Saskatchewan Movement Disorders Program

AbstractWe review the Saskatchewan Movement Disorders Program, which started in 1968 and has had the dual goals of patient care and research. The clinics are structured to collect research-worthy data including videos, longitudinal follow-up, and autopsy studies of patients seen in the clinics. At every clinic visit, the patient is evaluated by one or both authors. A total of 25% to 30% of the deceased come to autopsy. Frozen half-brain and formalin-fixed remnants from autopsy are preserved in our laboratories. Patients not seen in our clinic are not included in research, which makes it different from brain banks. So far, 515 cases have come to autopsy. So far, there have been 17 collaborating scientific teams from Canada, the United States, Europe, and Japan. The collaborators are not charged for access to our resources. This program offers a unique opportunity to study multiple aspects of movement disorder patients seen in clinical practice.

Download Full-text

Anal Canal Cancer Clinical Practice Guidelines in Oncology

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2005.0026 ◽

2005 ◽

Vol 3 (4) ◽

pp. 510 ◽

Cited By ~ 11

Keyword(s):

United States ◽

Clinical Practice ◽

Anal Canal ◽

Practice Guidelines ◽

Digestive System ◽

The United States ◽

Anal Canal Cancer ◽

Nccn Guidelines ◽

Recent Version

An estimated 3,990 new cases of anal cancer will occur in 2005, accounting for approximately 1.6% of digestive system cancers in the United States. Prognosis directly depends on the size of the primary tumor and the likelihood of lymphatic spread, with tumors 2 cm or smaller cured in 80% of cases. The NCCN guidelines recommend a thorough evaluation for any patient with a suspicious lesion in the anal canal and include additional recommendations for diagnosis, treatment, and follow up for anal canal cancer. For the most recent version of the guidelines, please visit NCCN.org

Download Full-text

Natural History and Evolution of Anti-Interferon-γ Autoantibody-Associated Immunodeficiency Syndrome in Thailand and the United States

Clinical Infectious Diseases ◽

10.1093/cid/ciz786 ◽

2019 ◽

Vol 71 (1) ◽

pp. 53-62 ◽

Cited By ~ 3

Author(s):

Gloria H Hong ◽

Ana M Ortega-Villa ◽

Sally Hunsberger ◽

Ploenchan Chetchotisakd ◽

Siriluck Anunnatsiri ◽

...

Keyword(s):

United States ◽

Natural History ◽

The United States ◽

Interferon Γ ◽

Mycobacterium Abscessus ◽

Annual Data ◽

Persistent Infections ◽

Ifn Γ ◽

Immunodeficiency Syndrome

Abstract Background The natural history of anti-interferon-γ (IFN-γ) autoantibody-associated immunodeficiency syndrome is not well understood. Methods Data of 74 patients with anti-IFN-γ autoantibodies at Srinagarind Hospital, Thailand, were collected annually (median follow-up duration, 7.5 years). Annual data for 19 patients and initial data for 4 patients with anti-IFN-γ autoantibodies at the US National Institutes of Health were collected (median follow-up duration, 4.5 years). Anti-IFN-γ autoantibody levels were measured in plasma samples. Results Ninety-one percent of US patients were of Southeast Asian descent; there was a stronger female predominance (91%) in US than Thai (64%) patients. Mycobacterium abscessus (34%) and Mycobacterium avium complex (83%) were the most common nontuberculous mycobacteria in Thailand and the United States, respectively. Skin infections were more common in Thailand (P = .001), whereas bone (P < .0001), lung (P = .002), and central nervous system (P = .03) infections were more common in the United States. Twenty-four percent of Thai patients died, most from infections. None of the 19 US patients with follow-up data died. Anti-IFN-γ autoantibody levels decreased over time in Thailand (P < .001) and the United States (P = .017), with either cyclophosphamide (P = .01) or rituximab therapy (P = .001). Conclusions Patients with anti-IFN-γ autoantibodies in Thailand and the United States had distinct demographic and clinical features. While titers generally decreased with time, anti-IFN-γ autoantibody disease had a chronic clinical course with persistent infections and death. Close long-term surveillance for new infections is recommended.

Download Full-text

SAT0172 UTILIZATION OF HYDROXYCHLOROQUINE AND CORTICOSTEROIDS AMONG LUPUS PATIENTS WITH INCIDENT END-STAGE RENAL DISEASE (ESRD) ONSET: A LONGITUDINAL STUDY USING USRDS REGISTRY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5103 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1027.2-1027

Author(s):

A. R. Broder ◽

W. Mowrey ◽

A. Valle ◽

B. Goilav ◽

K. Yoshida ◽

...

Keyword(s):

United States ◽

Lupus Nephritis ◽

Renal Disease ◽

International Classification Of Diseases ◽

The United States ◽

Diagnostic Code ◽

Prescribing Practices ◽

Part D ◽

Stage Renal Disease

Background:The development of ESRD due to lupus nephritis is one of the most common and serious complications of SLE. Mortality among SLE ESRD patients is 4-fold higher compared to lupus nephritis patients with preserved renal function1Mortality in SLE ESRD is also twice as high compared with non-SLE ESRD, even though SLE patients develop ESRD at a significantly younger age. In the absence of ESRD specific guidelines, medication utilization in SLE ESRD is unknown.Objectives:The objective of this study was to investigate the real-world current US-wide patterns of medication prescribing among lupus nephritis patients with new onset ESRD enrolled in the United States Renal Disease Systems (USRDS) registry. We specifically focused on HCQ and corticosteroids (CS) as the most used medications to treat SLE.Methods:Inclusion: USRDS patients 18 years and above with SLE as a primary cause of ESRD (International Classification of Diseases, 9thRevision (ICD9) diagnostic code 710.0, previously validated2). who developed ESRD between January 1st, 2006 and July 31, 2011 (to ensure at least 6 months of follow-up in the USRDS). Patients had to be enrolled in Medicare Part D (to capture pharmacy claims). The last follow-up date was defined as either the last date of continuous part D coverage or the end of the study period, Dec 31, 2013.Results:Of the 2579 patients included, 1708 (66%) were HCQ- at baseline, and 871 (34%) were HCQ+ at baseline. HCQ+ patients at baseline had a slightly lower duration of follow-up compared to HCQ- patients at baseline, median (IQR) of 2.32 (1.33, 3.97) years and 2.55 (1.44, 4.25) years, respectively, p= 0.02. During follow-up period, only 778 (30%) continued HCQ either intermittently or continuously to the last follow-up date, 1306 (51%) were never prescribed HCQ after baseline, and 495 (19%) discontinued HCQ before the last follow-up date. Of the 1801 patients who were either never prescribed or discontinued HCQ early after ESRD onset, 713 (40%) were prescribed CS to the end of the follow-up period: 55% were receiving a low dose <10mg/daily, and 43 were receiving moderate dose (10-20mg daily)Conclusion:HCQ may be underprescribed and CS may be overprescribed in SLE ESRD. Changing the current prescribing practices may improve outcomes in SLE ESRDReferences:[1]Yap DY et al., NDT 2012.[2]Broder A et al., AC&R 2016.Acknowledgments :The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.Funding: :NIH/NIAMS K23 AR068441 (A Broder), NIH/NIAMS R01 AR 057327 and K24 AR 066109 (KH Costenbader)Disclosure of Interests: :Anna R. Broder: None declared, Wenzhu Mowrey: None declared, Anna Valle: None declared, Beatrice Goilav: None declared, Kazuki Yoshida: None declared, Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca

Download Full-text

Tyrosine kinase inhibitor therapy discontinuation in patients with chronic myeloid leukemia in chronic phase in the United States after clinical practice guideline updates

Leukemia & Lymphoma ◽

10.1080/10428194.2021.1885656 ◽

2021 ◽

pp. 1-14

Author(s):

Ehab L. Atallah ◽

Islam Sadek ◽

Rodrigo Maegawa ◽

Xiting Cao ◽

Dominick Latremouille-Viau ◽

...

Keyword(s):

United States ◽

Clinical Practice ◽

Chronic Myeloid Leukemia ◽

Clinical Practice Guideline ◽

Myeloid Leukemia ◽

Kinase Inhibitor ◽

Chronic Phase ◽

The United States ◽

Therapy Discontinuation ◽

Tyrosine Kinase Inhibitor Therapy

Download Full-text

Results from the United States CTEPH Registry (US-CTEPH-R): Enrollment Characteristics and 1-Year Follow-up

CHEST Journal ◽

10.1016/j.chest.2021.05.052 ◽

2021 ◽

Author(s):

Kim M. Kerr ◽

C. Greg Elliott ◽

Kelly Chin ◽

Raymond L. Benza ◽

Richard N. Channick ◽

...

Keyword(s):

United States ◽

The United States

Download Full-text

PDG20 Cost-effectiveness of Nivolumab in Patients with Pre-treated Advanced Renal Cell Carcinoma (aRCC) in the United States: Impact of >5 Years of Follow-up Data from Checkmate 025

Value in Health ◽

10.1016/j.jval.2020.08.703 ◽

2020 ◽

Vol 23 ◽

pp. S524

Author(s):

J. May ◽

B. Malcolm ◽

F. Ejzykowicz ◽

M. Kurt ◽

J. Borrill ◽

...

Keyword(s):

United States ◽

Renal Cell Carcinoma ◽

Cost Effectiveness ◽

Cell Carcinoma ◽

Renal Cell ◽

The United States ◽

Advanced Renal Cell Carcinoma

Download Full-text

Philip S. Hench’s Rheumatology Axiomatic Generalizations: Table 1.

The Journal of Rheumatology ◽

10.3899/jrheum.110606 ◽

2011 ◽

Vol 38 (12) ◽

pp. 2664-2670

Author(s):

GENE G. HUNDER ◽

LEROY GRIFFING

Keyword(s):

Internal Medicine ◽

United States ◽

Patient Care ◽

Education Program ◽

Mayo Clinic ◽

The United States ◽

Internal Medicine Residents ◽

The Status ◽

Rheumatology Education ◽

Unique Part

Philip S. Hench, MD, the first Mayo Clinic rheumatologist, came to Mayo Clinic in 1921. Because of his efforts in patient care, education, and research, and those of his colleagues, Mayo Clinic has been considered the first academic rheumatology center established in the United States. An early, popular lecture he gave to the internal medicine residents was an important and unique part of the rheumatology education program and was entitled “Axiomatic Generalizations Useful in the Diagnosis of Rheumatic Diseases.” We review the axioms in light of the status of rheumatology in the 1920s and 1930s when they were written, and assess their relevance today, 70 to 80 years later.

Download Full-text

Gamma knife radiosurgery as a lesioning technique in movement disorder surgery

Neurosurgical FOCUS ◽

10.3171/foc.1997.2.3.14 ◽

1997 ◽

Vol 2 (3) ◽

pp. E13 ◽

Cited By ~ 4

Author(s):

Ronald F. Young ◽

Anne Shumway-Cook ◽

Sandra S. Vermeulen ◽

Peter Grimm ◽

John Blasko ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Movement Disorder ◽

Gamma Knife ◽

Movement Disorders ◽

Rating Scale ◽

Gamma Knife Radiosurgery ◽

Magnetic Resonance Images ◽

Maximum Deviation

Fifty-five patients underwent radiosurgical placement of lesions either in the thalamus (27 patients) or globus pallidus (28 patients) for treatment of movement disorders. Patients were evaluated pre- and postoperatively by a team of observers skilled in the assessment of gait and movement disorders who were blinded to the procedure performed. They were not associated with the surgical team and concomitantly and blindly also assessed a group of 11 control patients with Parkinson's disease who did not undergo any surgical procedures. All stereotactic lesions were made with the Leksell gamma unit using the 4-mm secondary collimator helmet and a single isocenter with dose maximums from 120 to 160 Gy. Clinical follow-up evaluation indicated that 88% of patients who underwent thalamotomy became tremor free or nearly tremor free. Statistically significant improvements in performance were noted in the independent assessments of Unified Parkinson's Disease Rating Scale (UPDRS) scores in the patients undergoing thalamotomy. Eighty-five and seven-tenths percent of patients undergoing pallidotomy who had exhibited levodopa-induced dyskinesias had total or near-total relief of that symptom. Clinical assessment indicated improvement of bradykinesia and rigidity in 64.3% of patients who underwent pallidotomy. Independent blinded assessments did not reveal statistically significant improvements in Hoehn and Yahr scores or UPDRS scores. On the other hand, 64.7% of patients showed improvements in subscores of the UPDRS, including activities of daily living (58%), total contralateral score (58%), and contralateral motor scores (47%). Ipsilateral total UPDRS and ipsilateral motor scores were both improved in 59% of patients. One (1.8%) of 55 patients experienced a homonymous hemianopsia 9 months after pallidotomy due to an unexpectedly large lesion. No other complications of any kind were seen. Follow-up neuroimaging confirmed correct lesion location in all patients, with a mean maximum deviation from the planned target of 1 mm in the vertical axis. Measurements of lesions at regular interals on postoperative magnetic resonance images demonstrated considerable variability in lesion volumes. The safety and efficacy of functional lesions made with the gamma knife appear to be similar to those made with the assistance of electrophysiological guidance with open functional stereotactic procedures. Functional lesions may be made safely and accurately using gamma knife radiosurgical techniques. The efficacy is equivalent to that reported for open techniques that use radiofrequency lesioning methods with electrophysiological guidance. Complications are very infrequent with the radiosurgical method. The use of functional radiosurgical lesioning to treat movement disorders is particularly attractive in older patients and those with major systemic diseases or coagulopathies; its use in the general movement disorder population seems reasonable as well.

Download Full-text