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  1. Article ; Online: Integration of palliative care consultation into the management of patients with chronic limb-threatening ischemia.

    Cattermole, Tessa C / Schimmel, McKenna L / Carpenter, Rachel L / Callas, Peter W / Gramling, Robert / Bertges, Daniel J / Ferranti, Katelynn M

    Journal of vascular surgery

    2023  Volume 78, Issue 2, Page(s) 454–463

    Abstract: Objective: We assessed the feasibility of integrating palliative care consultation into the routine management of patients with chronic limb-threatening ischemia (CLTI). Additionally, we sought to describe patient-reported outcomes from the palliative ... ...

    Abstract Objective: We assessed the feasibility of integrating palliative care consultation into the routine management of patients with chronic limb-threatening ischemia (CLTI). Additionally, we sought to describe patient-reported outcomes from the palliative care and vascular literature in patients with CLTI receiving a palliative care consultation at our institution.
    Methods: This was a single-institution, prospective, observational study that aimed to assess feasibility of incorporating palliative care consultation into the management of patients admitted to our tertiary academic medical center with CLTI by looking at utilization of palliative care before and after implementation of a protocol-based palliative care referral system. A survey comprised of patient-reported outcomes from the palliative care literature was administered to patients before and after palliative consultation. Length of stay and mortality were compared between our study cohort and a historic cohort of patients admitted with CLTI.
    Results: Over a 14-month enrollment period, 44% of patients (n = 39) with CLTI (rest pain, 36%; tissue loss, 64%) admitted to the vascular service received palliative care consultation, compared with 5% of patients (n = 4) who would have met criteria over the preceding 14 months before our protocol was instituted. The mean age was 69 years, 23% were female, 92% were white, and 49% were able to ambulate independently. Revascularization included bypass (46%), peripheral vascular intervention (23%), and femoral endarterectomy (21%). Additional procedures included minor amputation or wound debridement (26%) and major amputation (15%). No patients received medical management alone. After receiving palliative care consultation, patients reported experiencing less emotional distress than before consultation (P = .03). They also reported being less bothered by uncertainty regarding what to expect from the course of their illness (P = .002). Fewer patients reported being unsure of the purpose of their medical care after palliative care consultation (8%) vs before (18%), although this was not statistically significant (P = .10). Median length of stay was longer in the study group compared with the historic cohort (8 vs 7 days; P = .02). There was no difference in 30-day mortality (3% vs 8%; P = .42) between the study group and the historic cohort (n = 77).
    Conclusions: Integrating inpatient palliative care consultation into the routine management of patients with CLTI is feasible and may improve emotional domains of health-related quality of life. This study laid the foundation for future studies on longer term outcomes of patients with CLTI undergoing palliative care consultation as well as the benefit of outpatient palliative care consultation in patients with CLTI.
    MeSH term(s) Humans ; Female ; Aged ; Male ; Chronic Limb-Threatening Ischemia ; Risk Factors ; Peripheral Arterial Disease/diagnosis ; Peripheral Arterial Disease/therapy ; Palliative Care ; Quality of Life ; Prospective Studies ; Ischemia/diagnosis ; Ischemia/therapy ; Treatment Outcome ; Referral and Consultation ; Limb Salvage/methods ; Retrospective Studies ; Chronic Disease ; Endovascular Procedures/adverse effects
    Language English
    Publishing date 2023-04-23
    Publishing country United States
    Document type Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2022.12.069
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1933: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Association between gender and outcomes of lower extremity peripheral vascular interventions.

    Ferranti, Katelynn M / Osler, Turner M / Duffy, Reshma P / Stanley, Andy C / Bertges, Daniel J

    Journal of vascular surgery

    2015  Volume 62, Issue 4, Page(s) 990–997

    Abstract: Objective: The purpose of this study was to evaluate the association of gender with outcomes of peripheral vascular intervention (PVI) for intermittent claudication and critical limb ischemia (CLI).: Methods: We reviewed 3338 patients (1316 [39%] ... ...

    Abstract Objective: The purpose of this study was to evaluate the association of gender with outcomes of peripheral vascular intervention (PVI) for intermittent claudication and critical limb ischemia (CLI).
    Methods: We reviewed 3338 patients (1316 [39%] women) undergoing PVI for claudication (1892; 57%) or CLI (1446; 43%) in the Vascular Study Group of New England from January 2010 to June 2012. Kaplan-Meier analysis, stratified by indication, was used to assess relationships between gender and the main outcome measures of major amputation, reintervention, and survival during the first year.
    Results: Indications for PVI included claudication (n = 719 [38%] vs n = 1173 [62%]) and CLI (n = 597 [41%] vs n = 849 [59%]) in women and men, respectively (P = .0028). Women were older (69 vs 66 mean years; P < .00001), with less diabetes (43% vs 49%; P = .01), renal insufficiency (4.6% vs 7.3%; P = .0029), coronary artery disease (28% vs 35%; P < .00001), smoking (76% vs 86%; P = .01), and statin use (60% vs 64%; P = .0058). Technical success (95% vs 94%; P = .11), vascular injury (1.3% vs 1.0%; P = .82), and distal embolization (1.6% vs 1.3%; P = .46) were similar. Higher rates of hematoma (7.1% vs 3.4%; P ≤ .0001) and access site occlusion (0.91% vs 0.24%; P = .0085) were observed in women compared with men. There were no differences in major amputation (0.6% vs 0.6%; P = .81) or mortality (2.1% vs 1.5%; P = .20) rates at 30 days between women and men. Reinterventions (surgical and percutaneous) were similar between genders for claudicants (log-rank test, P = .75) and CLI patients (log-rank test, P = .93). Major amputation rates during the first year were not different for women and men and with claudication (log-rank test, P < .55) or CLI (log-rank test, P < .23). One-year survival was not different between women and men with claudication (95% vs 96%; P = .19) or CLI (77% vs 79%; P = .35).
    Conclusions: Whereas we observed higher rates of access site complications including hematoma and occlusion in women, we found no other evidence for gender disparity in reinterventions, major amputation, or survival rates after PVI for patients with claudication or CLI.
    MeSH term(s) Age Factors ; Aged ; Aged, 80 and over ; Amputation/statistics & numerical data ; Coronary Disease/complications ; Diabetes Complications ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage ; Intermittent Claudication/mortality ; Intermittent Claudication/therapy ; Ischemia/mortality ; Ischemia/therapy ; Kaplan-Meier Estimate ; Leg/blood supply ; Male ; Middle Aged ; Prospective Studies ; Renal Insufficiency/complications ; Sex Factors ; Smoking ; Treatment Outcome
    Chemical Substances Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Language English
    Publishing date 2015-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2015.03.066
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1933: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: The mouse frizzy (fr) and rat 'hairless' (frCR) mutations are natural variants of protease serine S1 family member 8 (Prss8).

    Spacek, Damek V / Perez, Amarilis F / Ferranti, Katelynn M / Wu, Lillya K-L / Moy, Daniel M / Magnan, David R / King, Thomas R

    Experimental dermatology

    2010  Volume 19, Issue 6, Page(s) 527–532

    Abstract: Please cite this paper as: The mouse frizzy (fr) and rat 'hairless' (fr(CR)) mutations are natural variants of protease serine S1 family member 8 (Prss8). Experimental Dermatology 2010; 19: 527-532. Abstract: We have previously suggested (based on ... ...

    Abstract Please cite this paper as: The mouse frizzy (fr) and rat 'hairless' (fr(CR)) mutations are natural variants of protease serine S1 family member 8 (Prss8). Experimental Dermatology 2010; 19: 527-532. Abstract: We have previously suggested (based on genetic mapping analysis) that the allelic 'fuzzy' and 'hairless' mutations in the rat are likely orthologues of the mouse frizzy mutation (fr). Here, we analysed three large intraspecific backcross panels that segregated for mouse fr to restrict this locus to a 0.6-Mb region that includes fewer than 30 genes. DNA sequencing of one of these candidates known to be expressed in skin, protease serine S1 family member 8 (Prss8), revealed a T to A transversion associated with the fr allele that would result in a valine to aspartate substitution at residue 170 in the gene product. To test whether this missense mutation might be the molecular basis of this frizzy variant, we crossed fr/fr mice with mice that carried a recessive perinatal lethal mutation in Prss8. Hybrid offspring that inherited both fr and the Prss8 null allele displayed abnormal hair and skin, showing that these two mutations are allelic, and suggesting strongly that the T to A mutation in Prss8 is responsible for the mutant frizzy phenotype. Sequence analysis of all Prss8 coding regions in the 'hairless' rat identified a 12-bp deletion in the third exon, indicating that mouse fr and the rat 'hairless' mutations are indeed orthologues. However, this analysis failed to detect any alterations to Prss8 coding sequences in the allelic 'fuzzy' rat variant.
    MeSH term(s) Animals ; Chromosome Mapping ; Chromosomes, Mammalian/genetics ; Crossing Over, Genetic/genetics ; Female ; Genetic Complementation Test ; Hair Diseases/genetics ; Hair Diseases/pathology ; Hair Follicle/pathology ; Inbreeding ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Mice, Mutant Strains ; Mutation/genetics ; Mutation, Missense/genetics ; Polymorphism, Single Nucleotide/genetics ; Rats ; Rats, Hairless ; Rats, Inbred BN ; Rats, Mutant Strains ; Sequence Analysis, DNA ; Sequence Deletion/genetics ; Serine Endopeptidases/genetics ; Skin/pathology ; Vibrissae/pathology
    Chemical Substances Serine Endopeptidases (EC 3.4.21.-) ; prostasin (EC 3.4.21.-)
    Language English
    Publishing date 2010-06
    Publishing country Denmark
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1130936-2
    ISSN 1600-0625 ; 0906-6705
    ISSN (online) 1600-0625
    ISSN 0906-6705
    DOI 10.1111/j.1600-0625.2009.01054.x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 3508: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    ab Jg. 2022: Lesesaal (EG)

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