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Penny S Mckibben - One of the best experts on this subject based on the ideXlab platform.
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a case control study of hiv seroconversion in health care workers after percutaneous exposure centers for disease control and prevention needlestick surveillance group
The New England Journal of Medicine, 1997Co-Authors: Denise M Cardo, David H Culver, Carol A Ciesielski, Pamela U Srivastava, Ruthanne Marcus, Dominique Abiteboul, Julia Heptonstall, Giuseppe Ippolito, Florence Lot, Penny S MckibbenAbstract:Background The average risk of human immunodeficiency virus (HIV) infection after percutaneous exposure to HIV-infected blood is 0.3 Percent, but the factors that influence this risk are not well understood. Methods We conducted a case-control study of health care workers with occupational, percutaneous exposure to HIV-infected blood. The case patients were those who became seropositive after exposure to HIV, as reported by national surveillance systems in France, Italy, the United Kingdom, and the United States. The controls were health care workers in a prospective surveillance project who were exposed to HIV but did not seroconvert. Results Logistic-regression analysis based on 33 case patients and 665 controls showed that significant risk factors for seroconversion were deep injury (odds ratio =15; 95 Percent Confidence Interval, 6.0 to 41), injury with a device that was visibly contaminated with the source patient's blood (odds ratio= 6.2; 95 Percent Confidence Interval, 2.2 to 21), a procedure involving a needle placed in the source patient's artery or vein (odds ratio=4.3; 95 Percent Confidence Interval, 1.7 to 12), and exposure to a source patient who died of the acquired immunodeficiency syndrome within two months afterward (odds ratio = 5.6; 95 Percent Confidence Interval, 2.0 to 16). The case patients were significantly less likely than the controls to have taken zidovudine after the exposure (odds ratio=0.19; 95 Percent Confidence Interval, 0.06 to 0.52). Conclusions The risk of HIV infection after percutaneous exposure increases with a larger volume of blood and, probably, a higher titer of HIV in the source patient's blood. Postexposure prophylaxis with zidovudine appears to be protective.
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a case control study of hiv seroconversion in health care workers after percutaneous exposure
The New England Journal of Medicine, 1997Co-Authors: Denise M Cardo, David H Culver, Carol A Ciesielski, Pamela U Srivastava, Ruthanne Marcus, Dominique Abiteboul, Julia Heptonstall, Giuseppe Ippolito, Florence Lot, Penny S MckibbenAbstract:Background The average risk of human immunodeficiency virus (HIV) infection after percutaneous exposure to HIV-infected blood is 0.3 Percent, but the factors that influence this risk are not well understood. Methods We conducted a case-control study of health care workers with occupational, percutaneous exposure to HIV-infected blood. The case patients were those who became seropositive after exposure to HIV, as reported by national surveillance systems in France, Italy, the United Kingdom, and the United States. The controls were health care workers in a prospective surveillance project who were exposed to HIV but did not seroconvert. Results Logistic-regression analysis based on 33 case patients and 665 controls showed that significant risk factors for seroconversion were deep injury (odds ratio =15; 95 Percent Confidence Interval, 6.0 to 41), injury with a device that was visibly contaminated with the source patient's blood (odds ratio= 6.2; 95 Percent Confidence Interval, 2.2 to 21), a procedure involving a needle placed in the source patient's artery or vein (odds ratio=4.3; 95 Percent Confidence Interval, 1.7 to 12), and exposure to a source patient who died of the acquired immunodeficiency syndrome within two months afterward (odds ratio = 5.6; 95 Percent Confidence Interval, 2.0 to 16). The case patients were significantly less likely than the controls to have taken zidovudine after the exposure (odds ratio=0.19; 95 Percent Confidence Interval, 0.06 to 0.52). Conclusions The risk of HIV infection after percutaneous exposure increases with a larger volume of blood and, probably, a higher titer of HIV in the source patient's blood. Postexposure prophylaxis with zidovudine appears to be protective.
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a case control study of hiv seroconversion in health care workers after percutaneous exposure centers for disease control and prevention needlestick surveillance group
The New England Journal of Medicine, 1997Co-Authors: Denise M Cardo, David H Culver, Carol A Ciesielski, Pamela U Srivastava, Ruthanne Marcus, Dominique Abiteboul, Julia Heptonstall, Giuseppe Ippolito, Florence Lot, Penny S MckibbenAbstract:Background The average risk of human immunodeficiency virus (HIV) infection after percutaneous exposure to HIV-infected blood is 0.3 Percent, but the factors that influence this risk are not well understood. Methods We conducted a case–control study of health care workers with occupational, percutaneous exposure to HIV-infected blood. The case patients were those who became seropositive after exposure to HIV, as reported by national surveillance systems in France, Italy, the United Kingdom, and the United States. The controls were health care workers in a prospective surveillance project who were exposed to HIV but did not seroconvert. Results Logistic-regression analysis based on 33 case patients and 665 controls showed that significant risk factors for seroconversion were deep injury (odds ratio = 15; 95 Percent Confidence Interval, 6.0 to 41), injury with a device that was visibly contaminated with the source patient's blood (odds ratio = 6.2; 95 Percent Confidence Interval, 2.2 to 21), a procedure inv...
William G Henderson - One of the best experts on this subject based on the ideXlab platform.
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open mesh versus laparoscopic mesh repair of inguinal hernia
The New England Journal of Medicine, 2004Co-Authors: Leigh A Neumayer, Anita Giobbiehurder, Olga Jonasson, Robert J Fitzgibbons, Dorothy D Dunlop, James Gibbs, Domenic J Reda, William G HendersonAbstract:BACKGROUND Repair of inguinal hernias in men is a common surgical procedure, but the most effective surgical technique is unknown. METHODS We randomly assigned men with inguinal hernias at 14 Veterans Affairs (VA) medical centers to either open mesh or laparoscopic mesh repair. The primary outcome was recurrence of hernias at two years. Secondary outcomes included complications and patient-centered outcomes. RESULTS Of the 2164 patients who were randomly assigned to one of the two procedures, 1983 underwent an operation; two-year follow-up was completed in 1696 (85.5 Percent). Recurrences were more common in the laparoscopic group (87 of 862 patients [10.1 Percent]) than in the open group (41 of 834 patients [4.9 Percent]; odds ratio, 2.2; 95 Percent Confidence Interval, 1.5 to 3.2). The rate of complications was higher in the laparoscopic-surgery group than in the open-surgery group (39.0 Percent vs. 33.4 Percent; adjusted odds ratio, 1.3; 95 Percent Confidence Interval, 1.1 to 1.6). The laparoscopic-surgery group had less pain initially than the open-surgery group on the day of surgery (difference in mean score on a visual-analogue scale, 10.2 mm; 95 Percent Confidence Interval, 4.8 to 15.6) and at two weeks (6.1 mm; 95 Percent Confidence Interval, 1.7 to 10.5) and returned to normal activities one day earlier (adjusted hazard ratio for a shorter time to return to normal activities, 1.2; 95 Percent Confidence Interval, 1.1 to 1.3). In prespecified analyses, there was a significant interaction between the surgical approach (open or laparoscopic) and the type of hernia (primary or recurrent) (P=0.012). Recurrence was significantly more common after laparoscopic repair than after open repair of primary hernias (10.1 Percent vs. 4.0 Percent), but rates of recurrence after repair of recurrent hernias were similar in the two groups (10.0 Percent and 14.1 Percent, respectively). CONCLUSIONS The open technique is superior to the laparoscopic technique for mesh repair of primary hernias.
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open mesh versus laparoscopic mesh repair of inguinal hernia
The New England Journal of Medicine, 2004Co-Authors: Leigh A Neumayer, Anita Giobbiehurder, Olga Jonasson, Robert J Fitzgibbons, Dorothy D Dunlop, James Gibbs, Domenic J Reda, William G HendersonAbstract:Background Repair of inguinal hernias in men is a common surgical procedure, but the most effective surgical technique is unknown. Methods We randomly assigned men with inguinal hernias at 14 Veterans Affairs (VA) medical centers to either open mesh or laparoscopic mesh repair. The primary outcome was recurrence of hernias at two years. Secondary outcomes included complications and patient-centered outcomes. Results Of the 2164 patients who were randomly assigned to one of the two procedures, 1983 underwent an operation; two-year follow-up was completed in 1696 (85.5 Percent). Recurrences were more common in the laparoscopic group (87 of 862 patients [10.1 Percent]) than in the open group (41 of 834 patients [4.9 Percent]; odds ratio, 2.2; 95 Percent Confidence Interval, 1.5 to 3.2). The rate of complications was higher in the laparoscopic-surgery group than in the open-surgery group (39.0 Percent vs. 33.4 Percent; adjusted odds ratio, 1.3; 95 Percent Confidence Interval, 1.1 to 1.6). The laparoscopic-sur...
Oluf Pedersen - One of the best experts on this subject based on the ideXlab platform.
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multifactorial intervention and cardiovascular disease in patients with type 2 diabetes
The New England Journal of Medicine, 2003Co-Authors: Peter Gaede, P Vedel, Nicolai Larsen, G Jensen, Hanshenrik Parving, Oluf PedersenAbstract:From the Steno Diabetes Center, Copenhagen (P.G., P.V., N.L., H.-H.P., O.P.); Herlev County Hospital, Herlev (N.L.); Amtssygehuset Roskilde, Roskilde (G.V.H.J.); and the Faculty of Health Science, Aarhus University, Aarhus (H.-H.P., O.P.) — all in Denmark. Address reprint requests to Dr. Pedersen at the Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark, or at oluf@steno.dk. N Engl J Med 2003;348:383-93. Copyright © 2003 Massachusetts Medical Society. background Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. methods The primary end point of this open, parallel trial was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, revascularization, and amputation. Eighty patients were randomly assigned to receive conventional treatment in accordance with national guidelines and 80 to receive intensive treatment, with a stepwise implementation of behavior modification and pharmacologic therapy that targeted hyperglycemia, hypertension, dyslipidemia, and microalbuminuria, along with secondary prevention of cardiovascular disease with aspirin. results The mean age of the patients was 55.1 years, and the mean follow-up was 7.8 years. The decline in glycosylated hemoglobin values, systolic and diastolic blood pressure, serum cholesterol and triglyceride levels measured after an overnight fast, and urinary albumin excretion rate were all significantly greater in the intensive-therapy group than in the conventional-therapy group. Patients receiving intensive therapy also had a significantly lower risk of cardiovascular disease (hazard ratio, 0.47; 95 Percent Confidence Interval, 0.24 to 0.73), nephropathy (hazard ratio, 0.39; 95 Percent Confidence Interval, 0.17 to 0.87), retinopathy (hazard ratio, 0.42; 95 Percent Confidence Interval, 0.21 to 0.86), and autonomic neuropathy (hazard ratio, 0.37; 95 Percent Confidence Interval, 0.18 to 0.79). conclusions A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular and microvascular events by about 50 Percent.
Denise M Cardo - One of the best experts on this subject based on the ideXlab platform.
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a case control study of hiv seroconversion in health care workers after percutaneous exposure centers for disease control and prevention needlestick surveillance group
The New England Journal of Medicine, 1997Co-Authors: Denise M Cardo, David H Culver, Carol A Ciesielski, Pamela U Srivastava, Ruthanne Marcus, Dominique Abiteboul, Julia Heptonstall, Giuseppe Ippolito, Florence Lot, Penny S MckibbenAbstract:Background The average risk of human immunodeficiency virus (HIV) infection after percutaneous exposure to HIV-infected blood is 0.3 Percent, but the factors that influence this risk are not well understood. Methods We conducted a case-control study of health care workers with occupational, percutaneous exposure to HIV-infected blood. The case patients were those who became seropositive after exposure to HIV, as reported by national surveillance systems in France, Italy, the United Kingdom, and the United States. The controls were health care workers in a prospective surveillance project who were exposed to HIV but did not seroconvert. Results Logistic-regression analysis based on 33 case patients and 665 controls showed that significant risk factors for seroconversion were deep injury (odds ratio =15; 95 Percent Confidence Interval, 6.0 to 41), injury with a device that was visibly contaminated with the source patient's blood (odds ratio= 6.2; 95 Percent Confidence Interval, 2.2 to 21), a procedure involving a needle placed in the source patient's artery or vein (odds ratio=4.3; 95 Percent Confidence Interval, 1.7 to 12), and exposure to a source patient who died of the acquired immunodeficiency syndrome within two months afterward (odds ratio = 5.6; 95 Percent Confidence Interval, 2.0 to 16). The case patients were significantly less likely than the controls to have taken zidovudine after the exposure (odds ratio=0.19; 95 Percent Confidence Interval, 0.06 to 0.52). Conclusions The risk of HIV infection after percutaneous exposure increases with a larger volume of blood and, probably, a higher titer of HIV in the source patient's blood. Postexposure prophylaxis with zidovudine appears to be protective.
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a case control study of hiv seroconversion in health care workers after percutaneous exposure
The New England Journal of Medicine, 1997Co-Authors: Denise M Cardo, David H Culver, Carol A Ciesielski, Pamela U Srivastava, Ruthanne Marcus, Dominique Abiteboul, Julia Heptonstall, Giuseppe Ippolito, Florence Lot, Penny S MckibbenAbstract:Background The average risk of human immunodeficiency virus (HIV) infection after percutaneous exposure to HIV-infected blood is 0.3 Percent, but the factors that influence this risk are not well understood. Methods We conducted a case-control study of health care workers with occupational, percutaneous exposure to HIV-infected blood. The case patients were those who became seropositive after exposure to HIV, as reported by national surveillance systems in France, Italy, the United Kingdom, and the United States. The controls were health care workers in a prospective surveillance project who were exposed to HIV but did not seroconvert. Results Logistic-regression analysis based on 33 case patients and 665 controls showed that significant risk factors for seroconversion were deep injury (odds ratio =15; 95 Percent Confidence Interval, 6.0 to 41), injury with a device that was visibly contaminated with the source patient's blood (odds ratio= 6.2; 95 Percent Confidence Interval, 2.2 to 21), a procedure involving a needle placed in the source patient's artery or vein (odds ratio=4.3; 95 Percent Confidence Interval, 1.7 to 12), and exposure to a source patient who died of the acquired immunodeficiency syndrome within two months afterward (odds ratio = 5.6; 95 Percent Confidence Interval, 2.0 to 16). The case patients were significantly less likely than the controls to have taken zidovudine after the exposure (odds ratio=0.19; 95 Percent Confidence Interval, 0.06 to 0.52). Conclusions The risk of HIV infection after percutaneous exposure increases with a larger volume of blood and, probably, a higher titer of HIV in the source patient's blood. Postexposure prophylaxis with zidovudine appears to be protective.
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a case control study of hiv seroconversion in health care workers after percutaneous exposure centers for disease control and prevention needlestick surveillance group
The New England Journal of Medicine, 1997Co-Authors: Denise M Cardo, David H Culver, Carol A Ciesielski, Pamela U Srivastava, Ruthanne Marcus, Dominique Abiteboul, Julia Heptonstall, Giuseppe Ippolito, Florence Lot, Penny S MckibbenAbstract:Background The average risk of human immunodeficiency virus (HIV) infection after percutaneous exposure to HIV-infected blood is 0.3 Percent, but the factors that influence this risk are not well understood. Methods We conducted a case–control study of health care workers with occupational, percutaneous exposure to HIV-infected blood. The case patients were those who became seropositive after exposure to HIV, as reported by national surveillance systems in France, Italy, the United Kingdom, and the United States. The controls were health care workers in a prospective surveillance project who were exposed to HIV but did not seroconvert. Results Logistic-regression analysis based on 33 case patients and 665 controls showed that significant risk factors for seroconversion were deep injury (odds ratio = 15; 95 Percent Confidence Interval, 6.0 to 41), injury with a device that was visibly contaminated with the source patient's blood (odds ratio = 6.2; 95 Percent Confidence Interval, 2.2 to 21), a procedure inv...
Salim Yusuf - One of the best experts on this subject based on the ideXlab platform.
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homocysteine lowering with folic acid and b vitamins in vascular disease
The New England Journal of Medicine, 2006Co-Authors: Eva Lonn, Salim Yusuf, J M Arnold, Janice Pogue, Mary Micks, Matthew J Mcqueen, Jeffrey L ProbstfieldAbstract:risk, 0.95; 95 Percent Confidence Interval, 0.84 to 1.07; P = 0.41). As compared with placebo, active treatment did not significantly decrease the risk of death from cardiovascular causes (relative risk, 0.96; 95 Percent Confidence Interval, 0.81 to 1.13), myocardial infarction (relative risk, 0.98; 95 Percent Confidence Interval, 0.85 to 1.14), or any of the secondary outcomes. Fewer patients assigned to active treatment than to placebo had a stroke (relative risk, 0.75; 95 Percent Confidence Interval, 0.59 to 0.97). More patients in the active-treatment group were hospitalized for unstable angina (relative risk, 1.24; 95 Percent Confidence Interval, 1.04 to 1.49). Conclusions Supplements combining folic acid and vitamins B 6 and B 12 did not reduce the risk of major cardiovascular events in patients with vascular disease. (ClinicalTrials.gov number, NCT00106886; Current Controlled Trials number, ISRCTN14017017.)
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vitamin e supplementation and cardiovascular events in high risk patients
The New England Journal of Medicine, 2000Co-Authors: Salim Yusuf, Janice Pogue, G Dagenais, Jackie Bosch, Peter SleightAbstract:Observational and experimental studies suggest that the amount of vitamin E ingested in food and in supplements is associated with a lower risk of coronary heart disease and atherosclerosis.We enrolled a total of 2545 women and 6996 men 55 years of age or older who were at high risk for cardiovascular events because they had cardiovascular disease or diabetes in addition to one other risk factor. These patients were randomly assigned according to a two-by-two factorial design to receive either 400 IU of vitamin E daily from natural sources or matching placebo and either an angiotensin-converting-enzyme inhibitor (ramipril) or matching placebo for a mean of 4.5 years (the results of the comparison of ramipril and placebo are reported in a companion article). The primary outcome was a composite of myocardial infarction, stroke, and death from cardiovascular causes. The secondary outcomes included unstable angina, congestive heart failure, revascularization or amputation, death from any cause, complications of diabetes, and cancer.A total of 772 of the 4761 patients assigned to vitamin E (16.2 Percent) and 739 of the 4780 assigned to placebo (15.5 Percent) had a primary outcome event (relative risk, 1.05; 95 Percent Confidence Interval, 0.95 to 1.16; P=0.33). There were no significant differences in the numbers of deaths from cardiovascular causes (342 of those assigned to vitamin E vs. 328 of those assigned to placebo; relative risk, 1.05; 95 Percent Confidence Interval, 0.90 to 1.22), myocardial infarction (532 vs. 524; relative risk, 1.02; 95 Percent Confidence Interval, 0.90 to 1.15), or stroke (209 vs. 180; relative risk, 1.17; 95 Percent Confidence Interval, 0.95 to 1.42). There were also no significant differences in the incidence of secondary cardiovascular outcomes or in death from any cause. There were no significant adverse effects of vitamin E.In patients at high risk for cardiovascular events, treatment with vitamin E for a mean of 4.5 years had no apparent effect on cardiovascular outcomes.
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effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions
The New England Journal of Medicine, 1992Co-Authors: Solvd Investigators, William B Hood, Salim Yusuf, Bertram Pitt, Clay Davis, Jay N CohnAbstract:Background It is not known whether the treatment of patients with asymptomatic left ventricular dysfunction reduces mortality and morbidity. We studied the effect of an angiotensin-converting--enzyme inhibitor, enalapril, on total mortality and mortality from cardiovascular causes, the development of heart failure, and hospitalization for heart failure among patients with ejection fractions of 0.35 or less who were not receiving drug treatment for heart failure. Methods Patients were randomly assigned to receive either placebo (n = 2117) or enalapril (n = 2111) at doses of 2.5 to 20 mg per day in a double-blind trial. Follow-up averaged 37.4 months. Results There were 334 deaths in the placebo group, as compared with 313 in the enalapril group (reduction in risk, 8 Percent by the log-rank test; 95 Percent Confidence Interval, -8 Percent [an increase of 8 Percent] to 21 Percent; P = 0.30). The reduction in mortality from cardiovascular causes was larger but was not statistically significant (298 deaths in the placebo group vs. 265 in the enalapril group; risk reduction, 12 Percent; 95 Percent Confidence Interval, -3 to 26 Percent; P = 0.12). When we combined patients in whom heart failure developed and those who died, the total number of deaths and cases of heart failure was lower in the enalapril group than in the placebo group (630 vs. 818; risk reduction, 29 Percent; 95 Percent Confidence Interval, 21 to 36 Percent; P less than 0.001). In addition, fewer patients given enalapril died or were hospitalized for heart failure (434 in the enalapril group; vs. 518 in the placebo group; risk reduction, 20 Percent; 95 Percent Confidence Interval, 9 to 30 Percent; P less than 0.001). Conclusions The angiotensin-converting--enzyme inhibitor enalapril significantly reduced the incidence of heart failure and the rate of related hospitalizations, as compared with the rates in the group given placebo, among patients with asymptomatic left ventricular dysfunction. There was also a trend toward fewer deaths due to cardiovascular causes among the patients who received enalapril.
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effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure
The New England Journal of Medicine, 1991Co-Authors: Solvd Investigators, William B Hood, Salim Yusuf, Bertram Pitt, C E Davis, Jay N CohnAbstract:Background Patients with congestive heart failure have a high mortality rate and are also hospitalized frequently. We studied the effect of an angiotensin-converting-enzyme inhibitor, enalapril, on mortality and hospitalization in patients with chronic heart failure and ejection fractions less than or equal to 0.35. Methods Patients receiving conventional treatment for heart failure were randomly assigned to receive either placebo (n = 1284) or enalapril (n = 1285) at doses of 2.5 to 20 mg per day in a double-bind trial. Approximately 90 Percent of the patients were in New York Heart Association functional classes II and III. The follow-up averaged 41.4 months. Results There were 510 deaths in the placebo group (39.7 Percent), as compared with 452 in the enalapril group (35.2 Percent) (reduction in risk, 16 Percent; 95 Percent Confidence Interval, 5 to 26 Percent; P = 0.0036). Although reductions in mortality were observed in several categories of cardiac deaths, the largest reduction occurred among the deaths attributed to progressive heart failure (251 in the placebo group vs. 209 in the enalapril group; reduction in risk, 22 Percent; 95 Percent Confidence Interval, 6 to 35 Percent). There was little apparent effect of treatment on deaths classified as due to arrhythmia without pump failure. Fewer patients died or were hospitalized for worsening heart failure (736 in the placebo group and 613 in the enalapril group; risk reduction, 26 Percent; 95 Percent Confidence Interval, 18 to 34 Percent; P less than 0.0001). Conclusions The addition of enalapril to conventional therapy significantly reduced mortality and hospitalizations for heart failure in patients with chronic congestive heart failure and reduced ejection fractions.
