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Multi-institutional Study (multi-institutional + study)
Selected AbstractsOutcome of Pulmonary Valve Replacements in Adults after Tetralogy Repair: A Multi-institutional StudyCONGENITAL HEART DISEASE, Issue 3 2008Thomas P. Graham Jr. MD ABSTRACT Objective., The purpose of this study was to assess the outcome of pulmonary valve replacement (PVR) in adults with moderate/severe pulmonary regurgitation after tetralogy repair, with particular emphasis on patient outcome, durability of valve repair, and improvement in symptomatology. Design/Setting/Patients., The project committee of the International Society of Congenital Heart Disease undertook a retrospective multi-institutional analysis of PVR. Seven centers participated in submitting data on 93 patients >18 years of age who had the operation performed and follow-up obtained. The average age of PVR was 26± years (median 27 years). Time of follow-up after replacement was 3 years (range 4 days,28 years). Outcomes/Measures/Results., Kaplan,Meier estimates of durability of PVR showed approximately 50% replacement at 11 years. There were two deaths at 6 and 12 months after valve replacement. Right ventricular (RV) size estimated by echocardiography from pre- to postoperative studies decreased in 81% (P < 0.001 testing for equal proportions), but RV systolic function increased in only 36% (P = 0.09). Ability index improved in 59% (P < 0.001) and clinical heart failure status improved in 57% with this problem before PVR. PVR did not improve arrhythmia status in a small group of patients. Conclusions., PVR is associated with low mortality, decrease in RV size and improvement in ability index, and uncertain effects on RV systolic function. Average valve durability was approximately 11 years. Criteria for PVR that will preserve RV function are not clearly identified, and management of these patients remains a difficult enterprise. [source] Multi-institutional study of barriers to research utilisation and evidence-based practice among hospital nursesJOURNAL OF CLINICAL NURSING, Issue 13-14 2010Caroline E Brown Aims., The study aims were to explore the relationships between perceived barriers to research use and the implementation of evidence-based practice among hospital nurses and to investigate the barriers as predictors of implementation of evidence-based practice. Background., Evidence-based practice is critical in improving healthcare quality. Although barriers to research use have been extensively studied, little is known about the relationships between the barriers and the implementation of evidence-based practice in nursing. Design., Cross-sectional study. Method., Data were collected between December 2006,January 2007 for this cross-sectional study using computerised Evidence-Based Practice Questionnaire and BARRIERS surveys. A convenience sample (n = 1301) of nurses from four hospitals in southern California, USA, participated. Hierarchical multiple regression analyses were performed for each of the three dependent variables: practice, attitude and knowledge/skills associated with evidence-based practice. BARRIERS subscales were used as predictor variables. Results., The perceived barriers to research use predicted only 2·7, 2·4 and 4·5% of practice, attitude and knowledge/skills associated with evidence-based practice. Conclusions., It was unexpected that the barriers to research use predicted such small fractions of practice, attitude and knowledge/skills associated with evidence-based practice. The barriers appear to have minimal influence over the implementation of evidence-based practice for most hospital nurses. Relevance to clinical practice., In implementing evidence-based practice, the focus on barriers to research use among general nursing staff may be misplaced. Further studies are needed to identify the predictors of evidence-based practice and to identify the subset of nurses who are most amenable to adopting evidence-based practice. [source] Alpha-methylacyl-CoA racemase: a multi-institutional study of a new prostate cancer markerHISTOPATHOLOGY, Issue 3 2004Z Jiang Aim :,To test whether ,-methylacyl-CoA racemase (AMACR) is a sensitive and specific marker of prostate cancer. Methods and results :,The expression levels of AMACR mRNA were measured by real-time polymerase chain reaction. A total of 807 prostatic specimens were further examined by immunohistochemistry specific for AMACR. Quantitative immunostaining analyses were carried out by using the ChromaVision Automated Cellular Imaging System and the Ariol SL-50 Imaging System, respectively. AMACR mRNA levels measured in prostatic adenocarcinoma were 55 times higher than those in benign prostate tissue. Of 454 cases of prostatic adenocarcinoma, 441 were positive for AMACR, while 254 of 277 cases of benign prostate were negative for AMACR. The sensitivity and specificity of AMACR immunodetection of prostatic adenocarcinomas were 97% and 92%, respectively. Both positive and negative predictive values were 95%. By automatic imaging analyses, the AMACR immunostaining intensity and percentage in prostatic adenocarcinomas were also significantly higher than those in benign prostatic tissue (105.9 versus 16.1 for intensity, 45.7% versus 0.02% and 35.03% versus 4.64% for percentage, respectively). Conclusions :,We have demonstrated the promising features of AMACR as a biomarker for prostate cancer in this large series and the potential to develop automated quantitative diagnostic tests. [source] Evaluation of antifungals in the surgical intensive care unit: a multi-institutional studyMYCOSES, Issue 3 2006Kevin W. Garey Summary In the USA, >50% of candidemia episodes occur in medical or surgical intensive care units (SICU). However, studies focused on patterns and rationale for antifungal use are lacking. The objective of this study was to evaluate systemic antifungal usage in SICU patients. Retrospective audit of SICU patients receiving antifungal therapy from four American hospitals. Medical records were reviewed for demographics, hospital variables, microbiology results, antifungal regimens and indications for therapy. A total of 2411 patient-days of antifungal use were evaluated in 225 patients. Fluconazole was the most frequently prescribed antifungal (1846 patient-days) followed by amphotericin B deoxycholate (251 patient-days), lipid formulations of amphotericin B (201 patient-days), itraconazole (71 patient-days), and caspofungin (42 patient-days). Antifungals were prescribed empirically (44%), for preemptive therapy in critically ill patients colonised with Candida (43%), or for candidiasis (12%). Candida species were recovered from 98% of patients with positive fungal cultures most commonly from pulmonary (53%) or urinary sources (17%). Fluconazole is the most frequently prescribed antifungal agent in SICUs and is most often prescribed for empiric or preemptive indications. Research efforts to identify patients who warrant preemptive antifungal therapy for invasive candidiasis could dramatically change antifungal prescribing patterns in the SICU. [source] Nocturia: An austrian study on the multifactorial etiology of this symptom,,NEUROUROLOGY AND URODYNAMICS, Issue 5 2009H. Christoph Klingler Abstract Aims To identify the different factors contributing to nocturia in a clinical setting. Patients and Methods Three hundred twenty-four patients (133 women, 191 men; mean age 63 years) were entered into this multi-institutional study. When presenting with nocturia we obtained detailed medical history and performed urine analysis, post-void residual volume and renal ultrasonography. Bothersome score and quality of life were evaluated using visual analogue scale and Kings' Health Questionnaire (KHQ), respectively. Patients were asked to complete a 48-hr voiding diary (VD). Nocturia and its associated problems were evaluated using KHQ and VD in conjunction with concurrent health variables. Results Mean nocturia was 2.8 in men versus in 3.1 women. Fifty percent of patients were aged >65 years, 60% had daytime lower urinary tract symptoms (LUTS) as well as nocturia, 33% had cardiac pathologies and 7% had peripheral edema. Principal causes for nocturia were global polyuria in 17%, nocturnal polyuria (NP) in 33% and reduced functional capacity <250 ml in 16.2%; 21.2% had mixed forms of NP and reduced bladder capacity and 12.6% suffered from other causes. Mean bothersome score was higher in women (P,<,0.001) and in patients with NP (P,=,0.012). Quality of life was significantly lower in women (P,=,0.001), in patients aged >65 years (P,=,0.029) and in those with reduced functional capacity (P,<,0.001). Mean voided 24-hr urine was higher in women (P,=,0.033) and in patients aged <65 years (P,=,0.019). Conclusions Nocturia had a high impact on bothersome score, strong associations with poor health and other LUTS. NP was the predominant cause of nocturia. Neurourol. Urodynam. 28:427,431, 2009. © 2009 Wiley-Liss, Inc. [source] Essential versus reactive thrombocythemia in children: Retrospective analyses of 12 casesPEDIATRIC BLOOD & CANCER, Issue 1 2007Abeer Abd El-Moneim Abstract Background Essential thrombocythemia (ET) rarely occurs in the pediatric population and little is known about the clinical course and the molecular characteristics. Procedure In this retrospective multi-institutional study we examine the clinical, hematological, and molecular features of 12 children aged 5,16 years with thrombocytosis and a suspected diagnosis of ET. Results Median follow-up was 59 months (range 10,72). Seven patients presented with clinical symptoms potentially related to thrombocytosis. The remaining five patients were diagnosed incidentally. Median platelet count at diagnosis was 1,325,×,109/L (range 600,3,050). In 11 out of 12 cases bone marrow morphology was consistent with ET, the remaining patient had chronic idiopathic myelofibrosis. Cytogenetic analyses were normal in all studied cases and only one out of nine analyzed cases harbored a JAKV617F allele. Within 6 months after initial presentation one patient who was initially asymptomatic developed thrombosis and another patient had mild bleeding. Eight patients were treated with acetylsalicylic acid, one patient received hydroxyurea, and two patients received anagrelide. At last follow-up, all patients were alive and none had developed leukemia. Five patients experienced hematological remission. Two children had not received any therapy. During the course of their disease, nine patients developed symptoms possibly attributable to an elevated platelet count. Conclusions In JAK2 mutation negative cases, long-term follow-up is helpful to distinguish between primary and secondary thrombocytosis. Secondary cases are not associated with organomegaly but may present with unspecific symptoms. Indications for treatment in children remain unclear. Pediatr Blood Cancer 2007;49:52,55. © 2006 Wiley-Liss, Inc. [source] Balloon valvuloplasty for congenital heart disease: Immediate and long-term results of multi-institutional studyPEDIATRICS INTERNATIONAL, Issue 5 2001Shigeyuki EchigoArticle first published online: 21 DEC 200 AbstractBackground and Objectives: Several studies have been reported in Japan. However, the reports consist of small series at individual institutions. We evaluated the immediate to long-term results of balloon valvuloplasty (BVP) of congenital pulmonary and aortic stenosis at multi-institutions in Japan. Methods and Results: Immediate and follow-up data were obtained from eight institutions in Japan. In our series of 172 cases of pulmonary valuvuloplasty excluding critical pulmonary stenosis, the mean pressure gradient decreased immediately after BVP from 61~27 mmHg to 28~20 mmHg and the reduced gradient continued at follow-up in most cases. The BVP for critical pulmonary stenosis could be accomplished in 35 of 39 patients. The mean right ventricular systolic pressure decreased from 102~29 mmHg to 62~23 mmHg. One of them required the surgical operation for perforation of the right ventricular outflow tract. In BVP for congenital aortic valvular stenosis of 77 cases excluding critical aortic stenosis, the mean pressure gradient decreased immediately after BVP from 68~24 mmHg to 34~23 mmHg. Thirty-one cases (55%) were free from any interventions in long-term follow-up. The BVP for critical aortic stenosis was performed in 29 neonates. The overall mortality rate was 34% and 24% of the patients required repeat intervention. The remaining 42% was free from any interventions. Conclusions: Balloon valvuloplasty for congenital pulmonary valvular stenosis is a safe and effective procedure and the initial treatment of choice. In spite of an occasional major complication, BVP for critical pulmonary stenosis is effective in many infants. Balloon aortic valvuloplasty is palliative. However, this procedure has the efficacy in deferring the surgical intervention. Balloon valvuloplasty for neonatal critical aortic stenosis is a useful method to recover from serious conditions. [source] Haematological and biochemical findings in cats in Australia with lymphosarcomaAUSTRALIAN VETERINARY JOURNAL, Issue 7 2000LJ GABOR Objective To describe, for the first time, haematological and serum biochemical findings in cases of lymphosarcoma in Australian cats. Design A prospective multi-institutional study. Procedure Of 118 affected cats presented to the authors over a 18-month period, 97 were evaluated haematologically and 87 biochemically. Haematological analysis usually included determination of packed cell volume, haemoglobin concentration, red blood cell and leukocyte counts, differential leukcocyte count, reticulocyte count and examination of buffy-coat smears for neoplastic cells. Serum biochemical analysis was done primarily with a discrete analyser and included a panel of commonly used analytes. Results Nonregenerative anaemia was present in 54% (52/97) of cats. Neutrophilia, present in 65% (59/91) of cats, was commonly associated with lymphocytopaenia, eosinopaenia and monocytosis. Of the 13 cats with a secondary leukaemic manifestation, only five had distinct lymphocytosis. Serum biochemical abnormalities either were nonspecific, such as hypoglycaemia in 37% (32/87) of cats, or related to specific tissue involvement, such as hypoalbuminaemia in 76% (31/41) of cats with alimentary involvement and azotaemia in 60% (15/25) of cats with renal involvement. Conclusion It was shown for the first time that haematological and serum biochemical findings are of limited value in diagnosing lymphosarcoma in Australian cats, except if they are leukaemic. Although clinical pathological changes were common, they were nonspecific or related to specific tissue involvement. Their value in assessing response to therapy needs to be examined further. Patient characteristics such as age, breed and sex also had limited effect on laboratory findings and those observed were of little consequence. Additionally, histological and immunophenotypical variations in tumour type had little effect on laboratory findings. [source] Procedural results and acute complications in stenting native and recurrent coarctation of the aorta in patients over 4 years of age: A multi-institutional studyCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2007Thomas J. Forbes MD Abstract Background: We report a multi-institutional experience with intravascular stenting (IS) for treatment of coarctation of the aorta. Methods and Results: Data was collected retrospectively by review of medical records from 17 institutions. The data was broken down to prior to 2002 and after 2002 for further analysis. A total of 565 procedures were performed with a median age of 15 years (mean = 18.1 years). Successful reduction in the post stent gradient (<20 mm Hg) or increase in post stent coarctation to descending aorta (DAo) ratio of >0.8 was achieved in 97.9% of procedures. There was significant improvement (P < 0.01) in pre versus post stent coarctation dimensions (7.4 mm ± 3.0 mm vs. 14.3 ± 3.2mm), systolic gradient (31.6 mm Hg ± 16.0 mm Hg vs. 2.7 mm Hg ± 4.2 mm Hg) and ratio of the coarctation segment to the DAo (0.43 ± 0.17 vs. 0.85 ± 0.15). Acute complications were encountered in 81/565 (14.3%) procedures. There were two procedure related deaths. Aortic wall complications included: aneurysm formation (n = 6), intimal tears (n = 8), and dissections (n = 9). The risk of aortic dissection increased significantly in patients over the age of 40 years. Technical complications included stent migration (n = 28), and balloon rupture (n = 13). Peripheral vascular complications included cerebral vascular accidents (CVA) (n = 4), peripheral emboli (n = 1), and significant access arterial injury (n = 13). Older age was significantly associated with occurrence of CVAs. A significant decrease in the technical complication rate from 16.3% to 6.1% (P < 0.001) was observed in procedures performed after January 2002. Conclusions: Stent placement for coarctation of aorta is an effective treatment option, though it remains a technically challenging procedure. Technical and aortic complications have decreased over the past 3 years due to, in part, improvement in balloon and stent design. Improvement in our ability to assess aortic wall compliance is essential prior to placement of ISs in older patients with coarctation of the aorta. © 2007 Wiley-Liss, Inc. [source] | ||||||||||