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Lou F.,SUNY Downstate Medical Center | Sarkaria I.,Sloan Kettering Cancer Center | Pietanza C.,Sloan Kettering Cancer Center | Travis W.,Sloan Kettering Cancer Center | And 5 more authors.
Annals of Thoracic Surgery | Year: 2013

Background: The current guidelines for follow-up care after treatment of non-small cell lung cancer recommend continued surveillance for detection of recurrent or metachronous disease. However, carcinoid tumors, especially those with a typical histologic profile, tend to be less aggressive. Our goal was to determine the patterns of relapse and the manner of detection of recurrences, to guide follow-up care after resection. Methods: Patients who underwent operations for pulmonary carcinoids at our institution were identified from a prospectively maintained database, and their medical records were reviewed for relapse patterns, detection methods, and outcomes. Results: A total of 337 patients who underwent resection between 1993 and 2010 were included, with a median follow-up time of 3.5 years. Typical and atypical carcinoids were present in 291 (86%) and 46 (14%) patients, respectively. Recurrences occurred in 21 patients (6%), with distant metastases in 20 patients (95%) and locoregional recurrence in only 1 patient. Most recurrences (15 [76%]) were not detected through scheduled surveillance imaging but after the presentation of symptoms (7 [33%]) or incidentally by studies performed for unrelated reasons (8 [38%]). The risk of recurrence increased with positive lymph nodes and atypical histologic type. Only 9 of 291 patients (3%) with typical carcinoids experienced recurrences, with a median time to recurrence of 4 years (range, 0.8-12 years). Conversely, 12 of 46 patients (26%) with atypical carcinoids experienced recurrences, with a median time to recurrence of 1.8 years (range, 0.2-7 years). Conclusions: After complete resection, scheduled surveillance imaging failed to detect most recurrences. Recurrence was rare in patients with node-negative typical carcinoids. Given the low risk of recurrence and the unclear efficacy of surveillance imaging, routine surveillance imaging may not be warranted in this cohort. © 2013 The Society of Thoracic Surgeons. Source

Kita M.,Virginia Mason Medical Center | Fox R.J.,Cleveland Clinic | Phillips J.T.,Baylor Research Institute | Hutchinson M.,St Vincents University Hospital Dublin | And 9 more authors.
Multiple Sclerosis | Year: 2014

Multiple sclerosis (MS) has a significant impact on health-related quality of life (HRQoL) with symptoms adversely affecting many aspects of everyday living. BG-12 (dimethyl fumarate) demonstrated significant efficacy in the phase III studies DEFINE and CONFIRM in patients with relapsing-remitting MS. In CONFIRM, HRQoL was worse in patients with greater disability at baseline, and who relapsed during the study, and improved with BG-12 treatment. Mean Short Form-36 Physical Component Summary scores for BG-12 increased over 2 years and scores for placebo decreased. Coupled with clinical and neuroradiological benefits, these HRQoL results further support BG-12 as an effective oral treatment for relapsing MS. © 2013 The Author(s). Source

Havrdova E.,Charles University | Hutchinson M.,St Vincents University Hospital Dublin | Kurukulasuriya N.C.,Biogen Idec | Raghupathi K.,Biogen Idec | And 3 more authors.
Expert Opinion on Pharmacotherapy | Year: 2013

Introduction: Multiple sclerosis (MS) is an autoimmune neurodegenerative disease of the central nervous system involving inflammation, chronic demyelination and axonal loss. MS affects more than 2 million people worldwide. Areas covered: This article aims to summarize the findings from two pivotal 2-year, randomized, double-blind, placebo-controlled, Phase III studies of BG-12 (dimethyl fumarate) for relapsing-remitting MS (RRMS): DEFINE (Determination of the Efficacy and Safety of Oral Fumarate in RRMS) and CONFIRM (Comparator and an Oral Fumarate in RRMS). Results from both studies demonstrated that BG-12 provides clinical and radiological efficacy over 2 years across a range of outcomes. These results were apparent as early as 12 weeks and sustained over the course of both studies. BG-12 was found to have an acceptable safety profile, with a similar overall incidence of adverse events across all treatment groups. Expert opinion: The combination of robust efficacy, ease of administration and established safety profile is unique to a new therapy in MS. Findings from the pivotal Phase III studies support BG-12 as a potential initial oral treatment for patients with RRMS or as an alternative to other currently available therapies. © Informa UK, Ltd. Source

Camargo J.F.,New York Medical College | Camargo J.F.,Metropolitan Hospital Center | Sakoulas G.,New York Medical College | Dodd J.D.,St Vincents University Hospital Dublin | And 5 more authors.
Infectious Diseases in Clinical Practice | Year: 2013

Septic pulmonary embolism (SPE) results when fragments of thrombus containing bacteria or fungi travel to the pulmonary circulation and lodge in segmental and subsegmental pulmonary arteries. Almost invariably such embolization implies the presence of an endovascular infection (typically endocarditis, septic thrombophlebitis, or catheter-related infection) as the source of embolism. Here we report a case of Staphylococcus aureus bacteremia complicated with SPE in a patient who had no septic foci other than a soft tissue infection. We found 17 similar cases in the literature and reviewed their clinical presentation and outcomes. The most common presenting symptoms were fever (88%), chest pain (47%), dyspnea (29%), and cough (18%). Skin and soft tissue infections represented the most common suspected source of SPE. Methicillin-resistant S. aureus was isolated in most of the cases (71%). The USA300 strain carrying the Panton-Valentine leukocidin toxin gene was uniformly identified in all of the patients in whom genotyping of the isolate was available. Almost 90% of the patients reviewed had a full recovery with 4 to 8 weeks of intravenous antibiotic therapy. We conclude that SPE of unknown origin is an infrequently reported but serious complication of S. aureus bacteremia. Copyright © 2012 by Lippincott Williams & Wilkins. Source

Mcnamara M.S.,University College Dublin | Fealy G.M.,University College Dublin | Casey M.,University College Dublin | O'Connor T.,University College Dublin | And 3 more authors.
Journal of Clinical Nursing | Year: 2014

Aims and objectives: To evaluate mentoring, coaching and action learning interventions used to develop nurses' and midwives' clinical leadership competencies and to describe the programme participants' experiences of the interventions. Background: Mentoring, coaching and action learning are effective interventions in clinical leadership development and were used in a new national clinical leadership development programme, introduced in Ireland in 2011. An evaluation of the programme focused on how participants experienced the interventions. Design: A qualitative design, using multiple data sources and multiple data collection methods. Methods: Methods used to generate data on participant experiences of individual interventions included focus groups, individual interviews and nonparticipant observation. Seventy participants, including 50 programme participants and those providing the interventions, contributed to the data collection. Results: Mentoring, coaching and action learning were positively experienced by participants and contributed to the development of clinical leadership competencies, as attested to by the programme participants and intervention facilitators. Conclusions: The use of interventions that are action-oriented and focused on service development, such as mentoring, coaching and action learning, should be supported in clinical leadership development programmes. Being quite different to short attendance courses, these interventions require longer-term commitment on the part of both individuals and their organisations. Relevance to clinical practice: In using mentoring, coaching and action learning interventions, the focus should be on each participant's current role and everyday practice and on helping the participant to develop and demonstrate clinical leadership skills in these contexts. © 2014 John Wiley & Sons Ltd. Source

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