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1.
J Thorac Cardiovasc Surg ; 168(3): 724-734.e7, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38508486

RESUMO

OBJECTIVE: Donation after circulatory death (DCD) donors offer the ability to expand the lung donor pool and ex vivo lung perfusion (EVLP) further contributes to this ability by allowing for additional evaluation and resuscitation of these extended criteria donors. We sought to determine the outcomes of recipients receiving organs from DCD EVLP donors in a multicenter setting. METHODS: This was an unplanned post hoc analysis of a multicenter, prospective, nonrandomized trial that took place during 2011 to 2017 with 3 years of follow-up. Patients were placed into 3 groups based off procurement strategy: brain-dead donor (control), brain-dead donor evaluated by EVLP, and DCD donors evaluated by EVLP. The primary outcomes were severe primary graft dysfunction at 72 hours and survival. Secondary outcomes included select perioperative outcomes, and 1-year and 3-years allograft function and quality of life measures. RESULTS: The DCD EVLP group had significantly higher incidence of severe primary graft dysfunction at 72 hours (P = .03), longer days on mechanical ventilation (P < .001) and in-hospital length of stay (P = .045). Survival at 3 years was 76.5% (95% CI, 69.2%-84.7%) for the control group, 68.3% (95% CI, 58.9%-79.1%) for the brain-dead donor group, and 60.7% (95% CI, 45.1%-81.8%) for the DCD group (P = .36). At 3-year follow-up, presence observed bronchiolitis obliterans syndrome or quality of life metrics did not differ among the groups. CONCLUSIONS: Although DCD EVLP allografts might not be appropriate to transplant in every candidate recipient, the expansion of their use might afford recipients stagnant on the waitlist a viable therapy.


Assuntos
Transplante de Pulmão , Perfusão , Doadores de Tecidos , Humanos , Transplante de Pulmão/métodos , Transplante de Pulmão/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Perfusão/métodos , Perfusão/efeitos adversos , Adulto , Estudos Prospectivos , Doadores de Tecidos/provisão & distribuição , Disfunção Primária do Enxerto/etiologia , Disfunção Primária do Enxerto/fisiopatologia , Sobrevivência de Enxerto , Preservação de Órgãos/métodos , Seleção do Doador , Fatores de Tempo , Morte Encefálica , Resultado do Tratamento , Pulmão/fisiopatologia , Obtenção de Tecidos e Órgãos/métodos , Fatores de Risco , Qualidade de Vida
2.
Clin Transplant ; 31(5)2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28295652

RESUMO

BACKGROUND: Kidney transplantation has been advocated as a therapeutic option in lung recipients who develop end-stage renal disease (ESRD). This analysis outlines patterns of allograft survival following kidney transplantation in previous lung recipients (KAL). METHODS: Data from the UNOS lung and kidney transplantation registries (1987-2013) were cross-linked to identify lung recipients who were subsequently listed for and/or underwent kidney transplantation. Time-dependent Cox models compared the survival rates in KAL patients with those waitlisted for renal transplantation who never received kidneys. Survival analyses compared outcomes between KAL patients and risk-matched recipients of primary, kidney-only transplantation with no history of lung transplantation (KTx). RESULTS: A total of 270 lung recipients subsequently underwent kidney transplantation (KAL). Regression models demonstrated a lower risk of post-listing mortality for KAL patients compared with 346 lung recipients on the kidney waitlist who never received kidneys (P<.05). Comparisons between matched KAL and KTx patients demonstrated significantly increased risk of death and graft loss (P<.05), but not death-censored graft loss, for KAL patients (P = .86). CONCLUSIONS: KAL patients enjoy a significant survival benefit compared with waitlisted lung recipients who do not receive kidneys. However, KAL patients do poorly compared with KTx patients. Decisions about KAL transplantation must be made on a case-by-case basis considering patient and donor factors.


Assuntos
Falência Renal Crônica/mortalidade , Transplante de Rim/mortalidade , Transplante de Pulmão/mortalidade , Sistema de Registros , Adulto , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/cirurgia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Transplantados , Transplante Homólogo
3.
Clin Infect Dis ; 64(7): 902-911, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-28077517

RESUMO

BACKGROUND: Nontuberculous mycobacteria (NTM) commonly colonize municipal water supplies and cause healthcare-associated outbreaks. We investigated a biphasic outbreak of Mycobacterium abscessus at a tertiary care hospital. METHODS: Case patients had recent hospital exposure and laboratory-confirmed colonization or infection with M. abscessus from January 2013 through December 2015. We conducted a multidisciplinary epidemiologic, field, and laboratory investigation. RESULTS: The incidence rate of M. abscessus increased from 0.7 cases per 10000 patient-days during the baseline period (January 2013-July 2013) to 3.0 cases per 10000 patient-days during phase 1 of the outbreak (August 2013-May 2014) (incidence rate ratio, 4.6 [95% confidence interval, 2.3-8.8]; P < .001). Thirty-six of 71 (51%) phase 1 cases were lung transplant patients with positive respiratory cultures. We eliminated tap water exposure to the aerodigestive tract among high-risk patients, and the incidence rate decreased to baseline. Twelve of 24 (50%) phase 2 (December 2014-June 2015) cases occurred in cardiac surgery patients with invasive infections. Phase 2 resolved after we implemented an intensified disinfection protocol and used sterile water for heater-cooler units of cardiopulmonary bypass machines. Molecular fingerprinting of clinical isolates identified 2 clonal strains of M. abscessus; 1 clone was isolated from water sources at a new hospital addition. We made several water engineering interventions to improve water flow and increase disinfectant levels. CONCLUSIONS: We investigated and mitigated a 2-phase clonal outbreak of M. abscessus linked to hospital tap water. Healthcare facilities with endemic NTM should consider similar tap water avoidance and engineering strategies to decrease risk of NTM infection.


Assuntos
Infecção Hospitalar , Surtos de Doenças , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium abscessus/classificação , Mycobacterium abscessus/genética , Idoso , Feminino , Genes Bacterianos , Hospitais , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/etiologia , Fatores de Risco
4.
J Heart Lung Transplant ; 36(5): 546-553, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27932071

RESUMO

BACKGROUND: The purpose of this study was to identify risk factors and outcome implications for 30-day hospital readmission in lung transplant recipients. METHODS: We conducted a retrospective cohort study of lung transplant cases from a single, high-volume lung transplant program between January 2000 and March 2012. Demographic and health data were reviewed for all patients. Risk factors for 30-day readmission (defined as readmission within 30 days of discharge from index lung transplant hospitalization) were modeled using logistic regression, with selection of parameters by backward elimination. RESULTS: The sample comprised 795 patients after excluding scheduled readmissions and in-hospital deaths. Overall 30-day readmission rate was 45.4% (n = 361). Readmission rates were similar across different diagnosis categories and procedure types. By univariate analysis, post-operative complications that predisposed to 30-day readmission included pneumonia, any infection, and atrial fibrillation (all p < 0.05). In the final multivariate model, occurrence of any post-transplant complication was the most significant risk factor for 30-day readmission (odds ratio = 1.764; 95% confidence interval, 1.259-2.470). Even for patients with no documented perioperative complication, readmission rates were still >35%. Kaplan-Meier analysis and multi-variate regression modeling to assess readmission as a predictor of long-term outcomes showed that 30-day readmission was not a significant predictor of worse survival in lung recipients. CONCLUSIONS: Occurrence of at least 1 post-transplant complication increases risk for 30-day readmission in lung transplant recipients. In this patient population, 30-day readmission does not predispose to adverse long-term survival. Quality indicators other than 30-day readmission may be needed to assess hospitals that perform lung transplantation.


Assuntos
Causas de Morte , Rejeição de Enxerto/epidemiologia , Transplante de Pulmão/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/fisiopatologia , Doença Aguda , Adulto , Idoso , Aloenxertos , Bases de Dados Factuais , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Transplante de Pulmão/métodos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , North Carolina , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo
5.
Ann Am Thorac Soc ; 13(2): 180-7, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26731642

RESUMO

RATIONALE: Delirium is common following lung transplant and is associated with poorer clinical outcomes. The extent to which intraoperative hemodynamic alterations may contribute to postoperative delirium among lung transplant recipients has not been examined. OBJECTIVES: To examine the impact of intraoperative hemodynamic changes on neurobehavioral outcomes among lung transplant recipients. METHODS: Intraoperative hemodynamic function during lung transplant was assessed in a consecutive series of patients between March and November 2013. Intraoperative cerebral perfusion pressure was assessed every minute in all patients. Following lung transplant, patients were monitored for the presence and severity of delirium using the Confusion Assessment Method and the Delirium Rating Scale until hospital discharge. MEASUREMENTS AND MAIN RESULTS: Sixty-three patients received lung transplants, of whom 23 (37%) subsequently developed delirium. Lower cerebral perfusion pressure was associated with increased risk of delirium (odds ratio [OR], 2.08 per 10-mm Hg decrease; 95% confidence interval [CI], 1.02-4.24; P = 0.043), longer duration of delirium (OR, 1.7 d longer per 10-mm Hg decrease; 95% CI, 1.1-2.7; P = 0.022), and greater delirium severity (b = -0.81; 95% CI, -1.47 to -0.15; P = 0.017). CONCLUSIONS: Poorer cerebral perfusion pressure during lung transplant is associated with greater risk for delirium following transplant, as well as greater duration and severity of delirium, independent of demographic and medical predictors.


Assuntos
Circulação Cerebrovascular/fisiologia , Delírio/epidemiologia , Complicações Intraoperatórias/epidemiologia , Transplante de Pulmão , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Pressão Arterial , Pressão Venosa Central , Estudos de Coortes , Delírio/fisiopatologia , Feminino , Hemodinâmica , Humanos , Complicações Intraoperatórias/fisiopatologia , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Razão de Chances , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
6.
J Heart Lung Transplant ; 34(8): 1058-65, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25980570

RESUMO

BACKGROUND: The Pulmonary-specific Quality-of-Life Scale (PQLS) was developed to measure quality of life (QoL) among patients awaiting lung transplant. The objective of this study was to determine the psychometric properties of the PQLS, identify empirically derived sub-scales, and examine ability to detect changes in pulmonary-specific QoL scores after lung transplantation. METHODS: Data were derived from the INSPIRE trial, a dual-site randomized controlled trial of coping skills training in 389 lung transplant candidates (obstructive [48.3%], restrictive [24.2%], cystic fibrosis [13.6%], and other [13.9%]). Cronbach alpha was calculated to assess the internal reliability of the PQLS (n = 388). Test-retest reliability was assessed with correlation coefficients between baseline and 12-week post-baseline scores for the usual care control condition (n = 140). Convergent validity was assessed with correlation coefficients between the PQLS and established measures of QoL and emotional distress, 6-minute walk test distance, forced expiratory volume in 1 second, and use of supplemental oxygen at rest (n = 388). Change from baseline to 6 months post-transplantation was assessed with repeated measures analysis of variance (n = 133). RESULTS: The PQLS was internally reliable and stable across 12 weeks. The PQLS correlated strongly with QoL measures (e.g., Shortness of Breath Questionnaire, r = 0.78, p < 0.0001), moderately with mood and anxiety (e.g., Beck Depression Inventory-II, r = 0.59, p < 0.0001), and modestly with lung disease severity (e.g., 6-minute walk test, r = -0.41, p < 0.0001). PQLS scores improved by nearly 2 SDs after transplant. CONCLUSIONS: These results demonstrated the reliability, validity, and sensitivity to change of the PQLS for measuring pulmonary QoL among patients with advanced lung disease and the responsiveness of the PQLS to changes in QoL after lung transplantation.


Assuntos
Pneumopatias/psicologia , Pneumopatias/cirurgia , Transplante de Pulmão/psicologia , Qualidade de Vida , Adaptação Psicológica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Inquéritos e Questionários , Listas de Espera , Adulto Jovem
7.
Psychol Res ; 79(5): 715-28, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25351943

RESUMO

The aim of this study was to assess the relations of daily moderate-to-vigorous physical activity (MVPA) to cognitive functions in 15-year-old adolescents from the Avon Longitudinal Study of Parents and Children while controlling for aerobic fitness. A sub-sample of 667 adolescents (M(age) = 15.4 ± 0.16 years; 55% females) who provided valid data on variables of interest, were used in the analyses. MVPA was objectively assessed using an Actigraph GT1M accelerometer and aerobic fitness was expressed as physical work capacity at the heart rate of 170 beats per minute from a cycle ergometer test. A computerized stop-signal task was used to measure mean reaction time (RT) and standard deviation of RT, as indicators of cognitive processing speed and variability during an attention and inhibitory control task. MVPA was not significantly related to cognitive processing speed or variability of cognitive performance in hierarchical linear regression models. In simple regression models, aerobic fitness was negatively related to mean RT on the simple go condition. Our results suggest that aerobic fitness, but not MVPA, was associated with cognitive processing speed under less cognitively demanding task conditions. The results thus indicate a potential global effect of aerobic fitness on cognitive functions in adolescents but this may differ depending on the specific task characteristics.


Assuntos
Cognição/fisiologia , Exercício Físico/psicologia , Actigrafia , Adolescente , Feminino , Humanos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Aptidão Física/psicologia , Tempo de Reação/fisiologia
8.
Transplantation ; 97(10): 1079-85, 2014 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-24646771

RESUMO

BACKGROUND: Coronary artery disease has a high prevalence among lung transplant recipients and has historically been a contraindication to transplant at many institutions. In patients with mild-to-moderate coronary artery disease (Mod-CAD) undergoing lung transplant, outcomes are not well defined. METHODS: All patients who underwent pulmonary transplantation from January 1996 through November 2010 with pretransplant coronary angiogram were included in our study. Recipients of multivisceral, redo, and lobar lung transplants and those who underwent pretransplant coronary revascularization were excluded. Patients were grouped into Mod-CAD or no-coronary artery disease group (No-CAD). Primary end point was overall survival. Secondary end points were 30-day events and the need for posttransplant coronary revascularization. RESULTS: Approximately 539 patients were included in the study: 362 in the No-CAD, 177 in the Mod-CAD group. Patients with Mod-CAD were predominantly male, older, and had a higher body mass index. No difference in either perioperative morbidity and mortality (Mod-CAD, 4.2% vs. No-CAD 3.3%, P=0.705) or late overall mortality was shown between groups. Mod-CAD patients had a shorter hospitalization (median: 12 days vs. 14 days, P=0.009) and required a higher rate of late coronary revascularization procedures (PCI: Mod-CAD vs. No-CAD, 0.3% vs. 4.0%, P=0.0035; CABG: Mod-CAD vs. No-CAD, 0.3% vs. 2.3%, P=0.0411). CONCLUSIONS: Mod-CAD does not appear to be associated with increased perioperative morbidity or decreased survival after transplant. Coronary artery disease may worsen and require coronary revascularization in patients with risk factors for disease progression. In these patients, close follow-up and screening for progression of coronary artery disease may help prevent late cardiac morbidity.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Pneumopatias/cirurgia , Transplante de Pulmão , Adulto , Idoso , Cateterismo Cardíaco , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/epidemiologia , Feminino , Seguimentos , Humanos , Pneumopatias/complicações , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
9.
Psychol Serv ; 10(1): 123-30, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22774705

RESUMO

The present study investigated the use of the Minnesota Multiphasic Personality Inventory (MMPI)-2 L (Lie) scale in the preemployment selection of police officers. In a prior article, Weiss, Davis, Rostow, and Kinsman (2003) found that high L scale scores are associated with a number of performance problems in law enforcement officers. These investigators recommended a L scale raw score cutoff of 8 when making hiring decisions. The present study sought to explore the usefulness of this recommendation by analyzing data from 4348 officers who had taken the MMPI-2 as a condition of preemployment and had follow-up data on performance provided by their supervisors. Results indicated that officers with L scale raw scores of 8 or higher had significantly more performance problems than those who had scores of 7 or below. Similar results were obtained when cut points of 7 and 9 were used. These results were robust insofar as they remained significant when other factors potentially related to the L scale, particularly level of education, ethnicity, and scores on the 10 MMPI-2 Clinical Scales, were controlled for in the analyses. Implications of these findings for police psychological evaluations are discussed.


Assuntos
Interpretação Estatística de Dados , Avaliação de Desempenho Profissional/estatística & dados numéricos , MMPI/estatística & dados numéricos , Seleção de Pessoal/métodos , Polícia/normas , Autoimagem , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Reprodutibilidade dos Testes , Estados Unidos , Virtudes , Adulto Jovem
10.
BMC Med Genomics ; 4: 70, 2011 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-21974901

RESUMO

BACKGROUND: The accurate diagnosis of idiopathic pulmonary fibrosis (IPF) is a major clinical challenge. We developed a model to diagnose IPF by applying Bayesian probit regression (BPR) modelling to gene expression profiles of whole lung tissue. METHODS: Whole lung tissue was obtained from patients with idiopathic pulmonary fibrosis (IPF) undergoing surgical lung biopsy or lung transplantation. Controls were obtained from normal organ donors. We performed cluster analyses to explore differences in our dataset. No significant difference was found between samples obtained from different lobes of the same patient. A significant difference was found between samples obtained at biopsy versus explant. Following preliminary analysis of the complete dataset, we selected three subsets for the development of diagnostic gene signatures: the first signature was developed from all IPF samples (as compared to controls); the second signature was developed from the subset of IPF samples obtained at biopsy; the third signature was developed from IPF explants. To assess the validity of each signature, we used an independent cohort of IPF and normal samples. Each signature was used to predict phenotype (IPF versus normal) in samples from the validation cohort. We compared the models' predictions to the true phenotype of each validation sample, and then calculated sensitivity, specificity and accuracy. RESULTS: Surprisingly, we found that all three signatures were reasonably valid predictors of diagnosis, with small differences in test sensitivity, specificity and overall accuracy. CONCLUSIONS: This study represents the first use of BPR on whole lung tissue; previously, BPR was primarily used to develop predictive models for cancer. This also represents the first report of an independently validated IPF gene expression signature. In summary, BPR is a promising tool for the development of gene expression signatures from non-neoplastic lung tissue. In the future, BPR might be used to develop definitive diagnostic gene signatures for IPF, prognostic gene signatures for IPF or gene signatures for other non-neoplastic lung disorders such as bronchiolitis obliterans.


Assuntos
Fibrose Pulmonar Idiopática/diagnóstico , Adulto , Idoso , Área Sob a Curva , Teorema de Bayes , Análise por Conglomerados , Estudos de Coortes , Feminino , Perfilação da Expressão Gênica , Humanos , Fibrose Pulmonar Idiopática/genética , Fibrose Pulmonar Idiopática/metabolismo , Pulmão/metabolismo , Pulmão/patologia , Transplante de Pulmão , Masculino , Pessoa de Meia-Idade , Fenótipo , Valor Preditivo dos Testes , Curva ROC , Análise de Regressão , Sensibilidade e Especificidade , Doadores de Tecidos
12.
Transplantation ; 89(6): 639-43, 2010 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-20075790

RESUMO

Publicly available program-specific data from the scientific registry of transplant recipients were used to determine the association between adult lung transplant center volume and 1-year recipient mortality from 2000 to 2007. We found a significant inverse association between the center volume of adult lung transplants and 1-year recipient mortality that is growing more pronounced over time. We conclude that procedure volume is an increasingly important determinant of lung transplant center volume and that policies that improve the performance of low-volume centers or reduce the number of patients who use such centers may be warranted.


Assuntos
Hospitais/estatística & dados numéricos , Transplante de Pulmão/estatística & dados numéricos , Transplante de Pulmão/tendências , Avaliação de Processos e Resultados em Cuidados de Saúde/tendências , Adulto , Competência Clínica , Regulamentação Governamental , Política de Saúde , Humanos , Modelos Logísticos , Transplante de Pulmão/legislação & jurisprudência , Transplante de Pulmão/mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde/legislação & jurisprudência , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
13.
Ann Thorac Surg ; 88(4): 1197-201, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19766807

RESUMO

BACKGROUND: Undersized ring annuloplasty and surgical revascularization are commonly used to correct ischemic mitral regurgitation (MR), but published series have failed to demonstrate a benefit compared with revascularization alone. We hypothesized that surgical revascularization and annuloplasty lead to a durable repair, but may also lead to increased mitral gradients that could limit the benefit of the repair technique. METHODS: Data were collected for 222 consecutive patients who underwent combined revascularization and repair for ischemic MR between 1999 and 2006. The most recent transthoracic echocardiogram available for each patient (namely, the study that occurred at the latest date after surgery) was reviewed to define the fate of ischemic MR. When present, the mean gradient across the mitral valve was measured. Cox regression modeling was then performed to determine whether increasing gradients were associated with decreased long-term survival or increased hospitalization for heart failure. RESULTS: For the group of 222 patients, echocardiographic follow-up was available for 68% (149 patients). At follow-up, 1.3% had severe MR and 9.4% had moderate MR; 54% of patients (66 of 123) were found to have gradients of 5 mm or greater across the mitral valve, with 11% demonstrating gradients of 8 mm or more. Cox proportional hazards models failed to show adverse effects of increasing mitral gradient on outcomes analyzed: survival hazard ratio = 0.95 (95% confidence interval: 0.82 to 1.11, p = 0.527) and survival/heart failure hospitalization hazard ratio = 1.04 (95% confidence interval: 0.93 to 1.17, p = 0.488). CONCLUSIONS: Undersized ring annuloplasty and revascularization can provide a durable correction of ischemic mitral regurgitation. This technique frequently increases the gradient across the mitral valve, but increasing mitral gradient does not appear to adversely impact survival or heart failure hospitalization.


Assuntos
Cateterismo/métodos , Insuficiência da Valva Mitral/terapia , Isquemia Miocárdica/complicações , Revascularização Miocárdica/métodos , Idoso , Intervalos de Confiança , Ecocardiografia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/cirurgia , North Carolina/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Taxa de Sobrevida/tendências
14.
Interact Cardiovasc Thorac Surg ; 8(1): 45-8, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18669527

RESUMO

In lung transplants necessitating cardiopulmonary bypass (CPB), aprotinin has been shown to decrease transfusion requirements. More recently, off-pump transplantation has become the standard of care. The efficacy of aprotinin use in this population has yet to be definitively examined. We completed a retrospective review of all adult OP-BOLTs performed between January 2000 and January 2006 at a single university center (n=215). Aprotinin use was determined by the attending anesthesiologist or surgeon. It was administered at the time of induction. The primary outcome was total blood products utilized in terms of units transfused during postoperative days 0, 1 and 2. One-hundred and one patients received aprotinin and 114 did not. An overall analysis of all of the patients in this study demonstrated a trend towards statistical significance for reduced total blood product transfusion for the aprotinin group compared to the non-aprotinin group (P=0.13). A subgroup analysis was performed in relation to each diagnosis. The use of aprotinin was associated with a significant reduction in peri-operative total blood products transfused in COPD patients (P=0.03) undergoing OP-BOLT. Subgroup analysis demonstrated that the use of aprotinin in the COPD population did result in a statistically significant decrease in total blood products transfused, specifically the total number of units of packed red blood cells given. These findings suggest that aprotinin administration should be considered for all patients undergoing OP-BOLT to reduce exposure to blood products and potential immune sensitization and infectious complications.


Assuntos
Aprotinina/administração & dosagem , Transfusão de Componentes Sanguíneos , Perda Sanguínea Cirúrgica/prevenção & controle , Hemostáticos/administração & dosagem , Transplante de Pulmão/efeitos adversos , Hemorragia Pós-Operatória/prevenção & controle , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Resultado do Tratamento
15.
J Heart Lung Transplant ; 26(8): 834-8, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17692788

RESUMO

BACKGROUND: The impact of panresistant bacteria, other than Burkholderia cepacia, on the survival after lung transplantation in patients with cystic fibrosis (CF) remains controversial. METHODS: To determine the impact of panresistant bacteria in CF patients on survival after lung transplantation a retrospective multicenter study was performed. All lung transplant recipients with a pre-transplant diagnosis of CF, at the University of Toronto (n = 53) and Duke University (n = 50), were included. Patients were included in the panresistant group if at least one specimen isolated from their respiratory secretions grew bacteria resistant or intermediate to all classes of antibiotics tested. Patients with sensitive or resistant B cepacia were excluded because of its adverse impact upon post-transplant survival. RESULTS: Forty-five of 103 (43.7%) patients harbored panresistant bacteria (43 had Pseudomonas aeruginosa, 1 had Stenotrophomonas maltophilia, and 1 had Achromobacter xylosoxidans). According to log-rank test, there was decreased survival in patients with panresistant bacteria compared to patients with sensitive bacteria (survival: 91.1 +/- 4.2% vs 98.3 +/- 1.7% at 3 months; 88.6 +/- 4.8% vs 96.6 +/- 2.4% at 1 year; 63.2 +/- 8.6% vs 90.7 +/- 4.0% at 3 years; 58.3 +/- 9.2% vs 85.6 +/- 5.2% at 5 years; p = 0.016). The results did not differ significantly between the two centers. Both groups had similar or better survival than CF patients as reported by the United Network of Organ Sharing (UNOS) registry (1-year, 86.0%; 3 years, 65.4%; 5 years, 49.6%). CONCLUSIONS: Patients with CF harboring panresistant bacteria have slightly decreased survival, but their survival is comparable to the results published by the UNOS registry.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Burkholderia/complicações , Burkholderia cepacia/isolamento & purificação , Fibrose Cística/cirurgia , Farmacorresistência Bacteriana , Transplante de Pulmão/mortalidade , Adulto , Infecções por Burkholderia/tratamento farmacológico , Infecções por Burkholderia/microbiologia , Contagem de Colônia Microbiana , Fibrose Cística/complicações , Fibrose Cística/mortalidade , Feminino , Humanos , Masculino , North Carolina/epidemiologia , Ontário/epidemiologia , Fatores de Risco , Taxa de Sobrevida
16.
J Appl Psychol ; 92(3): 616-27, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17484545

RESUMO

Over the past 2 decades, increasing attention has been directed at the relationship between individual differences and counterproductive work behaviors (CWB). However, most of this research has focused on personality variables as potential predictors of CWB; surprisingly little research has investigated the link between counterproductivity and cognitive ability. This study presents the first focal investigation of the cognitive ability-CWB relationship. The authors measured organizational and interpersonal CWB using organizational records of formally recorded incidents (e.g., destruction of property, physical violence). In a predictive study, for a large sample of law enforcement job applicants, a standardized psychometric test of cognitive ability predicted CWB, whereas educational attainment did not.


Assuntos
Cognição , Cultura Organizacional , Local de Trabalho/psicologia , Adulto , Tomada de Decisões , Feminino , Humanos , Inteligência , Masculino
17.
J Heart Lung Transplant ; 24(7 Suppl): S249-54, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15993781

RESUMO

BACKGROUND: The presence of antibodies to human leukocyte antigens (HLA) prior to transplantation has been linked to worse post-transplant outcomes in many solid organ transplants. The effect of these antibodies is less clear in lung transplant recipients, although previous studies have suggested an increased incidence of allograft dysfunction. METHODS: A retrospective study of all first lung transplant recipients from the University of Toronto (November 1983-July 2001, n = 380) and Duke University (April 1992-June 2000, n = 276) was performed. Demographic data, survival information, and level of last pre-transplant panel reactive antibody (PRA) were collected. PRA level was measured by the complement-dependent cell cytotoxicity assay at both centers. Survival analysis was performed using the Kaplan-Meier method, and groups were compared with the Wilcoxon rank sum test. RESULTS: Of 656 lung transplant recipients, 101 (15.4%) had a PRA greater than 0, 37 (5.6%) had a PRA greater than 10%, and 20 (3.0%) had a PRA greater than 25%. Patients with a PRA greater than 25% had decreased median survival than did the rest of the patients (1.5 vs 5.2 years) and at 1 month (70% vs 90%), 1 year (65% vs 76%), and 5 years (31% vs 50%), respectively (p = 0.006, Wilcoxon's rank sum test) test). CONCLUSION: Significant elevation of PRA prior to lung transplantation is associated with worse survival, especially in the early post-transplant period. This may be due to a direct effect of anti-HLA antibodies on the allograft. The effectiveness of treatments such as plasmapheresis and intravenous immunoglobulin prior to transplantation needs to be evaluated.


Assuntos
Anticorpos/sangue , Antígenos HLA/imunologia , Transplante de Pulmão/imunologia , Transplante de Pulmão/mortalidade , Adulto , Tipagem e Reações Cruzadas Sanguíneas , Testes Imunológicos de Citotoxicidade , Feminino , Rejeição de Enxerto/prevenção & controle , Insuficiência Cardíaca/imunologia , Humanos , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/imunologia , Fibrose Pulmonar/imunologia , Estudos Retrospectivos
18.
Ann Thorac Surg ; 77(5): 1792-801, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15111188

RESUMO

BACKGROUND: To evaluate the safety and effectiveness of a new biodegradable polymeric sealant to close intraoperative air leaks after pulmonary resection. METHODS: In a multicenter prospective randomized trial, 161 patients with a median age of 67 years old (range 18-85 years old), were randomized in a 2:1 ratio to receive sealant or control for at least one significant air leak (> or = 2.0 mm in size) after pulmonary resection. In the sealant group, all significant air leaks underwent attempted repair by standard methods (sutures, staples, or cautery) prior to the application of sealant. The control group underwent only standard methods. Blood was analyzed for immunologic response. Patients were followed up 1 month after surgery. RESULTS: Intraoperative air leaks were sealed in 77% of the sealant group compared with 16% in the control group (p < 0.001). The sealant group had significantly fewer patients with postoperative air leaks compared with the control group (65% vs 86%, p = 0.005). Median length of hospitalization was 6 days (range, 3-23 days) for the sealant group compared with 7 days (range 4-38 days) for controls (p = 0.028). There was no difference in mortality, morbidity, duration of chest tubes, or immune responses between the two groups. CONCLUSIONS: This study demonstrates the effectiveness of a biodegradable polymer when used as an adjunct to standard closure methods for sealing significant intraoperative air leaks that develop from pulmonary surgery. Use of the sealant led to a reduction in postoperative air leaks, which may have decreased the length of hospitalization.


Assuntos
Complicações Intraoperatórias/terapia , Pneumonectomia/efeitos adversos , Adesivos Teciduais/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biodegradação Ambiental , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/uso terapêutico , Estudos Prospectivos , Tensoativos/uso terapêutico
20.
Chest ; 122(4): 1168-75, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12377838

RESUMO

STUDY OBJECTIVES: Lung transplantation continues to be limited by the development of chronic allograft dysfunction in the form of bronchiolitis obliterans syndrome (BOS). The effect of a transplant operation on patients with BOS has not been well-studied, but patients who undergo double-lung transplantation have better long-term survival. We hypothesized that double-lung transplantation leads to decreased rates of BOS. METHODS: A retrospective review of all lung transplant recipients at our institution, surviving for > 6 months after undergoing their transplant operation. Demographic data, information on other factors leading to the development of BOS, survival information, and data on the presence and timing of BOS were collected. RESULTS: BOS occurred in 41.3% of the recipients (93 of 225 patients) at a median time of 4.2 years. Single-lung transplantation was associated with increased rates of BOS compared to double-lung transplantation (49.3% vs 31.7%, respectively; p = 0.007), at the time of the analysis. Single-lung and double-lung transplant recipients had different baseline characteristics, but after controlling for these factors the type of transplant remained a significant predictor of the length of time to the onset of BOS in a multivariable proportional hazard model. CONCLUSIONS: Double-lung transplantation is associated with a reduced risk for BOS in our study population. A multicenter study with complete BOS information on all patients with a single pretransplant diagnosis would be useful to confirm the above findings. Further research is needed to determine how the type of transplant contributes to the risk for BOS.


Assuntos
Bronquiolite Obliterante/etiologia , Bronquiolite Obliterante/mortalidade , Transplante de Pulmão/efeitos adversos , Distribuição por Idade , Bronquiolite Obliterante/fisiopatologia , Estudos de Coortes , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Incidência , Modelos Logísticos , Transplante de Pulmão/métodos , Transplante de Pulmão/mortalidade , Masculino , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Análise de Sobrevida , Síndrome
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