The Experts below are selected from a list of 115074 Experts worldwide ranked by ideXlab platform
Jeffrey A. Kline - One of the best experts on this subject based on the ideXlab platform.
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Risk Stratification and treatment strategy of pulmonary embolism.
Current opinion in critical care, 2012Co-Authors: Andrea Penaloza, Pierre-marie Roy, Jeffrey A. KlineAbstract:PURPOSE OF REVIEW: Pulmonary embolism remains one of the leading causes of cardiovascular mortality. The wide range of reported mortality rates reflects heterogeneity in comorbidity and severity of pulmonary embolism. Optimizing Risk Stratification to prognose pulmonary embolism patients appears to be important to improve management, treatment and clinical outcome. RECENT FINDINGS: Hemodynamic status is the most important short-term prognostic factor. High-Risk pulmonary embolism or massive pulmonary embolism is defined by the patient response more than the clot size: patients with circulatory shock including sustained hypotension should receive thrombolytic therapy in absence of contraindications. Nonmassive or normotensive pulmonary embolism can be further stratified using clinical features, imaging (echocardiography, computed tomography) and biomarkers (troponins, natriuretic peptides): low-Risk pulmonary embolism, evaluated by clinical model (Pulmonary Embolism Severity Index; PESI) can potentially be treated as outpatients; and intermediate-Risk pulmonary embolism, which can be further stratified into less-severe and more-severe intermediate Risk. The last may benefit from intensive clinical surveillance but the Risk-benefit ratio for thrombolysis has been inadequately quantified to make any strong recommendation. New anticoagulants may transform traditional pulmonary embolism treatment. SUMMARY: Optimizing Risk Stratification of patients with normotensive pulmonary embolism before they develop overt hemodynamic instability is the challenge of current pulmonary embolism management. Treatment strategy has to integrate this Risk Stratification and new anticoagulants arrival.
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Risk Stratification for Acute Pulmonary Embolism
Journal of the National Comprehensive Cancer Network : JNCCN, 2011Co-Authors: Jeffrey A. Kline, David W. MillerAbstract:This article discusses state-of-the-art techniques for predicting Risk of death after acute pulmonary embolism (PE), with special attention to how underlying malignancy adversely affects survival after an episode. Current methods of Risk Stratification generally categorize patients with PE as low-, moderate-, and high-Risk for in-hospital adverse outcomes of respiratory failure, circulatory shock, and death. Published Risk Stratification studies find that patients with PE and an underlying malignancy have a worse prognosis, but no validated Risk Stratification criteria have been published specifically for these patients. Standard treatment is full-dose heparin followed by oral anticoagulation. The term escalated treatment refers to the use of systemic or intrapulmonary fibrinolytic agents, catheter-based treatment, or surgical embolectomy. Most patients with low-Risk PE (normal vital signs and normal serum troponin, brain natriuretic peptide, and normal echocardiography) are treated successfully with standard anticoagulation, and many can be treated as outpatients. In contrast, patients with high-Risk PE (systolic blood pressure < 90 mm Hg and no contraindications) often benefit from escalated treatment. Treatment decisions for patients with moderate-Risk PE (normotension with evidence of right ventricular damage or dysfunction) are most controversial. Most patients in this category of Risk recover with standard therapy, but some benefit from escalated treatment. Patients with cancer with an incidentally discovered PE should be Risk stratified the same as those who have clinically suspected PE.
George Rodrigues - One of the best experts on this subject based on the ideXlab platform.
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The prostate cancer Risk Stratification project: database construction and Risk Stratification outcome analysis.
Journal of the National Comprehensive Cancer Network : JNCCN, 2014Co-Authors: George Rodrigues, Padraig Warde, Juanita Crook, Michael Brundage, Luis Souhami, Himu Lukka, Fabio Cury, Charles Catton, Gary Mok, André-guy MartinAbstract:This investigation reports on the biochemical and clinical outcomes of a newly created pan-Canadian Prostate Cancer Risk Stratification (ProCaRS) database developed by the Genitourinary Radiation Oncologists of Canada (GUROC). GUROC ProCaRS template-compliant data on 7974 patients who underwent radiotherapy were received from 7 unique databases. Descriptive analysis, Cox proportional hazards, and Kaplan-Meier analyses were performed using American Society for Radiation Oncology (ASTRO) biochemical failure-free survival (BFFS), prostate cancer-specific survival, and overall survival. Multivariable modeling for the primary ASTRO BFFS end point showed that age, prostate-specific antigen, T stage, and Gleason score and components such as hormonal therapy, and radiation treatment (brachytherapy with better outcome than external-beam) were predictive of outcome. Kaplan-Meier analysis of the existing GUROC and new NCCN classification system both showed good separation of all clinical outcome curves. The construction of a pan-Canadian database has informed important prostate cancer radiotherapy outcomes and Risk Stratification.
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Pre-treatment Risk Stratification of prostate cancer patients:A critical review
Canadian Urological Association Journal, 2012Co-Authors: George Rodrigues, Padraig Warde, Tom Pickles, Juanita Crook, Michael Brundage, Luis Souhami, Himu LukkaAbstract:Introduction: The use of accepted prostate cancer Risk Stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated Risk Stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer Risk Stratification schema to assess the feasibility and need for changes to existing Risk Stratification systems. Methods: A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and Risk Stratification in prostate cancer. Search terms included Risk Stratification, Risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing Risk Stratification schema. Results: The critical review identified three specific clinically relevant potential changes to the most commonly used three-group Risk Stratification system: (1) the creation of a very-low Risk category; (2) the splitting of intermediate-Risk into a low- and highintermediate Risk groups; and (3) the clarification of the interface between intermediate- and high-Risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important Risk-Stratification factors. Conclusions: Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer Risk Stratification systems. We propose potential changes to existing systems.
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Pre-treatment Risk Stratification of prostate cancer patients: A critical review
Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2012Co-Authors: George Rodrigues, Padraig Warde, Tom Pickles, Juanita Crook, Michael Brundage, Luis Souhami, Himu LukkaAbstract:The use of accepted prostate cancer Risk Stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated Risk Stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer Risk Stratification schema to assess the feasibility and need for changes to existing Risk Stratification systems. A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and Risk Stratification in prostate cancer. Search terms included Risk Stratification, Risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing Risk Stratification schema. The critical review identified three specific clinically relevant potential changes to the most commonly used three-group Risk Stratification system: (1) the creation of a very-low Risk category; (2) the splitting of intermediate-Risk into a low- and high-intermediate Risk groups; and (3) the clarification of the interface between intermediate- and high-Risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important Risk-Stratification factors. Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer Risk Stratification systems. We propose potential changes to existing systems.
Himu Lukka - One of the best experts on this subject based on the ideXlab platform.
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The prostate cancer Risk Stratification project: database construction and Risk Stratification outcome analysis.
Journal of the National Comprehensive Cancer Network : JNCCN, 2014Co-Authors: George Rodrigues, Padraig Warde, Juanita Crook, Michael Brundage, Luis Souhami, Himu Lukka, Fabio Cury, Charles Catton, Gary Mok, André-guy MartinAbstract:This investigation reports on the biochemical and clinical outcomes of a newly created pan-Canadian Prostate Cancer Risk Stratification (ProCaRS) database developed by the Genitourinary Radiation Oncologists of Canada (GUROC). GUROC ProCaRS template-compliant data on 7974 patients who underwent radiotherapy were received from 7 unique databases. Descriptive analysis, Cox proportional hazards, and Kaplan-Meier analyses were performed using American Society for Radiation Oncology (ASTRO) biochemical failure-free survival (BFFS), prostate cancer-specific survival, and overall survival. Multivariable modeling for the primary ASTRO BFFS end point showed that age, prostate-specific antigen, T stage, and Gleason score and components such as hormonal therapy, and radiation treatment (brachytherapy with better outcome than external-beam) were predictive of outcome. Kaplan-Meier analysis of the existing GUROC and new NCCN classification system both showed good separation of all clinical outcome curves. The construction of a pan-Canadian database has informed important prostate cancer radiotherapy outcomes and Risk Stratification.
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Pre-treatment Risk Stratification of prostate cancer patients:A critical review
Canadian Urological Association Journal, 2012Co-Authors: George Rodrigues, Padraig Warde, Tom Pickles, Juanita Crook, Michael Brundage, Luis Souhami, Himu LukkaAbstract:Introduction: The use of accepted prostate cancer Risk Stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated Risk Stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer Risk Stratification schema to assess the feasibility and need for changes to existing Risk Stratification systems. Methods: A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and Risk Stratification in prostate cancer. Search terms included Risk Stratification, Risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing Risk Stratification schema. Results: The critical review identified three specific clinically relevant potential changes to the most commonly used three-group Risk Stratification system: (1) the creation of a very-low Risk category; (2) the splitting of intermediate-Risk into a low- and highintermediate Risk groups; and (3) the clarification of the interface between intermediate- and high-Risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important Risk-Stratification factors. Conclusions: Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer Risk Stratification systems. We propose potential changes to existing systems.
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Pre-treatment Risk Stratification of prostate cancer patients: A critical review
Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2012Co-Authors: George Rodrigues, Padraig Warde, Tom Pickles, Juanita Crook, Michael Brundage, Luis Souhami, Himu LukkaAbstract:The use of accepted prostate cancer Risk Stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated Risk Stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer Risk Stratification schema to assess the feasibility and need for changes to existing Risk Stratification systems. A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and Risk Stratification in prostate cancer. Search terms included Risk Stratification, Risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing Risk Stratification schema. The critical review identified three specific clinically relevant potential changes to the most commonly used three-group Risk Stratification system: (1) the creation of a very-low Risk category; (2) the splitting of intermediate-Risk into a low- and high-intermediate Risk groups; and (3) the clarification of the interface between intermediate- and high-Risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important Risk-Stratification factors. Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer Risk Stratification systems. We propose potential changes to existing systems.
Jeffrey J. Goldberger - One of the best experts on this subject based on the ideXlab platform.
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Sudden Cardiac Death Risk Stratification
Circulation research, 2015Co-Authors: Marc W. Deyell, Andrew D. Krahn, Jeffrey J. GoldbergerAbstract:Arrhythmic sudden cardiac death (SCD) may be caused by ventricular tachycardia/fibrillation or pulseless electric activity/asystole. Effective Risk Stratification to identify patients at Risk of arrhythmic SCD is essential for targeting our healthcare and research resources to tackle this important public health issue. Although our understanding of SCD because of pulseless electric activity/asystole is growing, the overwhelming majority of research in Risk Stratification has focused on SCD-ventricular tachycardia/ventricular fibrillation. This review focuses on existing and novel Risk Stratification tools for SCD-ventricular tachycardia/ventricular fibrillation. For patients with left ventricular dysfunction or myocardial infarction, advances in imaging, measures of cardiac autonomic function, and measures of repolarization have shown considerable promise in refining Risk. Yet the majority of SCD-ventricular tachycardia/ventricular fibrillation occurs in patients without known cardiac disease. Biomarkers and novel imaging techniques may provide further Risk Stratification in the general population beyond traditional Risk Stratification for coronary artery disease alone. Despite these advances, significant challenges in Risk Stratification remain that must be overcome before a meaningful impact on SCD can be realized.
Luis Souhami - One of the best experts on this subject based on the ideXlab platform.
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The prostate cancer Risk Stratification project: database construction and Risk Stratification outcome analysis.
Journal of the National Comprehensive Cancer Network : JNCCN, 2014Co-Authors: George Rodrigues, Padraig Warde, Juanita Crook, Michael Brundage, Luis Souhami, Himu Lukka, Fabio Cury, Charles Catton, Gary Mok, André-guy MartinAbstract:This investigation reports on the biochemical and clinical outcomes of a newly created pan-Canadian Prostate Cancer Risk Stratification (ProCaRS) database developed by the Genitourinary Radiation Oncologists of Canada (GUROC). GUROC ProCaRS template-compliant data on 7974 patients who underwent radiotherapy were received from 7 unique databases. Descriptive analysis, Cox proportional hazards, and Kaplan-Meier analyses were performed using American Society for Radiation Oncology (ASTRO) biochemical failure-free survival (BFFS), prostate cancer-specific survival, and overall survival. Multivariable modeling for the primary ASTRO BFFS end point showed that age, prostate-specific antigen, T stage, and Gleason score and components such as hormonal therapy, and radiation treatment (brachytherapy with better outcome than external-beam) were predictive of outcome. Kaplan-Meier analysis of the existing GUROC and new NCCN classification system both showed good separation of all clinical outcome curves. The construction of a pan-Canadian database has informed important prostate cancer radiotherapy outcomes and Risk Stratification.
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Pre-treatment Risk Stratification of prostate cancer patients:A critical review
Canadian Urological Association Journal, 2012Co-Authors: George Rodrigues, Padraig Warde, Tom Pickles, Juanita Crook, Michael Brundage, Luis Souhami, Himu LukkaAbstract:Introduction: The use of accepted prostate cancer Risk Stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated Risk Stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer Risk Stratification schema to assess the feasibility and need for changes to existing Risk Stratification systems. Methods: A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and Risk Stratification in prostate cancer. Search terms included Risk Stratification, Risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing Risk Stratification schema. Results: The critical review identified three specific clinically relevant potential changes to the most commonly used three-group Risk Stratification system: (1) the creation of a very-low Risk category; (2) the splitting of intermediate-Risk into a low- and highintermediate Risk groups; and (3) the clarification of the interface between intermediate- and high-Risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important Risk-Stratification factors. Conclusions: Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer Risk Stratification systems. We propose potential changes to existing systems.
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Pre-treatment Risk Stratification of prostate cancer patients: A critical review
Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2012Co-Authors: George Rodrigues, Padraig Warde, Tom Pickles, Juanita Crook, Michael Brundage, Luis Souhami, Himu LukkaAbstract:The use of accepted prostate cancer Risk Stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated Risk Stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer Risk Stratification schema to assess the feasibility and need for changes to existing Risk Stratification systems. A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and Risk Stratification in prostate cancer. Search terms included Risk Stratification, Risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing Risk Stratification schema. The critical review identified three specific clinically relevant potential changes to the most commonly used three-group Risk Stratification system: (1) the creation of a very-low Risk category; (2) the splitting of intermediate-Risk into a low- and high-intermediate Risk groups; and (3) the clarification of the interface between intermediate- and high-Risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important Risk-Stratification factors. Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer Risk Stratification systems. We propose potential changes to existing systems.
