumulative dose of ifosfamide, cisplatin, or carboplatin; treatment ever with a calcineurin inhibitor; and volume of kidney irradiated to ≥5 or ≥10 Gy increased the odds for stages 3–5 CKD. Nephrectomy was significantly associated with stages 3–5 CKD in models for V15 or V20.ConclusionsWe found that 2.1% of our cohort of childhood cancer survivors had stages 3–5 CKD. These data may inform screening guidelines and new protocol development. 相似文献
994.
995.
Brian C. Lau Carolyn A. Hutyra Juan Marcos Gonzalez Richard C. Mather Brett D. Owens William N. Levine Grant E. Garrigues John D. Kelly David Kovacevic Jeffrey S. Abrams Frances Cuomo Patrick J. McMahon Scott Kaar Joshua S. Dines Anthony Miniaci Sameer Nagda Jonathan P. Braman Alicia K. Harrison Jonathan C. Riboh 《Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]》2021,30(3):e85-e102
996.
997.
Frontal Plane Rotation of the First Ray in Hallux Valgus using Standing Computerized Tomography (CT)
Jacob R. Randich Kelly J. John Kayéromi Gomez William Bush 《The Journal of foot and ankle surgery》2021,60(3):489-493
The purpose of the present study was to analyze the difference in frontal plane rotation of the entire first ray in patients with and without hallux valgus using standing weightbearing computed tomography (CT). Ten feet of 10 patients with hallux valgus and 36 feet of 36 patients without hallux valgus were examined. Standing weightbearing CT scans and radiographs were taken for all subjects. Frontal plane measurements of the sesamoid apparatus, first metatarsal head, first metatarsal base, and medial cuneiform were performed. Frontal plane rotation of the first tarsometatarsal joint and intrinsic first metatarsal torsion was calculated. An independent 2 sample t test was used to compare means of outcomes of interest across control and treatment groups. Statistical significance was set at an alpha level of 0.05. There was a significant increase in pronation of the sesamoid apparatus (23.49° vs 6.60°) and first metatarsal head (17.79° vs 9.81°) in patients with hallux valgus. There was a significant increase in first metatarsal torsion toward pronation in patients with hallux valgus (22.28° vs 13.52°). No significant difference was detected in the rotation at the first tarsometatarsal joint or the frontal plane orientations of the first metatarsal base and medial cuneiform. By examining the frontal plane position of the entire first ray during weightbearing using standing CT in patients with and without hallux valgus, we determined the level at which pronation originates to be within the first metatarsal bone rather than the first tarsometatarsal joint. 相似文献
998.
Weiss Anna Campbell Jordan Ballman Karla V. Sikov William M. Carey Lisa A. Hwang E. Shelley Poppe Matthew M. Partridge Ann H. Ollila David W. Golshan Mehra 《Annals of surgical oncology》2021,28(11):5960-5971
Annals of Surgical Oncology - De-escalation of axillary surgery after neoadjuvant chemotherapy (NAC) requires careful patient selection. We seek to determine predictors of nodal pathologic complete... 相似文献
999.
Herremans Kelly M. Cribbin Morgan P. Riner Andrea N. Neal Dan W. Hollen Tracy L. Clevenger Pamela Munoz Derly Blewett Shannon Giap Fantine Okunieff Paul G. Mendenhall Nancy P. Bradley Julie A. Mendenhall William M. Mailhot-Vega Raymond B. Brooks Eric Daily Karen C. Heldermon Coy D. Marshall Julia K. Hanna Mariam W. Leyngold Mark M. Virk Sarah S. Shaw Christiana M. Spiguel Lisa R. 《Annals of surgical oncology》2021,28(10):5775-5787
Annals of Surgical Oncology - Breast cancer-related lymphedema (BCRL) is a source of postoperative morbidity for breast cancer survivors. Lymphatic microsurgical preventive healing approach... 相似文献
1000.