Initial Study Period Research Articles

Lesson Learned with the Use of Iliac Branch Devices: Single Centre 10 Year Experience in 157 Consecutive Procedures

Absence of an adequate iliac seal rarely represents an absolute contraindication to endovascular abdominal aortic aneurysm repair. Iliac branch devices (IBD) are increasingly used in patients with extensive aorto-iliac aneurysmal disease, but few data are available on the long-term results of these procedures. Between 2006 and 2016, 157 consecutive IBD procedures performed at a single centre were entered into a prospective database. Indications included unilateral or bilateral common iliac artery aneurysms combined or not with abdominal aortic aneurysms. Long-term results were reported according to the Kaplan-Meier method. During the study period 149 patients were treated with an iliac branched endograft. Isolated IBD was implanted in 17.8% of the cases; technical success rate was 97.5%. Peri-operative procedure failure occurred in seven patients, four during surgery and three within 30 days of the procedure. Presence of ipsilateral hypogastric aneurysm (p=.031; Exp [B]=6.72) and intervention performed during the initial study period (p=.006; Exp [B]=10.40) were predictive of early failure on multivariate analysis. After a mean follow-up of 44.2 months actuarial freedom from IBD related re-intervention was 97.4%, 95.6%, 94.0%, and 91.8% at 1, 3, 5, and 9 years, respectively. Hypogastric artery patency was 94.7%, 92.6%, and 90.4% at 1, 3, and 10 years, respectively. Presence of a hypogastric aneurysm was an independent predictor of target artery occlusion during follow-up on multivariate analysis (p=.007; Exp [B]=5.93). Iliac branched endografting can now be performed with a high technical success rate; long-term freedom from re-intervention is comparable with patients treated with standard aortic endografting. IBD should be considered a first-option treatment in patients with adequate vascular anatomy unsuitable for standard endovascular aortic repair.

Ascites in Children: A Single-Center Experience of 27 Years.

The aim of our study was to describe the changing prevalence, demographic features, etiologies, and treatment of ascites in children hospitalized during a 27-year period at the Johns Hopkins Hospital (Baltimore, MD). We retrospectively reviewed discharges from 1983 to 2010 to select patients whose records included a diagnosis of ascites. We assessed the etiologies and degrees of ascites (ascites grade 1 detectable only by radiologic tests; ascites grades 2 and 3 recognized by moderate and marked abdominal distension by physical examinations). We classified 518 children into 9 etiology groups: intrahepatic disease (IH) (105), hepatic vein outflow obstruction (HVOO) (45), congestive heart disease (CH) (33), nephrotic syndrome (NS) (36), pancreatitis (26), inflammatory and infectious diseases (77), malignancy (49), idiopathic (71), and miscellaneous (76). IH and CH were predominant in the younger age group (0-5 years) versus HVOO, pancreatitis, and malignancy in the older age group (13-21 years) (P < 0.001). The prevalence of ascites increased over time from 1983 to 2006 and declined thereafter. Ascites grade 1 was more common than ascites grades 2 and 3 in all the groups (P = 0.048). IH and NS were more likely to have ascites grade 2 and 3 (P = 0.02). Although spironolactone was more frequently used in the IH group versus other etiologies, furosemide was used more frequently in NS and CH versus other etiologies (P < 0.001). The increased prevalence of ascites during the initial study period could reflect improved detection radiologic detection. The proportion of severe ascites and the various medical treatments differed among the etiologic groups.

A Large-Scale Initiative Inviting Patients to Share Personal Fitness Tracker Data with Their Providers: Initial Results.

BackgroundPersonal fitness trackers (PFT) have substantial potential to improve healthcare.ObjectiveTo quantify and characterize early adopters who shared their PFT data with providers.MethodsWe used bivariate statistics and logistic regression to compare patients who shared any PFT data vs. patients who did not.ResultsA patient portal was used to invite 79,953 registered portal users to share their data. Of 66,105 users included in our analysis, 499 (0.8%) uploaded data during an initial 37-day study period. Bivariate and regression analysis showed that early adopters were more likely than non-adopters to be younger, male, white, health system employees, and to have higher BMIs. Neither comorbidities nor utilization predicted adoption.ConclusionOur results demonstrate that patients had little intrinsic desire to share PFT data with their providers, and suggest that patients most at risk for poor health outcomes are least likely to share PFT data. Marketing, incentives, and/or cultural change may be needed to induce such data-sharing.

A Novel Neonatal Feeding Intolerance and Necrotizing Enterocolitis Risk-Scoring Tool Is Easy to Use and Valued by Nursing Staff.

Preterm infants are at increased risk of developing feeding intolerance and necrotizing enterocolitis. Comprehensive, targeted nursing assessments can evaluate the risk for and identify early signs of these conditions in an effort to prevent their destructive sequela. While the long-term goal is to develop a validated risk-scoring tool for the prediction of feeding intolerance and necrotizing enterocolitis, the objective of the preliminary phase presented here is to assess the ease of use and nurses' attitudes toward a novel feeding intolerance and necrotizing enterocolitis risk-scoring tool. A novel risk-scoring nursing tool was implemented in a University of Illinois-affiliated 48-bed level III neonatal intensive care unit. Data were collected from the electronic medical record of all preterm infants with parental consent during the initial 6-month study period. Scoring accuracy (accuracy of selection of risk factors based on electronic medical record data), ease of use, and nurses' attitudes toward the tool were assessed at the study site and by evaluators at a national neonatal nursing conference. Fourteen nurses scored 166 tools on the 63 enrolled infants. Sixteen tools (9.6%) contained errors. Mean study site tool ease of use was 8.1 (SD: 2.2) on a 10-point scale. Ninety percent of conference evaluators agreed/strongly agreed that the tool addressed important knowledge gaps. The tool is easy to use and valued by nurses. Following validation, widespread implementation is expected to be a clinically feasible means to improve infant clinical outcomes for minimal time and financial cost. Tool validation and refinement based on nursing feedback will improve its broad applicability and predictive utility.

The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS): Unifying Efforts to Inform Practice and Improve Global Outcomes in Peritoneal Dialysis.

♦ Extending technique survival on peritoneal dialysis (PD) remains a major challenge in optimizing outcomes for PD patients while increasing PD utilization. The primary objective of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) is to identify modifiable practices associated with improvements in PD technique and patient survival. In collaboration with the International Society for Peritoneal Dialysis (ISPD), PDOPPS seeks to standardize PD-related data definitions and provide a forum for effective international collaborative clinical research in PD. ♦ The PDOPPS is an international prospective cohort study in Australia, Canada, Japan, the United Kingdom (UK), and the United States (US). Each country is enrolling a random sample of incident and prevalent patients from national samples of 20 to 80 sites with at least 20 patients on PD. Enrolled patients will be followed over an initial 3-year study period. Demographic, comorbidity, and treatment-related variables, and patient-reported data, will be collected over the study course. The primary outcome will be all-cause PD technique failure or death; other outcomes will include cause-specific technique failure, hospitalizations, and patient-reported outcomes. ♦ A high proportion of the targeted number of study sites has been recruited to date in each country. Several ancillary studies have been funded with high momentum toward expansion to new countries and additional participation. ♦ The PDOPPS is the first large, international study to follow PD patients longitudinally to capture clinical practice. With data collected, the study will serve as an invaluable resource and research platform for the international PD community, and provide a means to understand variation in PD practices and outcomes, to identify optimal practices, and to ultimately improve outcomes for PD patients.

A randomised controlled trial comparing the effects of a 12-week supervised exercise versus usual care on outcomes in haematological cancer patients.

Following treatment, haematological cancer (HEM) patients exhibit significant physical deconditioning and psychological distress. Exercise has been shown as a clinically effective and safe intervention for cancer patients, with the potential to reverse the deleterious effects following treatment. Our aim was to investigate the efficacy of a 12-week exercise rehabilitation on cancer-related fatigue (CRF) and associated outcomes in HEM patients post-treatment. Patients with a HEM were recruited to participate in a 12-week exercise rehabilitation intervention post-treatment. Pre-, post- and follow-up assessments were conducted on outcome measures including CRF, quality of life (QoL), psychological distress, cardiovascular fitness, muscle strength (MS) and body composition. Patients were given tailored exercise programmes comprising aerobic and resistance exercises, carried out three times per week for 12 weeks in local gyms and clinics. Usual-care participants were offered a delayed, tailored 12-week exercise intervention after the initial study period. Thirty-seven patients (49 % recruitment rate) were randomly assigned to the 12-week exercise rehabilitation (n = 18) or usual care (n = 19) with a 91 % adherence to the exercise intervention. Following the exercise programme, significant improvements were seen in CRF (p = 0.01), cardiovascular fitness (p ≤ 0.001), QoL (p ≤ 0.001), MS (p ≤ 0.001) and body composition (p = 0.001), with moderate to large effects for all primary outcomes. Patient follow-up at 24 weeks demonstrated outcome maintenance in the exercise rehabilitation group and significant improvements in outcomes in usual-care patients following participation in a delayed exercise programme. There were no adverse reactions or study withdrawals. A 12-week exercise rehabilitation programme resulted in significant statistical (p ≤ 0.05) and clinical improvements in CRF and additional outcomes in HEM patients following treatment. Additionally, a 12-week delayed exercise programme showed similar significant improvements in patient outcomes. Australian New Zealand Clinical Trials Registry ACTRN12609000450213.

Substrate choice by the alien snail Ferrissia fragilis (Gastropoda: Planorbidae) in an industrial area: A case study in a forest pond (Southern Poland)

AbstractThe aims of this study were to determine the substrate choice by the alien snail Ferrissia fragilis (Tryon, 1863) (Phragmites australis and Typha latifolia remains, Nuphar lutea floating leaves and leaf deposit) as well as the environmental factors that influence the occurrence of this species. From 9 (T. latifolia and P. australis) to 11 (leaf deposit) snail species occurred on each type of substrate. F. fragilis belonged to the eudominants on most of the substrate types. This species reached its highest average density on floating N. lutea leaves (271 ind. m−2) and the lowest was on P. australis (60 ind. m−2). It occurred in different periods during the snail collection: in the initial study period on the floating N. lutea leaves (May) and on P. australis in the final period of the study (September). In July, we found a few specimens in the postseptal form on T. latifolia remains. The results of RDA analysis confirm the association between F. fragilis and T. latifolia as well as with floating N. lutea leaves. F. fragilis occurs at sites that have a higher content of calcium and iron in the water. Alien species more increasingly appear in disturbed anthropogenic water-bodies. An important vector in the dispersion of F. fragilis was probably the water birds or the economic activities that are related with the use of this forest pond. Studies on the occurrence of alien species contribute important data on the activities that are taken to preserve the biodiversity of freshwater environments

Who (Dis)Continues to use SMS in the Age of Ubiquitous Mobile Internet Access?

Using data of 11526 residential postpaid subscribers of the German subsidiary of a multinational mobile network operator (MNO) extracted from the firm's customer and billing records, this investigation empirically examines the association between monthly mobile Internet (MI) data traffic volume generated by consumers and their monthly number of SMS sent at the within- and between-subjects levels over 25 months from October 2011 to October 2013. Multilevel analysis of the time-varying and -constant study variables suggests that, in spite of a sharp decrease in the average/median number of outgoing SMS in the course of the investigation period, customer heterogeneity with regard to the relationship between MI and SMS use intensities is very large. The number of customers with a negative with-person regression slope for MI data volume is almost as high as the number of consumers, whose slope is positive. Subscribers, who are most likely to reduce their SMS volume in parallel to an increase of their MI data traffic, are persons, who (1) are heavy SMS users in the initial study period (October 2011), (2) are female, (3) have a longer MNO tenure, (4) are currently in an SMS flat price scheme, (5) are presently equipped with an Apple iPhone or a Samsung Galaxy smartphone and (6) put their current handset into operation more recently. Implications of these findings for service-marketing strategies of MNO and for future research on demand interdependencies between relatively newly introduced and well-established mobile communications services are discussed.

Not New, but Nearly Forgotten: the Testing Effect Decreases or even Disappears as the Complexity of Learning Materials Increases

The testing effect is a finding from cognitive psychology with relevance for education. It shows that after an initial study period, taking a practice test improves long-term retention compared to not taking a test and—more interestingly—compared to restudying the learning material. Boundary conditions of the effect that have received attention include the test format, retrieval success on the initial test, the retention interval, or the spacing of tests. Another potential boundary condition concerns the complexity of learning materials, that is, the number of interacting information elements a learning task contains. This insight is not new, as research from a century ago already had indicated that the testing effect decreases as the complexity of learning materials increases, but that finding seems to have been nearly forgotten. Studies presented in this special issue suggest that the effect may even disappear when the complexity of learning material is very high. Since many learning tasks in schools are high in element interactivity, a failure to find the effect under these conditions is relevant for education. Therefore, this special issue hopes to put this potential boundary condition back on the radar and provide a starting point for discussion and future research on this topic.

SMS use intensity changes in the age of ubiquitous mobile Internet access – A two-level investigation of residential mobile communications customers in Germany

Using data of 11526 residential postpaid subscribers of the German subsidiary of a multinational mobile network operator (MNO) extracted from the firm’s customer and billing records, this investigation empirically examines the association between monthly mobile Internet (MI) data traffic volume generated by consumers and their monthly number of SMS sent at the within- and between-subjects levels over 25months from October 2011 to October 2013. Multilevel analysis of the time-varying and -constant study variables suggests that, in spite of a sharp decrease in the average/median number of outgoing SMS between the first and the last study month, customer heterogeneity with regard to the relationship between MI and SMS use intensities is very large. The number of customers with a negative within-person regression slope for MI data volume is almost as high as the number of consumers, whose slope is positive. Subscribers, who are most likely to reduce their SMS volume in parallel to an increase of their MI data traffic, are persons, who (1) are heavy SMS users in the initial study period (October 2011), (2) are female, (3) have a longer MNO tenure, (4) are currently in an SMS flat price scheme, (5) are presently equipped with an Apple iPhone or a Samsung Galaxy smart phone and (6) put their current handset into operation more recently. Implications of these findings for service-marketing strategies of MNO and for future research on demand interdependencies between relatively newly introduced and well-established mobile communications services are discussed.

Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes

Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. Recent 52-week randomized controlled and open label studies have reported improvement of knee OA-specific outcomes compared to baseline status, and blinded saline control injections and at-home exercise therapy (p<0.05). However, long term effects of prolotherapy for knee OA are unknown. We therefore assessed long-term effects of prolotherapy on knee pain, function and stiffness among adults with knee OA. Post clinical-trial, open-label follow-up study. Outpatient; adults with mild-to-severe knee OA completing a 52-week prolotherapy study were enrolled. Participants received 3-5 monthly interventions and were assessed using the validated Western Ontario McMaster University Osteoarthritis Index, (WOMAC, 0-100 points), at baseline, 12, 26, 52 weeks, and 2.5 years. 65 participants (58±7.4 years old, 38 female) received 4.6±0.69 injection sessions in the initial 17-week treatment period. They reported progressive improvement in WOMAC scores at all time points in excess of minimal clinical important improvement benchmarks during the initial 52-week study period, from 13.8±17.4 points (23.6%) at 12 weeks, to 20.9±2.8 points, (p<0.05; 35.8% improvement) at 2.5±0.6 years (range 1.6-3.5 years) in the current follow-up analysis. Among assessed covariates, none were predictive of improvement in the WOMAC score. Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function and stiffness scores among most participants through a mean follow-up of 2.5 years and may be an appropriate therapy for patients with knee OA refractory to other conservative care.

Factors associated with periesophageal vagal nerve injury after pulmonary vein antrum isolation.

BackgroundPeriesophageal vagal nerve injury is recognized as a rare complication in atrial fibrillation ablation procedures. We investigated the factors associated with the occurrence of symptomatic periesophageal vagal nerve injury after pulmonary vein antrum isolation.Methods and ResultsOverall, 535 consecutive patients who underwent sole pulmonary vein antrum isolation were included. Point‐by‐point radiofrequency applications were applied using irrigated‐tip catheters under minimal sedation without esophageal temperature monitoring. In the initial 165 patients, the ablation settings for the posterior left atrium were a maximum energy of 25 to 30 W and a duration of 30 seconds. In the subsequent 370 patients, the power was additionally limited to 20 to 25 W at specific parts of the posterior left atrium where the ablation line transversed the esophagus. Symptomatic gastric hypomotility was found in 13 patients, and all were observed during the initial period (7.9%). No other collateral damage was observed. Logistic regression analysis revealed that the body mass index was the only independent predictor for identifying patients with gastric hypomotility (odds ratio 0.770; 95% confidence interval 0.643 to 0.922; P=0.0045) during the initial period. The prevalence of gastric hypomotility was significantly higher in the initial study period than subsequently (0 of 370, 0%; P<0.0001). All except for 1 patient recovered completely with conservative treatment within 4 months after the procedure.ConclusionsPeriesophageal vagal nerve injury is more common collateral damage than direct esophageal injury in pulmonary vein antrum isolation procedures. Titrating the radiofrequency energy at specific areas where the ablation line transverses the esophagus and taking account of the body mass index might reduce occurrences not only of direct esophageal damage but also of periesophageal vagal nerve injury in pulmonary vein antrum isolation procedures.

Long-Term Quality of Life (QOL) After Chemo-IMRT for Locally Advanced Oropharyngeal Cancer (OPC): A Prospective Longitudinal Study

Long-Term Quality of Life (QOL) After Chemo-IMRT for Locally Advanced Oropharyngeal Cancer (OPC): A Prospective Longitudinal Study

Self-Extubation in the Surgical Intensive Care Unit and Restraint Policy Change: A Retrospective Study

Background:Self-extubation is a serious complication of mechanical ventilation. The incidence of self-extubation in a university hospital may be altered by a recent policy change, which requires daily written and face-to-face patient re-evaluations regarding the need for restraints in the intensive care units. There are many concerns and suspicions that this might result in less use of restraints and thereby increase the risk of self-extubation.Methods:The goal of this study was to describe the incidence of self-extubation (SE) over time and report any observed change with the change in restraint policy (RP).Results:The rate of self-extubation during the control year was 1.62% which increased to 2.33% during the initial study period and decreased to 1.30% in the following year. The distant follow-up period eight years after the initial change in restraint policy showed a rate of 1.14%. Apache scores did not differ significantly between the years compared.Conclusion:A new restraint policy, which requires frequent reordering by physicians, has the potential to be associated with increased self-extubation, at least temporarily. Staff education may help reduce this risk. Further research will be useful in clarifying which interventions can most reduce this potentially life-threatening complication.

OP0034 Identification of Genetic Variants Associated with Response to Methotrexate in Patients with Early Rheumatoid Arthritis: Results from the Optima Study

BackgroundGenetic factors related to treatment response in rheumatoid arthritis (RA) have been described. International recommendations for the management of RA suggest initial therapy with synthetic DMARDs, with methotrexate (MTX) typically...

Evaluation and revision of an introduction to experiential rotations course

ObjectiveThe objectives of this study were to evaluate the perceived student value of topics taught in a university’s Introduction to Experiential Rotations (RX500) course, implement course revisions to address any perceived weaknesses, and to reassess the course following implementation of those course revisions.MethodsAdvanced Pharmacy Practice Experience (APPE) students from the university’s 2012 doctorate of pharmacy class were initially surveyed to assess the perceived usefulness and design of RX500. Based on the findings of the initial data, course revisions were developed and implemented for the following semester’s RX500 course. In order to assess for potential changes in the perceived value of the course following implementation, a follow-up survey was sent to students completing the revised course in the fall of 2012.ResultsFifty-eight students completed the initial survey in the fall of 2011, and 34 completed the follow-up survey in the fall of 2012. The majority of students in the both groups had completed at least four APPE experiences at the time of survey completion. Both of the study groups rated hands-on activities and visual presentations as their most beneficial learning styles within a classroom setting. Based on the initial survey findings, two topics were removed from the course, two topics were revised within the course, and three topics were added to the course. The follow-up survey results indicated an increased perceived usefulness of the two revised topics; however, the three new topics added to the course had mixed results.ConclusionsData from the initial study period identified perceived areas for improvement in the course’s ability to prepare pharmacy students for the APPE year. Following course revisions based on student perceptions, follow-up surveys indicated improvements in the perceived values of the revised topics. Faculty can continue, however, to work on delivery of newer topics being added to the APPE preparation course.

Accelerated Aging of Bio-oil from Fast Pyrolysis of Hardwood

Bio-oil is chemically and thermally unstable during storage and transportation. For that reason, it is necessary to evaluate the changes in the properties (chemical and physical) of bio-oil during storage to understand its chemical instability, which will further assist researchers in stabilization strategies. This paper describes the evaluation of an accelerated aging process on the physical and chemical properties of bio-oil from fast pyrolysis of ash and birch woods using two different pyrolyzers, a pilot scale (auger) and lab scale (tube furnace), respectively. The produced oils (freshly made) were aged at 80 °C over different periods (1, 3, and 7 days) in sealed nitrogen-purged Nalgene vessels. Fresh oil was analyzed alongside aged oils. Bio-oils were characterized by viscometer, Karl Fischer titration (H2O), pyrolysis–gas chromatography/mass spectrometry (GC/MS), thermogravimetric analysis (TGA), photo-microscopy, 13C nuclear magnetic resonance (NMR), and Fourier transform infrared spectroscopy (FTIR). The water content, viscosity, decomposition temperature (TGA) and ash content levels in bio-oil samples all increased as the aging period lengthened. GC/MS analysis showed a major reduction in GC-analyzable components. The mass of residue remaining after pyrolysis–GC/MS increased, and the structures of pyrolysis products of this non-volatile residue along with NMR and FTIR data suggest the following aging processes; some of the reactive compounds undergo polymerization or reaction with other compounds, including olefins, alcohols, and aldehydes. Some possible reaction mechanisms are given. The oils remained as a single phase throughout the initial study period; however, on day 7, a clear phase separation was observed by photo-microscopy.

Abstract P4-05-07: Molecular profiles of screen detected breast cancers: Final results of Turkish Bahcesehir breast cancer screening project

Abstract Objectives: Turkish Bahcesehir Breast Cancer Screening Project is a 10-year organized population based screening program carried out in one of the largest counties of Istanbul, Turkey. The aim of our study is to examine the biological features of screen detected breast cancers detected during the initial 4-year study period as an interim analysis. Study Design and Methods: Between January 2009 and May 2013, a total of 6298 women with ages 40–69 years were recruited in this prospective study. Two-view mammographies were obtained by 2-year intervals, and classified according to Breast Imaging Reporting and Data System of the American College of Radiology (ACR). Clinicopathological and biological tumor characteristics were analysed for those diagnosed with breast cancer. Tumors were stained for estrogen (ER) and progesterone receptors (PR), HER2-neu and Ki-67 by immunohistochemistry. Results: A total of 57 breast cancers (%0.9) were detected during the study period. The median age was 50 (40-70). The majority of patients (72%) were stage 0 or 1, whereas 28 patients (49%) were &amp;lt;50 age. Of 57 tumors, 45 (79%) were invasive cancers and 12 (21%) were ductal carcinoma in situ. Forty-eight patients (86%) underwent breast conservation, whereas 37 patients (65%) had sentinel lymph node biopsy only as axillary procedure. Of 45 invasive cancers, 31 (69%) were ductal carcinoma and 8 (18%) were pure lobular cacinoma. Among 45 invasive cancers stained for ER, PR, HER2-neu and Ki67, the majority of them (91%) were ER or PR receptor positive, whereas 11% were HER2-neu positive and 58% had low Ki67 levels (≤15). As molecular subtypes, the majority of them were found to be either luminal A (57%) or luminal B type (34%), whereas other nonluminal HER2 (4%) and triple negative cancers (5%) were less frequently detected. Conclusions: Our findings suggest that the majority of screen-detected breast cancers exhibit either luminal A or B subtype. However, more aggressive subtypes such as nonluminal HER2-neu or triple negative cancer are less likely to be detected by mammographic screening programs, requiring other preventive strategies. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-05-07.

Weekly Dose Reports: The Effects of a Continuous Quality Improvement Initiative on Coronary Computed Tomography Angiography Radiation Doses at a Tertiary Medical Center

Numerous protocols have been developed to reduce cardiac computed tomography angiography (cCTA) radiation dose while maintaining image quality. However, cCTA practice is highly dependent on physician and technologist experience and education. In this study, we sought to evaluate the incremental value of real-time feedback via weekly dose reports on a busy cCTA service. This time series analysis consisted of 450 consecutive patients whom underwent physician-supervised cCTA for clinically indicated native coronary evaluation between April 2011 and January 2013, with 150 patients before the initiation of weekly dose report (preintervention period: April-September 2011) and 150 patients after the initiation (postintervention period: September 2011-February 2012). To assess whether overall dose reductions were maintained over time, results were compared to a late control group consisting of 150 consecutive cCTA exams, which were performed after the study (September 2012-January 2013). Patient characteristics and effective radiation were recorded and compared. Total radiation dose was significantly lower in the postintervention period (3.4 mSv [1.7-5.7] and in the late control group (3.3 mSv [2.0-5.3] versus the preintervention period (4.1 mSv [2.1-6.6] (P = .005). The proportion of high-dose outliers was also decreased in the postintervention period and late control period (exams <10 mSv were 88.0% preintervention vs. 97.3% postintervention vs. 95.3% late control; exams <15 mSv were 98.0% preintervention vs. 100.0% postintervention vs. 98.7% late control; exams <20.0 mSv were 98.7% preintervention vs. 100.0% postintervention vs. 100.0% late control). Weekly dose report feedback of site radiation doses to patients undergoing physician-supervised cCTA resulted in significant overall dose reduction and reduction of high-dose outliers. Overall dose reductions were maintained beyond the initial study period.

Eradication of chronic methicillin-resistant Staphylococcus aureus infection in cystic fibrosis patients. An observational prospective cohort study of 11 patients

Chronic airway infection with methicillin-resistant Staphylococcus aureus (MRSA) in patients with cystic fibrosis (CF) is an increasing clinical problem, and therapeutic options are limited. Because chronic infection with MRSA can be associated with accelerated decline in lung function, eradication of MRSA is attempted in most CF centres today. The aim of this observational prospective cohort study was to determine whether it is possible to eradicate MRSA from airways of CF patients using prolonged oral antibiotic combination therapy together with topical decolonization measures. Eleven CF patients, (median age: 9 years (range 1-43); median FEV1: 91%pred (95%CI 74%-100%pred)) who were chronically infected with MRSA, were treated daily for six months with rifampicin and fusidic acid orally. This study did not include a patient control group. Two patients had to switch to an alternative schedule, using rifampicin and clindamycin, due to the resistance pattern of MRSA. Topical decolonization measures were applied to all patients and included mupirocin-containing nasal ointment in both nostrils three times daily for five days and chlorhexidine hair and body wash once daily for five days. Microbiological eradication was achieved in all patients at the end of the six-month eradication protocol, even when significant time (range 18 months to 9 years) had elapsed since initial isolation. In only one patient MRSA reappeared in the six-month follow-up period after the initial study period. Side-effects, like nausea, vomiting and diarrhoea were seen in five out of eleven patients, but did not lead to therapy cessation. Chronic MRSA infection can be eradicated from respiratory tract samples using a six month dual antibiotic regimen and topical MRSA decolonization measures.