Showing papers by "Virginia Commonwealth University published in 2017"
TL;DR: Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties, making ERAS an important example of value-based care applied to surgery.
Abstract: Importance Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Observations Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient. The care protocol is based on published evidence. The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, such as evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation. Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced. The elements of the protocol reduce the stress of the operation to retain anabolic homeostasis. The ERAS Society conducts structured implementation programs that are currently in use in more than 20 countries. Local ERAS teams from hospitals are trained to implement ERAS processes. Audit of process compliance and patient outcomes are important features. Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties. Conclusions and Relevance Enhanced Recovery After Surgery is an evidence-based care improvement process for surgical patients. Implementation of ERAS programs results in major improvements in clinical outcomes and cost, making ERAS an important example of value-based care applied to surgery.
2,023 citations
Johns Hopkins University1, Leipzig University2, Korea University3, Yale University4, West Virginia University5, University of Barcelona6, St George's, University of London7, Indiana University8, National Yang-Ming University9, Cleveland Clinic10, Aarhus University11, University at Buffalo12, Imperial College London13, Primary Children's Hospital14, Erasmus University Rotterdam15, Yeshiva University16, Ghent University17, Baylor University18, Virginia Commonwealth University19, Harvard University20, Federal University of São Paulo21, University of California, San Francisco22, Beaumont Hospital23, Boston University24, University of Oklahoma25, Carlos III Health Institute26, University of Michigan27, University of Melbourne28, Saint Louis University29, Université de Montréal30, University of Pennsylvania31, McGill University32, Mayo Clinic33, Lahey Hospital & Medical Center34, Royal Adelaide Hospital35, University of Milan36, University of Toronto37, Loyola University Chicago38, Jikei University School of Medicine39
TL;DR: This 2017 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a writing group, convened by these five international societies.
1,626 citations
Brigham and Women's Hospital1, GeneDx2, Columbia University3, Baylor College of Medicine4, University of North Carolina at Chapel Hill5, Nationwide Children's Hospital6, Stanford University7, University of Alabama at Birmingham8, University of Arkansas for Medical Sciences9, Oregon Health & Science University10, Virginia Commonwealth University11, American College of Medical Genetics12, Geisinger Health System13, Boston Children's Hospital14
TL;DR: The new process for accepting and evaluating nominations for updates to the secondary findings list is described, and the updated secondary findings minimum list includes 59 medically actionable genes recommended for return in clinical genomic sequencing.
1,357 citations
TL;DR: The InTBIR Participants and Investigators have provided informed consent for the study to take place in Poland.
Abstract: Additional co-authors: Endre Czeiter, Marek Czosnyka, Ramon Diaz-Arrastia, Jens P Dreier, Ann-Christine Duhaime, Ari Ercole, Thomas A van Essen, Valery L Feigin, Guoyi Gao, Joseph Giacino, Laura E Gonzalez-Lara, Russell L Gruen, Deepak Gupta, Jed A Hartings, Sean Hill, Ji-yao Jiang, Naomi Ketharanathan, Erwin J O Kompanje, Linda Lanyon, Steven Laureys, Fiona Lecky, Harvey Levin, Hester F Lingsma, Marc Maegele, Marek Majdan, Geoffrey Manley, Jill Marsteller, Luciana Mascia, Charles McFadyen, Stefania Mondello, Virginia Newcombe, Aarno Palotie, Paul M Parizel, Wilco Peul, James Piercy, Suzanne Polinder, Louis Puybasset, Todd E Rasmussen, Rolf Rossaint, Peter Smielewski, Jeannette Soderberg, Simon J Stanworth, Murray B Stein, Nicole von Steinbuchel, William Stewart, Ewout W Steyerberg, Nino Stocchetti, Anneliese Synnot, Braden Te Ao, Olli Tenovuo, Alice Theadom, Dick Tibboel, Walter Videtta, Kevin K W Wang, W Huw Williams, Kristine Yaffe for the InTBIR Participants and Investigators
1,354 citations
City of Hope National Medical Center1, Harvard University2, American Society of Clinical Oncology3, Virginia Commonwealth University4, University of North Carolina at Chapel Hill5, University of Michigan6, Northwestern University7, National Coalition for Cancer Survivorship8, Princess Margaret Cancer Centre9, Johns Hopkins University10
TL;DR: The guideline update reflects changes in evidence since the previous guideline and inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment.
Abstract: Purpose To provide evidence-based recommendations to oncology clinicians, patients, family and friend caregivers, and palliative care specialists to update the 2012 American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) on the integration of palliative care into standard oncology care for all patients diagnosed with cancer. Methods ASCO convened an Expert Panel of members of the ASCO Ad Hoc Palliative Care Expert Panel to develop an update. The 2012 PCO was based on a review of a randomized controlled trial (RCT) by the National Cancer Institute Physicians Data Query and additional trials. The panel conducted an updated systematic review seeking randomized clinical trials, systematic reviews, and meta-analyses, as well as secondary analyses of RCTs in the 2012 PCO, published from March 2010 to January 2016. Results The guideline update reflects changes in evidence since the previous guideline. Nine RCTs, one quasiexperimental trial, and five secondary analyses from RCTs in the 2012 PCO on providing palliative care services to patients with cancer and/or their caregivers, including family caregivers, were found to inform the update. Recommendations Inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment. Referral of patients to interdisciplinary palliative care teams is optimal, and services may complement existing programs. Providers may refer family and friend caregivers of patients with early or advanced cancer to palliative care services.
1,283 citations
Paris Descartes University1, Cornell University2, University of Massachusetts Medical School3, Spanish National Research Council4, Boston Children's Hospital5, University of Rome Tor Vergata6, University of Pittsburgh7, National University of Cuyo8, National Scientific and Technical Research Council9, Albert Einstein College of Medicine10, University of California, San Francisco11, University of New Mexico12, Goethe University Frankfurt13, University of Split14, University of Helsinki15, University of Salento16, German Cancer Research Center17, Virginia Commonwealth University18, St. Jude Children's Research Hospital19, Discovery Institute20, Harvard University21, University of Tromsø22, Eötvös Loránd University23, Hungarian Academy of Sciences24, New York University25, University of Vienna26, Babraham Institute27, University of South Australia28, Howard Hughes Medical Institute29, University of Texas Southwestern Medical Center30, University of Oviedo31, University of Graz32, National Institutes of Health33, Queens College34, City University of New York35, University of Tokyo36, University of Zurich37, Novartis38, Austrian Academy of Sciences39, University of Groningen40, University of Cambridge41, University of Padua42, University of Oxford43, University of Bern44, University of Oslo45, Foundation for Research & Technology – Hellas46, University of Crete47, Francis Crick Institute48, Osaka University49, Icahn School of Medicine at Mount Sinai50
TL;DR: A panel of leading experts in the field attempts here to define several autophagy‐related terms based on specific biochemical features to formulate recommendations that facilitate the dissemination of knowledge within and outside the field of autophagic research.
Abstract: Over the past two decades, the molecular machinery that underlies autophagic responses has been characterized with ever increasing precision in multiple model organisms. Moreover, it has become clear that autophagy and autophagy-related processes have profound implications for human pathophysiology. However, considerable confusion persists about the use of appropriate terms to indicate specific types of autophagy and some components of the autophagy machinery, which may have detrimental effects on the expansion of the field. Driven by the overt recognition of such a potential obstacle, a panel of leading experts in the field attempts here to define several autophagy-related terms based on specific biochemical features. The ultimate objective of this collaborative exchange is to formulate recommendations that facilitate the dissemination of knowledge within and outside the field of autophagy research.
1,095 citations
Dartmouth College1, The Dartmouth Institute for Health Policy and Clinical Practice2, University of Southern California3, University of Hawaii4, University of Pennsylvania5, Brown University6, University of Pittsburgh7, Oregon Research Institute8, University of Michigan9, Virginia Commonwealth University10
TL;DR: For instance, this paper performed a systematic review and meta-analysis of longitudinal studies that assessed initial use of e-cigarettes and subsequent cigarette smoking, and found that e-cigarette use was associated with higher risk for subsequent smoking initiation and past 30-day cigarette smoking.
Abstract: Importance The public health implications of e-cigarettes depend, in part, on whether e-cigarette use affects the risk of cigarette smoking. Objective To perform a systematic review and meta-analysis of longitudinal studies that assessed initial use of e-cigarettes and subsequent cigarette smoking. Data Sources PubMed, EMBASE, Cochrane Library, Web of Science, the 2016 Society for Research on Nicotine and Tobacco 22nd Annual Meeting abstracts, the 2016 Society of Behavioral Medicine 37th Annual Meeting & Scientific Sessions abstracts, and the 2016 National Institutes of Health Tobacco Regulatory Science Program Conference were searched between February 7 and February 17, 2017. The search included indexed terms and text words to capture concepts associated with e-cigarettes and traditional cigarettes in articles published from database inception to the date of the search. Study Selection Longitudinal studies reporting odds ratios for cigarette smoking initiation associated with ever use of e-cigarettes or past 30-day cigarette smoking associated with past 30-day e-cigarette use. Searches yielded 6959 unique studies, of which 9 met inclusion criteria (comprising 17 389 adolescents and young adults). Data Extraction and Synthesis Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale and the Risk of Bias in Non-randomized Studies of Interventions tool, respectively. Data and estimates were pooled using random-effects meta-analysis. Main Outcomes and Measures Among baseline never cigarette smokers, cigarette smoking initiation between baseline and follow-up. Among baseline non–past 30-day cigarette smokers who were past 30-day e-cigarette users, past 30-day cigarette smoking at follow-up. Results Among 17 389 adolescents and young adults, the ages ranged between 14 and 30 years at baseline, and 56.0% were female. The pooled probabilities of cigarette smoking initiation were 23.2% for baseline ever e-cigarette users and 7.2% for baseline never e-cigarette users. The pooled probabilities of past 30-day cigarette smoking at follow-up were 21.5% for baseline past 30-day e-cigarette users and 4.6% for baseline non–past 30-day e-cigarette users. Adjusting for known demographic, psychosocial, and behavioral risk factors for cigarette smoking, the pooled odds ratio for subsequent cigarette smoking initiation was 3.50 (95% CI, 2.38-5.16) for ever vs never e-cigarette users, and the pooled odds ratio for past 30-day cigarette smoking at follow-up was 4.28 (95% CI, 2.52-7.27) for past 30-day e-cigarette vs non–past 30-day e-cigarette users at baseline. A moderate level of heterogeneity was observed among studies ( I2 = 56%). Conclusions and Relevance e-Cigarette use was associated with greater risk for subsequent cigarette smoking initiation and past 30-day cigarette smoking. Strong e-cigarette regulation could potentially curb use among youth and possibly limit the future population-level burden of cigarette smoking.
848 citations
Christian R. Marshall, Daniel P. Howrigan1, Daniel P. Howrigan2, Daniele Merico +326 more•Institutions (98)
TL;DR: In this article, a centralized analysis pipeline was applied to a SCZ cohort of 21,094 cases and 20,227 controls, and a global enrichment of copy number variants (CNVs) was observed in cases (odds ratio (OR) = 1.11, P = 5.7 × 10-15), which persisted after excluding loci implicated in previous studies.
Abstract: Copy number variants (CNVs) have been strongly implicated in the genetic etiology of schizophrenia (SCZ). However, genome-wide investigation of the contribution of CNV to risk has been hampered by limited sample sizes. We sought to address this obstacle by applying a centralized analysis pipeline to a SCZ cohort of 21,094 cases and 20,227 controls. A global enrichment of CNV burden was observed in cases (odds ratio (OR) = 1.11, P = 5.7 × 10-15), which persisted after excluding loci implicated in previous studies (OR = 1.07, P = 1.7 × 10-6). CNV burden was enriched for genes associated with synaptic function (OR = 1.68, P = 2.8 × 10-11) and neurobehavioral phenotypes in mouse (OR = 1.18, P = 7.3 × 10-5). Genome-wide significant evidence was obtained for eight loci, including 1q21.1, 2p16.3 (NRXN1), 3q29, 7q11.2, 15q13.3, distal 16p11.2, proximal 16p11.2 and 22q11.2. Suggestive support was found for eight additional candidate susceptibility and protective loci, which consisted predominantly of CNVs mediated by nonallelic homologous recombination.
774 citations
TL;DR: This paper surveys research on ensembles for data stream classification as well as regression tasks and discusses advanced learning concepts such as imbalanced data streams, novelty detection, active and semi-supervised learning, complex data representations and structured outputs.
757 citations
University of Toronto1, German Cancer Research Center2, University of Düsseldorf3, University of Pittsburgh4, Ontario Institute for Cancer Research5, Seoul National University6, University of Warsaw7, University of Lyon8, Mayo Clinic9, The Chinese University of Hong Kong10, Johns Hopkins University11, University of Alabama at Birmingham12, Fred Hutchinson Cancer Research Center13, University of Washington14, University of California, San Francisco15, Hamilton Health Sciences16, McMaster University17, Vanderbilt University18, University of Colorado Denver19, Semmelweis University20, Erasmus University Rotterdam21, University of Ulsan22, Kitasato University23, Mexican Social Security Institute24, Masaryk University25, Emory University26, University of Debrecen27, University of Naples Federico II28, Washington University in St. Louis29, McGill University30, Montreal Children's Hospital31, Virginia Commonwealth University32, Chonnam National University33, University of Queensland34, University of Calgary35, University of São Paulo36, University of Cincinnati37, University of Arkansas for Medical Sciences38, The Catholic University of America39, University of California, Los Angeles40, University of Sydney41, Kumamoto University42, Saint Louis University43, Case Western Reserve University44
TL;DR: Similarity network fusion (SNF) applied to genome-wide DNA methylation and gene expression data across 763 primary samples identifies very homogeneous clusters of patients, supporting the presence of medulloblastoma subtypes.
737 citations
Guy's and St Thomas' NHS Foundation Trust1, John Radcliffe Hospital2, University of Nottingham3, Brigham and Women's Hospital4, ISMETT5, Banaras Hindu University6, Newton Wellesley Hospital7, Madras Institute of Orthopaedics and Traumatology8, University of the West Indies9, University of Michigan10, Sahlgrenska University Hospital11, Queen Mary University of London12, Aga Khan University13, University of Manchester14, Virginia Commonwealth University15, University of Padua16, Changi General Hospital17, King's College London18, Southampton General Hospital19, Texas Tech University Health Sciences Center20, McMaster University21, University Hospital Waterford22, Turku University Hospital23, University of Mainz24, Bezmialem Foundation University25, Colchester Hospital University NHS Foundation Trust26, Kent State University27, Guy's Hospital28, Cairo University29, Children's of Alabama30
TL;DR: The development of the STROCSS guideline (Strengthening the Reporting of Cohort Studies in Surgery), consisting of a 17-item checklist, is described and it is hoped its use will increase the transparency and reporting quality of such studies.
VU University Medical Center1, University of Southern California2, Max Planck Society3, McMaster University4, University of Adelaide5, University of California, Irvine6, Erasmus University Rotterdam7, Delft University of Technology8, Erasmus University Medical Center9, German Center for Neurodegenerative Diseases10, Greifswald University Hospital11, University of Münster12, University of Marburg13, University of Queensland14, QIMR Berghofer Medical Research Institute15, Queensland University of Technology16, Virginia Commonwealth University17, University of Göttingen18, University Hospital Heidelberg19, University of Sydney20, Otto-von-Guericke University Magdeburg21, Trinity College, Dublin22, University of Regensburg23, University Medical Center Groningen24, Leiden University Medical Center25, University of Melbourne26, University of Texas Health Science Center at Houston27, Charité28, University of Bonn29, University of Lübeck30, University Medical Center Freiburg31, Stanford University32, University of Calgary33, Warneford Hospital34, Royal Edinburgh Hospital35, University of Edinburgh36, University of Bern37, Cardiff University38, Leibniz Institute for Neurobiology39, University of Tübingen40, Siberian State Medical University41, Mental Health Research Institute42, Tomsk State University43
TL;DR: In this article, the authors present the largest ever worldwide study by the ENIGMA (Enhancing Neuro Imaging Genetics through Meta-Analysis) Major Depressive Disorder Working Group on cortical structural alterations in MDD.
Abstract: The neuro-anatomical substrates of major depressive disorder (MDD) are still not well understood, despite many neuroimaging studies over the past few decades. Here we present the largest ever worldwide study by the ENIGMA (Enhancing Neuro Imaging Genetics through Meta-Analysis) Major Depressive Disorder Working Group on cortical structural alterations in MDD. Structural T1-weighted brain magnetic resonance imaging (MRI) scans from 2148 MDD patients and 7957 healthy controls were analysed with harmonized protocols at 20 sites around the world. To detect consistent effects of MDD and its modulators on cortical thickness and surface area estimates derived from MRI, statistical effects from sites were meta-analysed separately for adults and adolescents. Adults with MDD had thinner cortical gray matter than controls in the orbitofrontal cortex (OFC), anterior and posterior cingulate, insula and temporal lobes (Cohen's d effect sizes: -0.10 to -0.14). These effects were most pronounced in first episode and adult-onset patients (>21 years). Compared to matched controls, adolescents with MDD had lower total surface area (but no differences in cortical thickness) and regional reductions in frontal regions (medial OFC and superior frontal gyrus) and primary and higher-order visual, somatosensory and motor areas (d: -0.26 to -0.57). The strongest effects were found in recurrent adolescent patients. This highly powered global effort to identify consistent brain abnormalities showed widespread cortical alterations in MDD patients as compared to controls and suggests that MDD may impact brain structure in a highly dynamic way, with different patterns of alterations at different stages of life.
Mayo Clinic1, Yale University2, Case Western Reserve University3, Children's National Medical Center4, University of California, San Diego5, University of Miami6, Virginia Commonwealth University7, University of Calgary8, Cleveland Clinic9, University of Gothenburg10, University of British Columbia11, Saint Louis University12, Johns Hopkins University13, Dartmouth College14, University of Washington15, University of Texas MD Anderson Cancer Center16, Veterans Health Administration17, Royal Melbourne Hospital18, Cedars-Sinai Medical Center19, University of Colorado Denver20
TL;DR: Fred M. Kusumoto,MD, FHRS, FACC, Chair, Mark H. Schoenfeld, MD, F hrs, F ACC, FAHA, CCDS, Vice-Chair, Bruce L. Wilkoff, MD; Ulrika M. Birgersdotter-Green, MD.
Kaiser Permanente1, University of California, San Francisco2, University of Iowa3, Harvard University4, Columbia University5, University of Pennsylvania6, Virginia Tech7, Duke University8, Virginia Commonwealth University9, Yale University10, University of Alabama at Birmingham11, University of California, Los Angeles12, Brown University13, Boston University14, Northwestern University15, University of Hawaii16
TL;DR: It is concluded with moderate certainty that screening for obesity in children and adolescents 6 years and older is of moderate net benefit and clinicians should offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status.
Abstract: Importance Based on year 2000 Centers for Disease Control and Prevention growth charts, approximately 17% of children and adolescents aged 2 to 19 years in the United States have obesity, and almost 32% of children and adolescents are overweight or have obesity. Obesity in children and adolescents is associated with morbidity such as mental health and psychological issues, asthma, obstructive sleep apnea, orthopedic problems, and adverse cardiovascular and metabolic outcomes (eg, high blood pressure, abnormal lipid levels, and insulin resistance). Children and adolescents may also experience teasing and bullying behaviors based on their weight. Obesity in childhood and adolescence may continue into adulthood and lead to adverse cardiovascular outcomes or other obesity-related morbidity, such as type 2 diabetes. Subpopulation Considerations Although the overall rate of child and adolescent obesity has stabilized over the last decade after increasing steadily for 3 decades, obesity rates continue to increase in certain populations, such as African American girls and Hispanic boys. These racial/ethnic differences in obesity prevalence are likely a result of both genetic and nongenetic factors (eg, socioeconomic status, intake of sugar-sweetened beverages and fast food, and having a television in the bedroom). Objective To update the 2010 US Preventive Services Task Force (USPSTF) recommendation on screening for obesity in children 6 years and older. Evidence Review The USPSTF reviewed the evidence on screening for obesity in children and adolescents and the benefits and harms of weight management interventions. Findings Comprehensive, intensive behavioral interventions (≥26 contact hours) in children and adolescents 6 years and older who have obesity can result in improvements in weight status for up to 12 months; there is inadequate evidence regarding the effectiveness of less intensive interventions. The harms of behavioral interventions can be bounded as small to none, and the harms of screening are minimal. Therefore, the USPSTF concluded with moderate certainty that screening for obesity in children and adolescents 6 years and older is of moderate net benefit. Conclusions and Recommendation The USPSTF recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status. (B recommendation)
University of North Florida1, Georgia Regents University2, Medical University of South Carolina3, East Carolina University4, Universidade Federal do Rio Grande do Sul5, Baptist Health6, University of the West Indies7, University of Miami8, University of Illinois at Chicago9, University of São Paulo10, State University of Campinas11, Virginia Commonwealth University12
TL;DR: In patients with Sickle cell disease, crizanlizumab therapy resulted in a significantly lower rate of sickle cell–related pain crises than placebo and was associated with a low incidence of adverse events.
Abstract: BackgroundThe up-regulation of P-selectin in endothelial cells and platelets contributes to the cell–cell interactions that are involved in the pathogenesis of vaso-occlusion and sickle cell–related pain crises. The safety and efficacy of crizanlizumab, an antibody against the adhesion molecule P-selectin, were evaluated in patients with sickle cell disease. MethodsIn this double-blind, randomized, placebo-controlled, phase 2 trial, we assigned patients to receive low-dose crizanlizumab (2.5 mg per kilogram of body weight), high-dose crizanlizumab (5.0 mg per kilogram), or placebo, administered intravenously 14 times over a period of 52 weeks. Patients who were receiving concomitant hydroxyurea as well as those not receiving hydroxyurea were included in the study. The primary end point was the annual rate of sickle cell–related pain crises with high-dose crizanlizumab versus placebo. The annual rate of days hospitalized, the times to first and second crises, annual rates of uncomplicated crises (defined a...
Johns Hopkins University1, Leipzig University2, Humanitas University3, Korea University4, Yale University5, West Virginia University6, University of Barcelona7, St George's, University of London8, Indiana University9, National Yang-Ming University10, Cleveland Clinic11, Aarhus University12, University at Buffalo13, Imperial College London14, Primary Children's Hospital15, Erasmus University Rotterdam16, Yeshiva University17, Ghent University18, Baylor University19, Virginia Commonwealth University20, Harvard University21, Federal University of São Paulo22, University of California, San Francisco23, Beaumont Hospital24, Boston University25, University of Oklahoma26, University of Michigan27, Carlos III Health Institute28, University of Melbourne29, Saint Louis University30, Université de Montréal31, University of Pennsylvania32, McGill University33, Mayo Clinic34, Lahey Hospital & Medical Center35, Royal Adelaide Hospital36, University of Milan37, University of Toronto38, Loyola University Chicago39, Jikei University School of Medicine40
TL;DR: This 2017 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a writing group, convened by these five international societies.
Abstract: During the past three decades, catheter and surgical ablation of atrial fibrillation (AF) have evolved from investigational procedures to their current role as effective treatment options for patients with AF. Surgical ablation of AF, using either standard, minimally invasive, or hybrid techniques, is available in most major hospitals throughout the world. Catheter ablation of AF is even more widely available, and is now the most commonly performed catheter ablation procedure.
In 2007, an initial Consensus Statement on Catheter and Surgical AF Ablation was developed as a joint effort of the Heart Rhythm Society (HRS), the European Heart Rhythm Association (EHRA), and the European Cardiac Arrhythmia Society (ECAS).1 The 2007 document was also developed in collaboration with the Society of Thoracic Surgeons (STS) and the American College of Cardiology (ACC). This Consensus Statement on Catheter and Surgical AF Ablation was rewritten in 2012 to reflect the many advances in AF ablation that had occurred in the interim.2 The rate of advancement in the tools, techniques, and outcomes of AF ablation continue to increase as enormous research efforts are focused on the mechanisms, outcomes, and treatment of AF. For this reason, the HRS initiated an effort to rewrite and update this Consensus Statement. Reflecting both the worldwide importance of AF, as well as the worldwide performance of AF ablation, this document is the result of a joint partnership between the HRS, EHRA, ECAS, the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Society of Cardiac Stimulation and Electrophysiology (Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia [SOLAECE]). The purpose of this 2017 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a writing group, convened by these five international societies. The writing group is charged with defining the indications, techniques, and outcomes of AF ablation procedures. Included within this document are recommendations pertinent to the design of clinical trials in the field of AF ablation and the reporting of outcomes, including definitions relevant to this topic.
The writing group is composed of 60 experts representing 11 organizations: HRS, EHRA, ECAS, APHRS, SOLAECE, STS, ACC, American Heart Association (AHA), Canadian Heart Rhythm Society (CHRS), Japanese Heart Rhythm Society (JHRS), and Brazilian Society of Cardiac Arrhythmias (Sociedade Brasileira de Arritmias Cardiacas [SOBRAC]). All the members of the writing group, as well as peer reviewers of the document, have provided disclosure statements for all relationships that might be perceived as real or potential conflicts of interest. All author and peer reviewer disclosure information is provided in Appendix A and Appendix B.
In writing a consensus document, it is recognized that consensus does not mean that there was complete agreement among all the writing group members. Surveys of the entire writing group were used to identify areas of consensus concerning performance of AF ablation procedures and to develop recommendations concerning the indications for catheter and surgical AF ablation. These recommendations were systematically balloted by the 60 writing group members and were approved by a minimum of 80% of these members. The recommendations were also subject to a 1-month public comment period. Each partnering and collaborating organization then officially reviewed, commented on, edited, and endorsed the final document and recommendations.
The grading system for indication of class of evidence level was adapted based on that used by the ACC and the AHA.3,4 It is important to state, however, that this document is not a guideline. The indications for catheter and surgical ablation of AF, as well as recommendations for procedure performance, are presented with a Class and Level of Evidence (LOE) to be consistent with what the reader is familiar with seeing in guideline statements. A Class I recommendation means that the benefits of the AF ablation procedure markedly exceed the risks, and that AF ablation should be performed; a Class IIa recommendation means that the benefits of an AF ablation procedure exceed the risks, and that it is reasonable to perform AF ablation; a Class IIb recommendation means that the benefit of AF ablation is greater or equal to the risks, and that AF ablation may be considered; and a Class III recommendation means that AF ablation is of no proven benefit and is not recommended.
The writing group reviewed and ranked evidence supporting current recommendations with the weight of evidence ranked as Level A if the data were derived from high-quality evidence from more than one randomized clinical trial, meta-analyses of high-quality randomized clinical trials, or one or more randomized clinical trials corroborated by high-quality registry studies. The writing group ranked available evidence as Level B-R when there was moderate-quality evidence from one or more randomized clinical trials, or meta-analyses of moderate-quality randomized clinical trials. Level B-NR was used to denote moderate-quality evidence from one or more well-designed, well-executed nonrandomized studies, observational studies, or registry studies. This designation was also used to denote moderate-quality evidence from meta-analyses of such studies. Evidence was ranked as Level C-LD when the primary source of the recommendation was randomized or nonrandomized observational or registry studies with limitations of design or execution, meta-analyses of such studies, or physiological or mechanistic studies of human subjects. Level C-EO was defined as expert opinion based on the clinical experience of the writing group.
Despite a large number of authors, the participation of several societies and professional organizations, and the attempts of the group to reflect the current knowledge in the field adequately, this document is not intended as a guideline. Rather, the group would like to refer to the current guidelines on AF management for the purpose of guiding overall AF management strategies.5,6 This consensus document is specifically focused on catheter and surgical ablation of AF, and summarizes the opinion of the writing group members based on an extensive literature review as well as their own experience. It is directed to all health care professionals who are involved in the care of patients with AF, particularly those who are caring for patients who are undergoing, or are being considered for, catheter or surgical ablation procedures for AF, and those involved in research in the field of AF ablation. This statement is not intended to recommend or promote catheter or surgical ablation of AF. Rather, the ultimate judgment regarding care of a particular patient must be made by the health care provider and the patient in light of all the circumstances presented by that patient.
The main objective of this document is to improve patient care by providing a foundation of knowledge for those involved with catheter ablation of AF. A second major objective is to provide recommendations for designing clinical trials and reporting outcomes of clinical trials of AF ablation. It is recognized that this field continues to evolve rapidly. As this document was being prepared, further clinical trials of catheter and surgical ablation of AF were under way.
Dresden University of Technology1, University College London2, Eskişehir Osmangazi University3, Virginia Commonwealth University4, University of Cologne5, Université du Québec à Trois-Rivières6, University of Jena7, University College of Medical Sciences8, Massachusetts Eye and Ear Infirmary9, Konkuk University10, St. Lawrence University11, Cairo University12, Mie University13, Aristotle University of Thessaloniki14, University of Bern15, University of Vermont Medical Center16, University of Insubria17, Kanazawa Medical University18, University of Barcelona19, Medical University of Vienna20, University of Padua21, The Catholic University of America22, University of East Anglia23, University of Chicago24, University of Colorado Boulder25, Université catholique de Louvain26, Wolfson Medical Center27, Taipei Veterans General Hospital28, University of Buenos Aires29, Karolinska University Hospital30, University of Duisburg-Essen31, University of Pardubice32, University Hospital of Basel33
TL;DR: Clinicians and researchers are encouraged to adopt a common language in olfactory dysfunction to increase the methodological quality, consistency and generalisability of work in this field.
Abstract: Background: Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst full recommendations are outlined in the main document, key points include: -Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy. -Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability. -Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour threshold, and/or one of odour identification or discrimination. -Comprehensive chemosensory assessment should include gustatory screening. -Smell training can be helpful in patients with olfactory loss of several aetiologies. Conclusions: We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.
TL;DR: The case shows a novel pacing strategy for patients with BBB that affects many patients with heart failure, and demonstrates the feasibility of pacing the left bundle branch (LBB) immediately beyond the conduction block to functionally restore the impaired His-Purkinje conduction system.
TL;DR: In this paper, the authors use the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.
TL;DR: FMT from a rationally selected donor reduced hospitalizations, improved cognition, and dysbiosis in cirrhosis with recurrent HE, and increased diversity and beneficial taxa.
Yale University1, McMaster University2, University of California, Los Angeles3, University of Wisconsin-Madison4, University of Oklahoma5, University of California, Davis6, Case Western Reserve University7, Duke University8, Tufts Medical Center9, Boston Children's Hospital10, Virginia Commonwealth University11, American College of Rheumatology12
TL;DR: To develop recommendations for prevention and treatment of glucocorticoid‐induced osteoporosis (GIOP).
Abstract: Objective
To develop recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP).
Methods
We conducted a systematic review to synthesize the evidence for the benefits and harms of GIOP prevention and treatment options. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence. We used a group consensus process to determine the final recommendations and grade their strength. The guideline addresses initial assessment and reassessment in patients beginning or continuing long-term (≥3 months) glucocorticoid (GC) treatment, as well as the relative benefits and harms of lifestyle modification and of calcium, vitamin D, bisphosphonate, raloxifene, teriparatide, and denosumab treatment in the general adult population receiving long-term GC treatment, as well as in special populations of long-term GC users.
Results
Because of limited evidence regarding the benefits and harms of interventions in GC users, most recommendations in this guideline are conditional (uncertain balance between benefits and harms). Recommendations include treating only with calcium and vitamin D in adults at low fracture risk, treating with calcium and vitamin D plus an additional osteoporosis medication (oral bisphosphonate preferred) in adults at moderate-to-high fracture risk, continuing calcium plus vitamin D but switching from an oral bisphosphonate to another antifracture medication in adults in whom oral bisphosphonate treatment is not appropriate, and continuing oral bisphosphonate treatment or switching to another antifracture medication in adults who complete a planned oral bisphosphonate regimen but continue to receive GC treatment. Recommendations for special populations, including children, people with organ transplants, women of childbearing potential, and people receiving very high-dose GC treatment, are also made.
Conclusion
This guideline provides direction for clinicians and patients making treatment decisions. Clinicians and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
Katholieke Universiteit Leuven1, University Hospital of Basel2, Nuffield Orthopaedic Centre3, University of Oxford4, University Hospital of Lausanne5, Third Military Medical University6, Tel Aviv University7, Paracelsus Private Medical University of Salzburg8, Virginia Commonwealth University9, University of Southern California10, Chapel Allerton Hospital11, Erasmus University Rotterdam12
TL;DR: The intention of establishing this definition of FRI was to offer clinicians the opportunity to standardize clinical reports and improve the quality of published literature, and should be validated by prospective data collection in the future.
Abstract: Fracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or compare. In order to address this issue, an expert group comprised of a number of scientific and medical organizations has been convened, with the support of the AO Foundation, in order to develop a consensus definition. The process that led to this proposed definition started with a systematic literature review, which revealed that the majority of randomized controlled trials in fracture care do not use a standardized definition of FRI. In response to this conclusion, an international survey on the need for and key components of a definition of FRI was distributed amongst all registered AOTrauma users. Approximately 90% of the more than 2000 surgeons who responded suggested that a definition of FRI is required. As a final step, a consensus meeting was held with an expert panel. The outcome of this process led to a consensus definition of FRI. Two levels of certainty around diagnostic features were defined. Criteria could be confirmatory (infection definitely present) or suggestive. Four confirmatory criteria were defined: Fistula, sinus or wound breakdown; Purulent drainage from the wound or presence of pus during surgery; Phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; Presence of microorganisms in deep tissue taken during an operative intervention, as confirmed by histopathological examination. Furthermore, a list of suggestive criteria was defined. These require further investigations in order to look for confirmatory criteria. In the current paper, an overview is provided of the proposed definition and a rationale for each component and decision. The intention of establishing this definition of FRI was to offer clinicians the opportunity to standardize clinical reports and improve the quality of published literature. It is important to note that the proposed definition was not designed to guide treatment of FRI and should be validated by prospective data collection in the future.
Dartmouth College1, University of Texas Southwestern Medical Center2, Duke University3, National Institutes of Health4, University of Michigan5, University of Illinois at Chicago6, Columbia University7, Columbia University Medical Center8, University of Minnesota9, Anschutz Medical Campus10, Virginia Commonwealth University11, University of British Columbia12, University of Louisville13, Stanford University14, University of Massachusetts Medical School15, Albany Medical College16, University of California, Los Angeles17, Hofstra University18, New York University19, University of Dundee20, St. Jude Medical21, Emory University22, Centre for Addiction and Mental Health23, Toronto Western Hospital24
TL;DR: This study confirmed the safety and feasibility of subcallosal cingulate DBS as a treatment for treatment-resistant depression but did not show statistically significant antidepressant efficacy in a 6-month double-blind, sham-controlled trial.
Ben-Gurion University of the Negev1, University of Oxford2, Tel Aviv University3, Bishop Museum4, Villanova University5, Imperial College London6, Zoological Society of London7, University of Valle8, University College London9, University of Brasília10, Technion – Israel Institute of Technology11, Universiti Malaysia Sarawak12, University of Central Florida13, La Sierra University14, Museu Paraense Emílio Goeldi15, University of Michigan16, University of São Paulo17, Royal Museum for Central Africa18, Royal Belgian Institute of Natural Sciences19, University of Lincoln20, Pontificia Universidad Católica del Ecuador21, Institut de recherche pour le développement22, Virginia Commonwealth University23, Chinese Academy of Sciences24, American Museum of Natural History25
TL;DR: It is shown that additional conservation actions are needed to effectively protect reptiles, particularly lizards and turtles, and that adding reptile knowledge to a global complementarity conservation priority scheme identifies many locations that consequently become important.
Abstract: The distributions of amphibians, birds and mammals have underpinned global and local conservation priorities, and have been fundamental to our understanding of the determinants of global biodiversity. In contrast, the global distributions of reptiles, representing a third of terrestrial vertebrate diversity, have been unavailable. This prevented the incorporation of reptiles into conservation planning and biased our understanding of the underlying processes governing global vertebrate biodiversity. Here, we present and analyse the global distribution of 10,064 reptile species (99% of extant terrestrial species). We show that richness patterns of the other three tetrapod classes are good spatial surrogates for species richness of all reptiles combined and of snakes, but characterize diversity patterns of lizards and turtles poorly. Hotspots of total and endemic lizard richness overlap very little with those of other taxa. Moreover, existing protected areas, sites of biodiversity significance and global conservation schemes represent birds and mammals better than reptiles. We show that additional conservation actions are needed to effectively protect reptiles, particularly lizards and turtles. Adding reptile knowledge to a global complementarity conservation priority scheme identifies many locations that consequently become important. Notably, investing resources in some of the world’s arid, grassland and savannah habitats might be necessary to represent all terrestrial vertebrates efficiently.
TL;DR: In this article, the authors draw upon affective events theory, research regarding funders' perceptions, and research regarding expectation alignment between products and their presenters to develop and test an indirect effects model of crowdfunding resource allocation decisions.
TL;DR: This survey summarizes, categorize and analyze those contributions on data preprocessing that cope with streaming data, and takes into account the existing relationships between the different families of methods (feature and instance selection, and discretization).
TL;DR: It is very likely that in the next few years several medications will be available to clinicians treating patients with NAFLD across the entire spectrum of disease.
Abstract: Given the high prevalence and rising incidence of non-alcoholic fatty liver disease (NAFLD), the absence of approved therapies is striking. Although the mainstay of treatment of NAFLD is weight loss, it is hard to maintain, prompting the need for pharmacotherapy as well. A greater understanding of disease pathogenesis in recent years was followed by development of new classes of medications, as well as potential repurposing of currently available agents. NAFLD therapies target four main pathways. The dominant approach is targeting hepatic fat accumulation and the resultant metabolic stress. Medications in this group include peroxisome proliferator-activator receptor agonists (eg, pioglitazone, elafibranor, saroglitazar), medications targeting the bile acid-farnesoid X receptor axis (obeticholic acid), inhibitors of de novo lipogenesis (aramchol, NDI-010976), incretins (liraglutide) and fibroblast growth factor (FGF)-21 or FGF-19 analogues. A second approach is targeting the oxidative stress, inflammation and injury that follow the metabolic stress. Medications from this group include antioxidants (vitamin E), medications with a target in the tumour necrosis factor α pathway (emricasan, pentoxifylline) and immune modulators (amlexanox, cenicriviroc). A third group has a target in the gut, including antiobesity agents such as orlistat or gut microbiome modulators (IMM-124e, faecal microbial transplant, solithromycin). Finally, as the ongoing injury leads to fibrosis, the harbinger of liver-related morbidity and mortality, antifibrotics (simtuzumab and GR-MD-02) will be an important element of therapy. It is very likely that in the next few years several medications will be available to clinicians treating patients with NAFLD across the entire spectrum of disease.
Yale University1, McMaster University2, University of California, Los Angeles3, University of Wisconsin-Madison4, University of Oklahoma5, University of California, Davis6, Case Western Reserve University7, Duke University8, Tufts Medical Center9, Boston Children's Hospital10, Virginia Commonwealth University11, American College of Rheumatology12
TL;DR: To develop recommendations for prevention and treatment of glucocorticoid‐induced osteoporosis (GIOP).
Abstract: To develop recommendations for prevention and treatment of glucocorticoid‐induced osteoporosis (GIOP).
TL;DR: Permanent His-bundle pacing may be considered as a rescue strategy for failed BVP and may be a reasonable primary alternative to BVP for CRT.
Marche Polytechnic University1, United Arab Emirates University2, Obafemi Awolowo University3, John Hunter Hospital4, Rambam Health Care Campus5, University of Hawaii at Manoa6, University of Santiago de Compostela7, University of California, San Diego8, Tbilisi State Medical University9, University of Maryland, Baltimore10, Russian National Research Medical University11, Virginia Commonwealth University12, State University of Campinas13, Mansoura University14, Yonsei University15, Ruhr University Bochum16, Inje University17, University of Southern California18, Erzincan University19, University of Belgrade20, Tel Aviv University21, Foothills Medical Centre22, Kyoto University23, Edendale Hospital24, University of Helsinki25, Universidad Nacional de Asunción26, University of Washington27, Pt. B.D. Sharma PGIMS Rohtak28, University of the West Indies29, University of Colorado Denver30, University of Ilorin31, Jordan University of Science and Technology32, University of Valle33, University of São Paulo34, Ehime University35, Tan Tock Seng Hospital36, University of Bergen37, Stavanger University Hospital38, Charles University in Prague39, Radboud University Nijmegen40, Harvard University41, Chang Gung University42, Sher-I-Kashmir Institute of Medical Sciences43, Royal Perth Hospital44
TL;DR: The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.
Abstract: Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.