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Johnson S, Dalton‐Locke C, Baker J, Hanlon C, Salisbury TT, Fossey M, Newbigging K, Carr SE, Hensel J, Carrà G, Hepp U, Caneo C, Needle JJ, Lloyd‐Evans B. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. World Psychiatry 2022; 21:220-236. [PMID: 35524608 PMCID: PMC9077627 DOI: 10.1002/wps.20962] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best ap-proaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision-making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low- and middle-income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low-resource settings may lead to wider learning from locally embedded strategies.
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Affiliation(s)
- Sonia Johnson
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | | | - John Baker
- School of Healthcare, University of LeedsLeedsUK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK,Department of PsychiatrySchool of Medicine, and Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa UniversityAddis AbabaEthiopia
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Matt Fossey
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordUK
| | - Karen Newbigging
- Department of PsychiatryUniversity of OxfordOxfordUK,Institute for Mental Health, University of BirminghamBirminghamUK
| | - Sarah E. Carr
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Jennifer Hensel
- Department of PsychiatryUniversity of ManitobaWinnipegMBCanada
| | - Giuseppe Carrà
- Department of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur, Zürcher UnterlandWinterthurSwitzerland
| | - Constanza Caneo
- Departamento de Psiquiatría, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
| | - Justin J. Needle
- Centre for Health Services Research, School of Health Sciences, City, University of LondonLondonUK
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Khosla S, Constantakis J, Baker J. (PO-191) Seizures or Behavioral Disturbances? A case report on neuropsychiatric manifestations of Cornelia de Lange Syndrome and management in an Emergency Department Consultation-Liaison Setting. J Acad Consult Liaison Psychiatry 2022. [DOI: 10.1016/j.jaclp.2022.03.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Baker J, Schott J. AD and its comorbidities: An obstacle to develop a clinically efficient treatment? Rev Neurol (Paris) 2022; 178:450-459. [DOI: 10.1016/j.neurol.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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Savage SA, Baker J, Milton F, Butler C, Zeman A. Clinical outcomes in Transient Epileptic Amnesia: a 10-year follow-up cohort study of 47 cases. Epilepsia 2022; 63:1115-1129. [PMID: 35253220 PMCID: PMC9310913 DOI: 10.1111/epi.17214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/08/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
Objective Transient epileptic amnesia (TEA) is a form of adult‐onset epilepsy where presenting features are well described, but little is known regarding prognosis. This study aimed to elucidate the long‐term prognosis of TEA regarding seizure control, memory, medical comorbidities, and life expectancy. Methods Up‐to‐date clinical information was collected for 47 people diagnosed with TEA who had joined the The Impairment of Memory in Epilepsy (TIME) study 10 years earlier. At entry to the study, information about comorbid conditions was systematically collected. Details regarding subsequent diagnoses, seizure activity, changes to treatment, or reports of cognitive impairment were obtained through the family doctor. The variables of interest were compared with UK population data. Results Mortality in the cohort was 21 of 47 (45%), with an average age at death of 82.5 years. Seizures remained well controlled for the majority but medications required adjustments in dose and type for some (28%). A small number (three cases) remained seizure‐free without medication. History of cardiovascular disorders was frequent (78.7%), typically involving hypertension (55.3%). Autoimmune disorders (25.5%), cancer (23.4%), and depression (21.3%) were also commonly reported. Although persisting memory problems were often noted, dementia was diagnosed in seven cases (14.9%). Life expectancy and comorbidities in TEA did not differ from available population norms. Significance Results suggest that life expectancy is not reduced in TEA. Although TEA does not appear to be a self‐limiting form of epilepsy, seizures are typically well controlled via medication. Because adjustments to medication may be required, even after long periods of stability, ongoing medical monitoring is recommended. Comorbid vascular disorders are frequent but appear similar to general population estimates. Monitoring mood may be important, given that people with chronic conditions are often vulnerable to depression. Because of persisting memory difficulties, the development of effective memory interventions for people with TEA is warranted.
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Affiliation(s)
- Sharon A Savage
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter, EX1 2LU, UK.,School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - John Baker
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter, EX1 2LU, UK.,Dementia Research Centre, UCL Queen Square institute of Neurology, London, WC1N 3BG, UK
| | - Fraser Milton
- Discipline of Psychology, University of Exeter, Washington Singer Laboratories, Exeter, EX4 4QG, UK
| | - Chris Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Department of Brain Sciences, Imperial College, London, W12 0NN, UK
| | - Adam Zeman
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter, EX1 2LU, UK
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Evans-Reeves K, Baker J. Worldwide news and comment. Tob Control 2022. [DOI: 10.1136/tobaccocontrol-2022-057288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brierley-Jones L, Ramsey L, Canvin K, Kendal S, Baker J. To what extent are patients involved in researching safety in acute mental healthcare? Res Involv Engagem 2022; 8:8. [PMID: 35227330 PMCID: PMC8886877 DOI: 10.1186/s40900-022-00337-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is a growing need to involve patients in the development of patient safety interventions. Mental health services, despite their strong history of patient involvement, have been slow to develop patient safety interventions, particularly in inpatient settings. METHODS A systematic search was undertaken of both academic and grey literature. Whilst no lay member of the team worked directly on the review, they were part of the project steering group which provided oversight throughout the review process. This included people with lived experience of mental health services. From a research perspective the main focus for lay members was in co-producing the digital technology, the key project output. Smits et al.'s (Res Involv Engagem 6:1-30, 2020) Involvement Matrix was used to taxonomise levels of patient involvement. Studies were included if they were set in any inpatient mental health care context regardless of design. The quality of all selected studies was appraised using Mixed Methods Appraisal Methodology (MMAT). RESULTS Fifty-two studies were classified, synthesised and their levels of patient involvement in the research and development of patient safety interventions were taxonomised. Almost two-thirds of studies (n = 33) researched reducing restrictive practices. Only four studies reported engaging patients in the research process as decision-makers, with the remaining studies divided almost equally between engaging patients in the research process as partners, advisors and co-thinkers. Just under half of all studies engaged patients in just one stage of the research process. CONCLUSION Involvement of patients in researching patient safety and developing interventions in an inpatient mental health context seems diverse in its nature. Researchers need to both more fully consider and better describe their approaches to involving patients in safety research in inpatient mental health. Doing so will likely lead to the development of higher quality safety interventions.
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Affiliation(s)
| | - Lauren Ramsey
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | | | - Sarah Kendal
- School of Healthcare, University of Leeds, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK.
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Yu D, Wang Z, Cai Y, McBride K, Osuagwu UL, Pickering K, Baker J, Cutfield R, Orr-Walker BJ, Sundborn G, Jameson MB, Zhao Z, Simmons D. Ethnic Differences in Cancer Rates Among Adults With Type 2 Diabetes in New Zealand From 1994 to 2018. JAMA Netw Open 2022; 5:e2147171. [PMID: 35129595 PMCID: PMC8822383 DOI: 10.1001/jamanetworkopen.2021.47171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE People with type 2 diabetes have greater risk for some site-specific cancers, and risks of cancers differ among racial and ethnic groups in the general population of Aotearoa New Zealand. The extent of ethnic disparities in cancer risks among people with type 2 diabetes in New Zealand is unclear. OBJECTIVE To compare the risks of 21 common adult cancers among Māori, Pasifika, and New Zealand European individuals with type 2 diabetes in New Zealand from 1994 to 2018. DESIGN, SETTING, AND PARTICIPANTS This population-based, matched cohort study used data from the primary care audit program in Auckland, New Zealand, linked with national cancer, death, and hospitalization registration databases, collected from January 1, 1994, to July 31, 2018, with follow-up data obtained through December 31, 2019. Using a tapered matching method to balance potential confounders (sociodemographic characteristics, lifestyle, anthropometric and clinical measurements, treatments [antidiabetes, antihypertensive, lipid-lowering, and anticoagulant], period effects, and recorded duration of diabetes), comparative cohorts were formed between New Zealand European and Māori and New Zealand European and Pasifika individuals aged 18 years or older with type 2 diabetes. Sex-specific matched cohorts were formed for sex-specific cancers. EXPOSURES Māori, Pasifika, and New Zealand European (reference group) ethnicity. MAIN OUTCOMES AND MEASURES The incidence rates of 21 common cancers recorded in nationally linked databases between 1994 and 2018 were the main outcomes. Weighted Cox proportional hazards regression was used to assess ethnic differences in risk of each cancer. RESULTS A total of 33 524 adults were included: 15 469 New Zealand European (mean [SD] age, 61.6 [13.2] years; 8522 [55.1%] male), 6656 Māori (mean [SD] age, 51.2 [12.4] years; 3345 [50.3%] female), and 11 399 Pasifika (mean [SD] age, 52.8 [12.7] years; 5994 [52.6%] female) individuals. In the matched New Zealand European and Māori cohort (New Zealand European: 8361 individuals; mean [SD] age, 58.9 [12.9] years; 4595 [55.0%] male; Māori: 5039 individuals; mean [SD] age, 51.4 [12.3] years; 2542 [50.5%] male), significant differences between New Zealand European and Māori individuals were identified in the risk for 7 cancers. Compared with New Zealand European individuals, the hazard ratios (HRs) among Māori individuals were 15.36 (95% CI, 4.50-52.34) for thyroid cancer, 7.94 (95% CI, 1.57-40.24) for gallbladder cancer, 4.81 (95% CI, 1.08-21.42) for cervical cancer (females only), 1.97 (95% CI, 1.30-2.99) for lung cancer, 1.81 (95% CI, 1.08-3.03) for liver cancer, 0.56 (95% CI, 0.35-0.90) for colon cancer, and 0.11 (95% CI, 0.04-0.27) for malignant melanoma. In the matched New Zealand European and Pasifika cohort (New Zealand European: 9340 individuals; mean [SD] age, 60.6 [13.1] years; 4885 [52.3%] male; Pasifika: 8828 individuals; mean [SD] age, 53.1 [12.6] years; 4612 [52.2%] female), significant differences between New Zealand European and Pasifika individuals were identified for 6 cancers. Compared with New Zealand European individuals, HRs among Pasifika individuals were 25.10 (95% CI, 3.14-200.63) for gallbladder cancer, 4.47 (95% CI, 1.25-16.03) for thyroid cancer, 0.48 (95% CI, 0.30-0.78) for colon cancer, 0.21 (95% CI, 0.09-0.48) for rectal cancer, 0.21 (95% CI, 0.07-0.65) for malignant melanoma, and 0.01 (95% CI, 0.01-0.10) for bladder cancer. CONCLUSIONS AND RELEVANCE In this cohort study, differences in the risk of 21 common cancers were found between New Zealand European, Māori, and Pasifika groups of adults with type 2 diabetes in New Zealand from 1994 to 2018. Research into the mechanisms underlying these differences as well as additional screening strategies (eg, for thyroid and gallbladder cancers) appear to be warranted.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, United Kingdom
| | - Zheng Wang
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Yamei Cai
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Kate McBride
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | - Uchechukwu Levi Osuagwu
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Brandon J. Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Michael B. Jameson
- Oncology Department, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical Campus, The University of Auckland, Hamilton, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - David Simmons
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
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Griffiths R, Dawber A, McDougall T, Midgley S, Baker J. Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: Systematic review and narrative synthesis. Int J Ment Health Nurs 2022; 31:35-50. [PMID: 34626155 PMCID: PMC9293022 DOI: 10.1111/inm.12940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/03/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
Rates of self-harm amongst children appear to be increasing. This presents challenges for practitioners responsible for maintaining the safety of children admitted to mental health inpatient settings. Policy guidelines recommend that practitioners should aim to avoid the use of restrictive practices for children. It is currently unclear, however, what evidence-based alternatives to restrictive practices are available. We aimed to identify what non-restrictive interventions have been proposed to reduce self-harm amongst children in mental health inpatient settings and to evaluate the evidence supporting their use in clinical practice. A systematic search of five databases (CINAHL, Embase, Ovid MEDLINE, APA Psycinfo, and Cochrane) was conducted to identify articles reporting on non-restrictive interventions aimed at reducing self-harm amongst children in mental health inpatient settings. Articles were quality assessed and relevant data were extracted and synthesized using narrative synthesis. Searches identified relatively few relevant articles (n = 7) and these were generally of low methodological quality. The underlying theoretical assumptions and putative mechanisms of change for the interventions described were often unclear. Despite concerns about the rates of self-harm amongst children in mental health inpatient settings, there is a lack of high-quality research to inform clinical practice. There is an urgent need to develop effective non-restrictive interventions aimed at reducing self-harm for children using inpatient mental health services. Intervention development should be theoretically informed and be conducted in collaboration with people who have lived experience of this issue.
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Affiliation(s)
- Robert Griffiths
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alison Dawber
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Tim McDougall
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Salli Midgley
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
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Ramsey L, Albutt A, Perfetto K, Quinton N, Baker J, Louch G, O’Hara J. Systemic safety inequities for people with learning disabilities: a qualitative integrative analysis of the experiences of English health and social care for people with learning disabilities, their families and carers. Int J Equity Health 2022; 21:13. [PMID: 35090463 PMCID: PMC8795982 DOI: 10.1186/s12939-021-01612-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/18/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Failures in care for people with learning disabilities have been repeatedly highlighted and remain an international issue, exemplified by a disparity in premature death due to poor quality and unsafe care. This needs urgent attention. Therefore, the aim of the study was to understand the care experiences of people with learning disabilities, and explore the potential patient safety issues they, their carers and families raised. METHODS Two data sources exploring the lived experience of care for people with learning disabilities were synthesised using an integrative approach, and explored using reflexive thematic analysis. This comprised two focus groups with a total of 13 people with learning disabilities and supportive staff, and 377 narratives posted publicly via the feedback platform Care Opinion. RESULTS The qualitative exploration highlighted three key themes. Firstly, health and social care systems operated with varying levels of rigidity. This contributed to an inability to effectively cater to; complex and individualised care needs, written and verbal communication needs and needs for adequate time and space. Secondly, there were various gaps and traps within systems for this population. This highlighted the importance of care continuity, interoperability and attending to the variation in support provision from professionals. Finally, essential 'dependency work' was reliant upon social capital and fulfilled by paid and unpaid caring roles to divergent extents, however, advocacy provided an additional supportive safety net. CONCLUSIONS A series of safety inequities have been identified for people with learning disabilities, alongside potential protective buffers. These include; access to social support and advocacy, a malleable system able to accommodate for individualised care and communication needs, adequate staffing levels, sufficient learning disabilities expertise within and between care settings, and the interoperability of safety initiatives. In order to attend to the safety inequities for this population, these factors need to be considered at a policy and organisational level, spanning across health and social care systems. Findings have wide ranging implications for those with learning disabilities, their carers and families and health and social care providers, with the potential for international learning more widely.
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Affiliation(s)
- Lauren Ramsey
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- Bradford Institute for Health Research and NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Abigail Albutt
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- Bradford Institute for Health Research and NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Kayley Perfetto
- Queen’s University, 9 University Avenue, Kingston, Ontario Canada
| | - Naomi Quinton
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Gemma Louch
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- Bradford Institute for Health Research and NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Jane O’Hara
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- School of Healthcare, University of Leeds, Leeds, UK
- School of Healthcare University of Leeds UK and Theme Lead of Patient Involvement in Patient Safety NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Leeds, UK
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Guthrie S, Baker J, Cahill J, Hemsley B. Mealtime difficulties in adults with mental health conditions: an integrative review. J Ment Health 2022; 32:504-516. [PMID: 35037562 DOI: 10.1080/09638237.2021.2022633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dysphagia and choking are highly prevalent in adults with mental health conditions. However, there is scant research considering the personal experience of dysphagia for this population. AIMS To understand the evidence-base for strategies to involve the patient in recognition, assessment and treatment of mealtime difficulties. METHODS This integrative review synthesised the literature on the experience of dysphagia in patients with mental health conditions. Patient consultation led to co-designed search terms and eligibility criteria for a systematic search of five scientific databases following Prisma guidance. Quality assessment of the eligible studies and reflexive thematic analysis were completed. RESULTS 31 studies were included for review. These included case reports, literature reviews and cross-sectional studies. Quality of evidence was weak and no intervention studies were identified. There was scant detail regarding the personal experience of dysphagia or choking. Themes identified related to biomedical perspectives, influencing factors presented without context, and decision-making led by clinicians. CONCLUSIONS Guidance on mental healthcare calls attention to under-diagnosis of physical co-morbidities and advocates patient inclusion. However, the patient voice in this population is rarely described regarding dysphagia. Further inclusive research is indicated to explore the impact of dysphagia and choking, and implications for interventions and outcome measures.
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Affiliation(s)
- Susan Guthrie
- School of Healthcare, University of Leeds, Leeds, UK.,Leeds and York Partnership Foundation Trust, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK.,Leeds and York Partnership Foundation Trust, Leeds, UK
| | - Jane Cahill
- School of Healthcare, University of Leeds, Leeds, UK
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Evans-Reeves K, Baker J. Worldwide news and comment. Tob Control 2021. [DOI: 10.1136/tobaccocontrol-2021-057183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Street RE, Lu K, Freiberger T, Murray‐Smith H, Keuss SE, Baker J, Wong A, Richards M, Fox NC, Crutch SJ, Schott JM. Implementation of remote neuropsychological assessments in the Insight 46 study: Lessons learned from the transition to videoconferencing and telephone assessments. Alzheimers Dement 2021. [DOI: 10.1002/alz.055850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rebecca E Street
- Dementia Research Centre, UCL Queen Square Institute of Neurology London United Kingdom
| | - Kirsty Lu
- Dementia Research Centre, UCL Queen Square Institute of Neurology London United Kingdom
| | - Tamar Freiberger
- Dementia Research Centre, UCL Queen Square Institute of Neurology London United Kingdom
| | - Heidi Murray‐Smith
- Dementia Research Centre, UCL Queen Square Institute of Neurology London United Kingdom
| | - Sarah E Keuss
- Dementia Research Centre, UCL Queen Square Institute of Neurology London United Kingdom
| | - John Baker
- Dementia Research Centre, UCL Queen Square Institute of Neurology London United Kingdom
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL London United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL London United Kingdom
| | - Nick C Fox
- Dementia Research Centre London United Kingdom
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology London United Kingdom
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Gill T, Pollard AJ, Baker J, Tredwin C. Cracked Tooth Syndrome: Assessment, Prognosis and Predictable Management Strategies. Eur J Prosthodont Restor Dent 2021; 29:209-217. [PMID: 33770422 DOI: 10.1922/ejprd_2232gill09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cracked tooth syndrome (CTS) is a common presentation in general practice. The diagnosis and management of teeth with CTS may be difficult due to the unknown extent of the crack. This article reviews the aetiology, diagnosis, management and prognosis of teeth with CTS. A thorough examination is required to effectively assess CTS. Intervention should aim to relieve symptoms and brace the remaining tooth structure effectively against further flexion. Restored teeth with CTS have a guarded prognosis due to the risk of further crack propagation, but the chances of survival at 5-years is acceptable (74.1-96.8%).
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Affiliation(s)
- T Gill
- Academic Clinical Fellow & Specialist Registrar Restorative Dentistry, Royal London Hospital, Whitechapel Rd, Whitechapel, London, E1 1FR
- Honorary Clinical Research Fellow, Centre of Oral Bioengineering, Queen Mary University of London, Whitechapel, London, E1 1FR
| | - A J Pollard
- Specialist Registrar Periodontology, University Hospitals Bristol, University of Bristol Dental School, Lower Maudlin St, Bristol BS1 2LY, UK
| | - J Baker
- Specialist in Fixed & Removable Prosthodontics, 55 Wimpole Street, London W1G 8YL
| | - C Tredwin
- Professor of Restorative Dentistry and Head of Peninsula Dental School, Peninsula Dental School, University of Plymouth, Drakes Circus, Plymouth, PL4 8AA
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Sidiqi B, Eckstein J, Nosrati J, Baker J, Antone J, Malesevic V, Seetharamu N, Sharma R, Ghaly M. Analysis of Toxicity and Local Control for Ultra-Central Lung Tumors Undergoing Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gill G, Souri S, Button T, DiBiase S, Potters L, Baker J. Designing Robust and Automated Treatment Plans Utilizing Dynamic Couch Motion With Automated Treatment Planning: Delivering Dose to a New Dimension ― Part B. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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67
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Finnegan K, Tanabe P, Baker J. Addressing Opportunities & Misunderstandings of ASCP International Certification in the Philippines. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
The objective of this study is to identify the positive viewpoints and misunderstandings Filipino applicants have about the BOC’s international credential and credential maintenance programs. With a total of 10,836 MLS(ASCPi) certificants, the Philippines is the BOC’s largest and most successful international certification market. However, despite the Philippines being the BOC’s largest international certification market, the BOC only certifies about a third of eligible Filipino graduates each year.
Therefore, to encourage additional interest in achieving BOC credentials and to eliminate misunderstanding surrounding the BOC’s Credential Maintenance Program (CMP), the ASCP BOC International Credentialing Committee created and deployed a survey.
The purpose of the survey was to learn as much as possible about the medical laboratory scientist certification market in the Philippines, as well as determine what opportunities Filipino‘s were afforded after they earned their credential. The resulting report based on analysis of the survey results showed there are a number of issues affecting Filipino participation in the BOC’s credential and CMP offerings.
Methods/Case Report
422 individuals from 44 countries of education participated in the survey. This study is a summary of results from the 265 Filipino respondents.
Results (if a Case Study enter NA)
This study confirmed a number of assertions the BOC had about the Filipino credential market. The most important of these assertions is MLS(ASCPi) certification is appealing to Philippine- educated individuals due to its portability (i.e., work eligibility, emigration, etc.).
Conclusion
The BOC should continue leaning into the portability of MLS(ASCPi) certification, but also needs to do a better job of promoting our other international certifications for which Filipinos may be eligible. The BOC needs to place greater emphasis on educating Filipinos on the importance of CMP and on what can be used for CE towards CMP. For example, the BOC needs to create an outreach campaign that helps Filipino credential holders understand CE earned for their PRC (i.e., Philippines-licensure requirements) can also be used for their CMP. Finally, considering the popularity of BOC certification in the Philippines, the BOC should work on creating more content that focuses on promoting the usefulness of pursing an advanced credential, the portability of certification, and the overall demystification of CMP.
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Affiliation(s)
- K Finnegan
- Clinical Laboratory Sciences, Stony Brook University, Stony Brook, New York, UNITED STATES
| | - P Tanabe
- BOC, ASCP, Chicago, Illinois, UNITED STATES
| | - J Baker
- BOC, ASCP, Chicago, Illinois, UNITED STATES
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68
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Evans-Reeves K, Baker J. Worldwide news and comment. Tob Control 2021. [DOI: 10.1136/tobaccocontrol-2021-057080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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69
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Raber J, Holden S, Sudhakar R, Hall R, Glaeser B, Lenarczyk M, Rockwell K, Nawarawong N, Sterrett J, Perez R, Leonard SW, Morré J, Choi J, Kronenberg A, Borg A, Kwok A, Stevens JF, Olsen CM, Willey JS, Bobe G, Baker J. Effects of 5-Ion Beam Irradiation and Hindlimb Unloading on Metabolic Pathways in Plasma and Brain of Behaviorally Tested WAG/Rij Rats. Front Physiol 2021; 12:746509. [PMID: 34646164 PMCID: PMC8503608 DOI: 10.3389/fphys.2021.746509] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/24/2021] [Indexed: 01/13/2023] Open
Abstract
A limitation of simulated space radiation studies is that radiation exposure is not the only environmental challenge astronauts face during missions. Therefore, we characterized behavioral and cognitive performance of male WAG/Rij rats 3 months after sham-irradiation or total body irradiation with a simplified 5-ion mixed beam exposure in the absence or presence of simulated weightlessness using hindlimb unloading (HU) alone. Six months following behavioral and cognitive testing or 9 months following sham-irradiation or total body irradiation, plasma and brain tissues (hippocampus and cortex) were processed to determine whether the behavioral and cognitive effects were associated with long-term alterations in metabolic pathways in plasma and brain. Sham HU, but not irradiated HU, rats were impaired in spatial habituation learning. Rats irradiated with 1.5 Gy showed increased depressive-like behaviors. This was seen in the absence but not presence of HU. Thus, HU has differential effects in sham-irradiated and irradiated animals and specific behavioral measures are associated with plasma levels of distinct metabolites 6 months later. The combined effects of HU and radiation on metabolic pathways in plasma and brain illustrate the complex interaction of environmental stressors and highlights the importance of assessing these interactions.
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Affiliation(s)
- Jacob Raber
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States.,Department of Neurology, Psychiatry, and Radiation Medicine, Division of Neuroscience, ONPRC, Oregon Health and Science University, Portland, OR, United States.,College of Pharmacy, Oregon State University, Corvallis, OR, United States
| | - Sarah Holden
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Reetesh Sudhakar
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Reed Hall
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Breanna Glaeser
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Marek Lenarczyk
- Radiation Biosciences Laboratory, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kristen Rockwell
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Natalie Nawarawong
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jennifer Sterrett
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ruby Perez
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Scott William Leonard
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jeffrey Morré
- Mass Spectrometry Core, Oregon State University, Corvallis, OR, United States
| | - Jaewoo Choi
- Linus Pauling Institute, Oregon State University, Corvallis, OR, United States
| | - Amy Kronenberg
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, United States
| | - Alexander Borg
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Andy Kwok
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jan Frederik Stevens
- College of Pharmacy, Oregon State University, Corvallis, OR, United States.,Linus Pauling Institute, Oregon State University, Corvallis, OR, United States
| | - Christopher M Olsen
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jeffrey S Willey
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Gerd Bobe
- Linus Pauling Institute, Oregon State University, Corvallis, OR, United States.,Department of Animal Sciences, Oregon State University, Corvallis, OR, United States
| | - John Baker
- Department of Pharmacology and Toxicology, Neuroscience Center, Medical College of Wisconsin, Milwaukee, WI, United States.,Radiation Biosciences Laboratory, Medical College of Wisconsin, Milwaukee, WI, United States
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Bell D, Baker J, Williams C, Bassin L. A Trend-Based Early Warning Score Can Be Implemented in a Hospital Electronic Medical Record to Effectively Predict Inpatient Deterioration. Crit Care Med 2021; 49:e961-e967. [PMID: 33935165 PMCID: PMC8439669 DOI: 10.1097/ccm.0000000000005064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether a statistically derived, trend-based, deterioration index is superior to other early warning scores at predicting adverse events and whether it can be integrated into an electronic medical record to enable real-time alerts. DESIGN Forty-three variables and their trends from cases and controls were used to develop a logistic model and deterioration index to predict patient deterioration greater than or equal to 1 hour prior to an adverse event. SETTING Two large Australian teaching hospitals. PATIENTS Cases were considered as patients who suffered adverse events (unexpected death, unplanned ICU transfer, urgent surgery, and rapid-response alert) between August 1, 2016, and April 1, 2019. INTERVENTIONS The logistic model and deterioration index were tested on historical data and then integrated into an electronic medical record for a 6-month prospective "silent" validation. MEASUREMENTS AND MAIN RESULTS Data were acquired from 258,732 admissions. There were 8,002 adverse events. The addition of vital sign and laboratory trend values to the logistic model increased the area under the curve from 0.84 to 0.89 and the sensitivity to predict an adverse event 1-48 hours prior from 0.35 to 0.41. A 48-hour simulation showed that the logistic model had a higher area under the curve than the Modified Early Warning Score and National Early Warning Score (0.87 vs 0.74 vs 0.71). During the silently run prospective trial, the sensitivity of the deterioration index to detect adverse event any time prior to the adverse event was 0.474, 0.369 1 hour prior, and 0.327 4 hours prior, with a specificity of 0.972. CONCLUSIONS A deterioration prediction model was developed using patient demographics, ward-based observations, laboratory values, and their trends. The model's outputs were converted to a deterioration index that was successfully integrated into a live hospital electronic medical record. The sensitivity and specificity of the tool to detect inpatient deterioration were superior to traditional early warning scores.
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Affiliation(s)
- David Bell
- Department of Clinical Informatics, Sydney Adventist Hospital, Sydney, NSW, Australia
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - John Baker
- Department of Clinical Informatics, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Chris Williams
- Department of Clinical Informatics, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Levi Bassin
- Department of Clinical Informatics, Sydney Adventist Hospital, Sydney, NSW, Australia
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
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Yu D, Osuagwu L, Pickering K, Baker J, Cutfield R, Orr-Walke B, CaI Y, Zhao Z, Simmons D. 165Ethnic differences in type 2 diabetes mortality and hospitalisation rates in a New Zealand population1994-2018. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Type 2 Diabetes (T2DM) affects different populations disproportionately including in New Zealand (NZ), where long-term temporal trends in cause-specific clinical outcomes between Māori, European and Pacific people remain unclear.
Methods
Data from patients with T2DM, aged 35-84 years enrolled 1994-2018 in a NZ primary care audit programme (the Diabetes Care Support Service) were linked with national death registration, hospitalisation, pharmaceutical claims and primary care databases. Cause-specific death and hospitalisation rates were adjusted for gender, age, smoking, obesity, social-economic status and time periods by age-period-cohort models.
Results
Overall, 79,912 (50.6% female, mean-age 56±15 years, median follow-up 9.7 years) patients with T2DM were enrolled. For Europeans vs Māori, adjusted incidence rates ratio (IRR) and absolute risk difference /1000 person-years were 1.96 (95% CI: 1.80- 2.14) and 22.85 (19.93-25.77) for all-cause mortality, 1.93 (1.63-2.29) and 6.97 (5.14-8.80) for cardiovascular (CVD) mortality, 1.64 (1.40-1.93) and 3.08 (2.25-3.92) for cancer mortality, 1.26 (1.25-1.28) and 42.70 (41.32-44.08) for CVD hospitalisation, 1.31 (1.28-1.34) and 44.76 (42.37-47.15) for cancer hospitalisation, 2.05 (1.96-2.14) and 31.44 (29.67-33.21) for end-stage renal disease (ESRD) hospitalisation. Pacific rates were significantly less than Māori, but higher than Europeans for ESRD (IRR:1.59 (1.52-1.67)) and CVD (1.09 (1.07-1.10)) hospitalisation.
Conclusions
Poorer health outcomes have persisted among Māori and Pacific people with T2DM for >20 years. New policies supporting more intensive management of T2DM are urgently needed. Differences in outcomes between Māori and Pacific people warrant further research.
Key messages
Outcome disparities have persisted among Māori and Pacific people with T2DM for >20 years.
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Affiliation(s)
- Dahai Yu
- Keele University, Newcastle, United Kingdom
- First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | | | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
| | | | | | - Yamei CaI
- First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Zhanzheng Zhao
- First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
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72
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Evans-Reeves K, Baker J. Worldwide news and comment. Tob Control 2021. [DOI: 10.1136/tobaccocontrol-2021-056941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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73
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Lemor A, Basir MB, Gorgis S, Todd J, Marso S, Gelormini J, Akhtar Y, Baker J, Chahin J, Abdul-Waheed M, Thukral N, O'Neill W. Impact of Age in Acute Myocardial Infarction Cardiogenic Shock: Insights From the National Cardiogenic Shock Initiative. Crit Pathw Cardiol 2021; 20:163-167. [PMID: 33606413 DOI: 10.1097/hpc.0000000000000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute myocardial infarction complicated by cardiogenic shock (AMICS) is associated with high mortality. Patients ≥75 years old represent an increasing proportion of those who present with AMICS and are at high risk for adverse outcomes. METHODS The National Cardiogenic Shock Initiative includes patients with AMICS treated using a standard shock protocol with early invasive hemodynamic monitoring, mechanical circulatory support (MCS), and percutaneous coronary intervention (PCI). We evaluated the outcomes of patients based on their age group, dividing them into <75 and ≥75 years old. RESULTS We included 300 consecutive patients: 238 were <75 years old (79.3%) and 62 patients ≥75 years old. There were significant differences in survival; patients <75 years old had a 75.6% survival, while those ≥75 years old had a 50% survival (adjusted OR: 10.4, P = 0.001). SCAI shock classification impacted survival as well; those <75 years old with class C or D shock had a survival of 84%, compared with 57% in those ≥75 years old. Patients ≥75 years old requiring 1 or 2 vasopressors had significantly lower survival rates (36% and 25%, respectively) when compared with patients <75 years old (76.7% with 1 and 60.5% with >1 vasopressor). CONCLUSIONS Age is inversely proportional to survival; patients <75 years old have high rates of survival if treated using best practices with invasive hemodynamic monitoring, early MCS, and PCI. However, using a standardized protocol can improve survival in the elderly; therefore, age on its own should not be a reason to withhold PCI or MCS use.
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Affiliation(s)
- Alejandro Lemor
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI
| | - Mir B Basir
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI
| | - Sarah Gorgis
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI
| | - Josh Todd
- Department of Cardiology, Fort Sanders Medical Center, Knoxville, TN
| | - Steve Marso
- Department of Cardiology, Overland Park Regional Medical Center, Overland Park, KS
| | - Joseph Gelormini
- Department of Cardiology, Mercy Hospital of Buffalo, Buffalo, NY
| | - Yasir Akhtar
- Department of Cardiology, North Knoxville Medical Center, Knox County, TN
| | - John Baker
- Department of Cardiology, Jackson/Madison Co. General Hospital, Jackson, TN
| | - Juan Chahin
- Department of Cardiology, Excela Health Westmoreland, Greensburg, PA
| | | | - Nandish Thukral
- Department of Cardiology, Methodist Heart Hospital, San Antonio, TX
| | - William O'Neill
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI
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Tait L, Lopes MA, Stothart G, Baker J, Kazanina N, Zhang J, Goodfellow M. A large-scale brain network mechanism for increased seizure propensity in Alzheimer's disease. PLoS Comput Biol 2021; 17:e1009252. [PMID: 34379638 PMCID: PMC8382184 DOI: 10.1371/journal.pcbi.1009252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/23/2021] [Accepted: 07/06/2021] [Indexed: 11/19/2022] Open
Abstract
People with Alzheimer’s disease (AD) are 6-10 times more likely to develop seizures than the healthy aging population. Leading hypotheses largely consider hyperexcitability of local cortical tissue as primarily responsible for increased seizure prevalence in AD. However, in the general population of people with epilepsy, large-scale brain network organization additionally plays a role in determining seizure likelihood and phenotype. Here, we propose that alterations to large-scale brain network organization seen in AD may contribute to increased seizure likelihood. To test this hypothesis, we combine computational modelling with electrophysiological data using an approach that has proved informative in clinical epilepsy cohorts without AD. EEG was recorded from 21 people with probable AD and 26 healthy controls. At the time of EEG acquisition, all participants were free from seizures. Whole brain functional connectivity derived from source-reconstructed EEG recordings was used to build subject-specific brain network models of seizure transitions. As cortical tissue excitability was increased in the simulations, AD simulations were more likely to transition into seizures than simulations from healthy controls, suggesting an increased group-level probability of developing seizures at a future time for AD participants. We subsequently used the model to assess seizure propensity of different regions across the cortex. We found the most important regions for seizure generation were those typically burdened by amyloid-beta at the early stages of AD, as previously reported by in-vivo and post-mortem staging of amyloid plaques. Analysis of these spatial distributions also give potential insight into mechanisms of increased susceptibility to generalized (as opposed to focal) seizures in AD vs controls. This research suggests avenues for future studies testing patients with seizures, e.g. co-morbid AD/epilepsy patients, and comparisons with PET and MRI scans to relate regional seizure propensity with AD pathologies. People with Alzheimer’s disease (AD) are more likely to develop seizures than cognitively healthy people. In this study, we aimed to understand whether whole-brain network structure is related to this increased seizure likelihood. We used electroencephalography (EEG) to estimate brain networks from people with AD and healthy controls. We subsequently inserted these networks into a model brain and simulated disease progression by increasing the excitability of brain tissue. We found the simulated AD brains were more likely to develop seizures than the simulated control brains. No participants had seizures when we collected data, so our results suggest an increased probability of developing seizures at a future time for AD participants. Therefore functional brain network structure may play a role in increased seizure likelihood in AD. We also used the model to examine which brain regions were most important for generating seizures, and found that the seizure-generating regions corresponded to those typically affected in early AD. Our results also provide a potential explanation for why people with AD are more likely to have generalized seizures (i.e. seizures involving the whole brain, as opposed to ‘focal’ seizures which only involve certain areas) than the general population with epilepsy.
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Affiliation(s)
- Luke Tait
- Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, United Kingdom
- * E-mail:
| | - Marinho A. Lopes
- Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, United Kingdom
| | - George Stothart
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - John Baker
- Dementia Research Centre, Queen Square Institute of Neurology, UCL, London, United Kingdom
| | - Nina Kazanina
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Jiaxiang Zhang
- Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, United Kingdom
| | - Marc Goodfellow
- Living Systems Institute, University of Exeter, Exeter, United Kingdom
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75
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Yu D, Cai Y, Osuagwu UL, Pickering K, Baker J, Cutfield R, Jansen RM, Orr-Walker BJ, Sundborn G, Zhao Z, Simmons D. Metabolic Profiles of Maori, Pacific, and European New Zealanders With Type 2 Diabetes Over 25 Years. Diabetes Care 2021; 44:dc211255. [PMID: 34362817 DOI: 10.2337/dc21-1255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/14/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Dahai Yu
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, U.K
| | - Yamei Cai
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | | | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | | | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - David Simmons
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Macarthur Clinical School, Western Sydney University, Campbelltown, Sydney, Australia
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76
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Saboori S, Jarvis M, Baker J, Seminara B, Vickers D, Pacicco T, Moshiree B. Hard to Swallow Results. Dysphagia 2021; 37:863-867. [PMID: 34297152 DOI: 10.1007/s00455-021-10344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
The American Neurogastroenterology and Motility Society (ANMS) proposed quality measures (QMs) for performance and interpretation of esophageal manometry (EM). We implemented a quality improvement (QI) study at a large community hospital to assess and improve procedural adherence and interpretation of EM studies based on the ANMS QMs using the Chicago Classification 3.0 (CC) Guidelines. For pre-intervention, three motility independent reviewers reinterpreted 60 EM studies conducted by community gastroenterologists without Tier II-III motility training from October to December 2018 for compliance with pre-procedural, procedural, and data interpretation ANMS QMs. In December 2018, we developed a pre-procedural form, educated nurses on EM procedural compliance, and provided preliminary pre-intervention results to gastroenterologists along with literature utilizing the CC 3.0 Guidelines. For post-intervention, we reinterpreted 54 EM studies from January to August 2019 and investigated whether they met QMs for data interpretation with respect to the CC Guidelines and resulted in appropriate treatment. We found a statistically significant improvement in procedural compliance among nursing staff for 30 s of swallows (76% post-intervention versus 12% pre-intervention, p < 0.001) and 7 evaluable swallows (94% post-intervention versus 53% pre-intervention, p < 0.001). However, quality metrics within data interpretation by physicians post-intervention showed mixed results. An incorrect diagnosis was made in 50% (n = 27)) of studies with 72% (n = 39) having at least one missing item based on the CC. The most missed diagnosis was fragmented peristalsis (30%, n = 29). Among the 39% (n = 21) of surgery referrals, 24% (n = 5) were incorrectly referred. Our study shows poor data interpretation by community gastroenterologists without formal motility training despite adequate performance by nursing staff. This further supports the need for a national ANMS certification process for formal HRM education.
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Affiliation(s)
- S Saboori
- Department of Internal Medicine at Atrium Health's Carolinas Medical Center, 5th Floor Medical Education Building, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
| | - M Jarvis
- Department of Internal Medicine at Atrium Health's Carolinas Medical Center, Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - J Baker
- Department of Internal Medicine and Surgery at Atrium Health's Carolinas Medical Center, Charlotte, USA
| | - B Seminara
- Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - D Vickers
- Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - T Pacicco
- Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - B Moshiree
- UNC School of Medicine-Charlotte Campus, Atrium Health Gastroenterology and Hepatology, Charlotte, USA
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77
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Hefler M, Baker J. Worldwide news and comment. Tob Control 2021. [DOI: 10.1136/tobaccocontrol-2021-056836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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78
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Albutt A, Berzins K, Louch G, Baker J. Health professionals' perspectives of safety issues in mental health services: A qualitative study. Int J Ment Health Nurs 2021; 30:798-810. [PMID: 33728730 DOI: 10.1111/inm.12838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/04/2020] [Accepted: 12/20/2020] [Indexed: 11/29/2022]
Abstract
The study aimed to explore mental health professionals' perceptions of patient safety issues across community and inpatient mental health services. Fourteen mental health professionals across community and inpatient settings participated in qualitative interviews. Framework analysis, guided by the Yorkshire Contributory Factors Framework - Mental Health, was used to analyse the data. Safety issues identified by mental health professionals mapped on to 19 of the 21 factors in the Yorkshire Contributory Factors Framework - Mental Health. The factors most frequently mentioned by participants were 'safety culture' which focused on raising concerns, learning from incidents and the influence of targets; 'communication systems' to support effective communication between staff; 'service user factors' including a perceived increase in illness acuity; 'service process' including how patients access and interact with services; and 'staff workload' perceived being as unmanageable. Mental health professionals consider there to be a broad range of safety issues associated with mental health services. Future research should aim to develop interventions to improve safety focused across the factors raised by professionals.
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Affiliation(s)
- Abigail Albutt
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - Gemma Louch
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
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Teece A, Baker J, Smith H. Understanding the decision-making of critical care nurses when restraining a patient with psychomotor agitation secondary to hyperactive delirium: A 'Think Aloud' study. J Clin Nurs 2021; 31:121-133. [PMID: 34056784 DOI: 10.1111/jocn.15889] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 01/02/2023]
Abstract
AIMS & OBJECTIVES This study aimed to explore the decision-making processes undertaken by critical care nurses when considering restraint to manage a patient with psychomotor agitation secondary to hyperactive delirium. BACKGROUND Psychomotor agitation is frequently cited as clinical rationale for initiating chemical or physical restraint. Despite the presence of clinical guidance for restraint in critical care, wide variations in nursing and prescribing practice are evident. Nurses are the primary decision makers when initiating restraint, but little is known about this process and influencing factors. DESIGN A pragmatic qualitative approach was used to explore critical care nurses' decision-making processes. METHODS A 'think aloud' approach was undertaken. Audio-visual vignettes featuring simulated patients were used as stimulus to elicit decision-making processes from thirty critical care nurses and practitioners. The COREQ checklist was followed. RESULTS Five themes relating to restraint were identified: Intrinsic beliefs and aptitudes; Handover and labelling; Failure to maintain a consistent approach; Restraint might be used to replace vigilance; The tyranny of the now. CONCLUSIONS Restraint was more frequent when staffing ratios were reduced below 1:1 and opportunities for vigilance reduced. Participants described physical and psychological exhaustion when caring for a patient with delirium and how this might lead to restraint to create 'space' for respite. Variations in practice were evident and restraint use appears rooted in custom and culture rather than objective assessment. RELEVANCE TO CLINICAL PRACTICE The lack of pre-emptive management for hyperactive delirium and reduced staffing ratios lead to the decision to restrain to preserve safety in acute agitation. The struggle to manage agitated behaviour is associated with nurse burnout and reduced engagement with therapeutic management methods, suggesting the need for psychological and educational support for clinical staff. Delirium is an important and debilitating form of organ dysfunction which should be collaboratively managed by the multi-disciplinary team.
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Affiliation(s)
| | - John Baker
- School of Healthcare, University of Leeds, UK
| | - Helen Smith
- School of Healthcare, University of Leeds, UK
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Baker J, Masood M, Rahman MA, Thornton L, Begg S. Tobacco retailer density and smoking behavior in a rural Australian jurisdiction without a tobacco retailer licensing system. Tob Induc Dis 2021; 19:39. [PMID: 34045936 PMCID: PMC8133357 DOI: 10.18332/tid/134190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION An emerging body of research has developed around tobacco retailer density and its contribution to smoking behavior. This cross-sectional study aimed to determine the association between tobacco retailer density and smoking behavior in a rural Australian jurisdiction without a tobacco retailer licensing system in place. METHODS A local government database (updated 2018) of listed tobacco retailers (n=93) was accessed and potential unlisted tobacco retailers (n=230) were added using online searches. All retailers (n=323) were visited in 2019 and GPS coordinates of retailers that sold tobacco (n=125) were assigned to suburbs in ArcMap. A community survey conducted in the Local Government Area provided smoking and sociodemographic data amongst adult respondents (n=8981). Associations between tobacco retailer density (calculated as the number of retailers per km2 based on respondents’ suburb of residence) and daily, occasional and experimental smoking were assessed using multilevel logistic regression analysis. Separate models with and without covariates were undertaken. RESULTS Without adjusting for possible confounders, living in suburbs with greater retailer density did not increase the odds of daily smoking (OR=1.01; 95% CI: 0.92–1.12), occasional smoking (OR=1.05; 95% CI: 0.94–1.18), or experimental smoking (OR=0.98; 95% 0.92– 1.05). However, after adjustment, living in suburbs with greater retailer density increased the odds of occasional smoking behavior (AOR=1.37; 95% CI: 1.10–1.71) but not daily or experimental smoking. CONCLUSIONS This study found a significant positive association between tobacco retailer density and the likelihood of occasional smoking in a rural Australian jurisdiction without a tobacco retailer licensing system in place. The findings strengthen calls for the introduction of a comprehensive, positive tobacco retailer licensing system to provide a framework for improving compliance with legislation and to reduce the overall availability of tobacco products in the community.
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Affiliation(s)
- John Baker
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Mohd Masood
- Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia.,Institute of Dentistry, University of Turku, Turku, Finland
| | - Muhammad Aziz Rahman
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Australia.,School of Health, Federation University, Berwick, Australia
| | - Lukar Thornton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Stephen Begg
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
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Teece A, Baker J, Smith H. Using audiovisual vignettes to collect data remotely on complex clinical care: a practical insight. Nurse Res 2021; 29:41-48. [PMID: 33982528 DOI: 10.7748/nr.2021.e1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Vignettes are regularly used in nursing research and education to explore complex clinical situations. However, paper-based vignettes lack clinical realism and do not fully recreate the pressures, sights and sounds of clinical settings, limiting their usefulness when studying complex decision-making processes. AIM To discuss the approach taken by the authors in developing and implementing audiovisual vignettes to collect data remotely in a qualitative study. DISCUSSION The authors describe how they created audiovisual vignettes for a qualitative 'Think Aloud' study exploring how critical care nurses decide whether to restrain agitated patients with varying degrees of psychomotor agitation. They discuss the practicalities of filming, editing and hosting, as well as the theoretical and clinical background that informed the creation of the vignettes. CONCLUSION Audiovisual vignettes are a cost- and time-effective way of remotely exploring decision-making in challenging environments. This innovative method assists in studying decision-making under simulated clinical pressures and captures data about how people make complex decisions. IMPLICATIONS FOR PRACTICE Audiovisual vignettes are an innovative tool for collecting data and could also be used in educational settings and offer the opportunity to explore complex clinical decision making remotely. Clinical accuracy is essential for immersing participants and simulating an environment and its pressures. The method could be further enhanced by making vignettes responsive to participants' decisions.
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Affiliation(s)
- Angela Teece
- School of Healthcare, University of Leeds, Leeds, England
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, England
| | - Helen Smith
- School of Healthcare, University of Leeds, Leeds, England
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Dehghansai N, Pinder RA, Baker J, Renshaw I. Challenges and stresses experienced by athletes and coaches leading up to the Paralympic Games. PLoS One 2021; 16:e0251171. [PMID: 33956860 PMCID: PMC8101742 DOI: 10.1371/journal.pone.0251171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
The demands of high-performance sport are exacerbated during the lead up to the Major Games (i.e., Paralympics). The purpose of this study was to better understand the challenges experienced and strategies utilized by Australian athletes (n = 7) and coaches (n = 5) preparing for the Tokyo Paralympic Games using semi-structured interviews. The thematic analysis highlighted challenges specific to participants’ sport (e.g., budgetary constraints, decentralized experiences, athletes with various impairments), personal life (e.g., moving cities to access coaching, postponing vocational/educational developments, isolation from social circles), and associated uncertainties (e.g., COVID-19, qualifications, accreditations). Participants managed these challenges by utilizing strategies to ‘anticipate and prepare’ (e.g., detailed planning, effective communication, contingency plans) and ‘manage expectations’ (e.g., understanding specific roles and boundaries, focusing on the process [i.e., effort over results]). Trust and communication between athletes and coaches was key in coaches’ better understanding of how athletes’ impairments interact with their training and competition environments and tailor support to each athlete’s unique needs. Last, participants reflected on the ‘pressure’ of the Games due to their performance having an impact on their career trajectory ‘post-Tokyo’ with some athletes contemplating retirement and others realizing the consequences of their performance on sport-related vocation and sponsorship. Coaches also accepted the success of their programs and job security will depend on outcomes at the Games. The findings from this study shed light on factors to consider to reduce challenges for teams preparing for major competitions but also highlight key practical implications to support athletes and coaches leading up, during, and post-major Games.
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Affiliation(s)
- N. Dehghansai
- School of Kinesiology and Health Science, York University, Toronto, Canada
- Paralympic Innovation, Paralympics Australia, Adelaide, Australia
- * E-mail:
| | - R. A. Pinder
- Paralympic Innovation, Paralympics Australia, Adelaide, Australia
| | - J. Baker
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - I. Renshaw
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
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Gale L, Harris S, Pattison S, Baker J, Fowler J. Development and evaluation of sub-element testing of SiC/SiC ceramic matrix composites at elevated temperatures. Ann Ital Chir 2021. [DOI: 10.1016/j.jeurceramsoc.2020.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hefler M, Baker J. Worldwide news and comment. Tob Control 2021. [DOI: 10.1136/tobaccocontrol-2021-056686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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85
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Masic A, Landsberg G, Milgram B, Merali Z, Durst T, Sanchez Vindas P, Garcia M, Baker J, Liu R, Arnason J. Efficacy of Souroubea-Platanus Dietary Supplement Containing Triterpenes in Beagle Dogs Using a Thunderstorm Noise-Induced Model of Fear and Anxiety. Molecules 2021; 26:molecules26072049. [PMID: 33916654 PMCID: PMC8038379 DOI: 10.3390/molecules26072049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/17/2022] Open
Abstract
A novel botanical dietary supplement, formulated as a chewable tablet containing a defined mixture of Souroubea spp. vine and Platanus spp. Bark, was tested as a canine anxiolytic for thunderstorm noise-induced stress (noise aversion). The tablet contained five highly stable triterpenes and delivered 10 mg of the active ingredient betulinic acid (BA) for an intended 1 mg/kg dose in a 10 kg dog. BA in tablets was stable for 30 months in storage at 23 °C. Efficacy of the tablets in reducing anxiety in dogs was assessed in a blinded, placebo-controlled study by recording changes in blood cortisol levels and measures of behavioral activity in response to recorded intermittent thunder. Sixty beagles were assigned into groups receiving: placebo, 0.5×, 1×, 2×, and 4× dose, or the positive control (diazepam), for five days. Reduction in anxiety measures was partially dose-dependent and the 1× dose was effective in reducing inactivity time (p = 0.0111) or increased activity time (p = 0.0299) compared with placebo, indicating a decrease in anxiety response. Cortisol measures also showed a dose-dependent reduction in cortisol in dogs treated with the test tablet.
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Affiliation(s)
- Aleksandar Masic
- Department of Microbiology, Educons University, Vojvode Putnika 87, Sremska Kamenica 21208, Serbia
- Correspondence: (A.M.); (J.A.)
| | - Gary Landsberg
- CanCog Technologies Inc., P.O. Box 248, Toronto, ON N1M 2W8, Canada; (G.L.); (B.M.)
| | - Bill Milgram
- CanCog Technologies Inc., P.O. Box 248, Toronto, ON N1M 2W8, Canada; (G.L.); (B.M.)
| | - Zul Merali
- Brain and Mind Institute, the Aga Khan University, 3 Park Place, Nairobi 00100, Kenya;
| | - Tony Durst
- Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Pablo Sanchez Vindas
- Herbario Juvenal Valerio Rodriguez, Universidad Nacional, Heredia 3000, Costa Rica; (P.S.V.); (M.G.)
| | - Mario Garcia
- Herbario Juvenal Valerio Rodriguez, Universidad Nacional, Heredia 3000, Costa Rica; (P.S.V.); (M.G.)
| | - John Baker
- Stonehedge Bioresources Inc., Stirling, ON K8N 5J2, Canada;
| | - Rui Liu
- Department of Biology, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - John Arnason
- Department of Biology, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Correspondence: (A.M.); (J.A.)
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Williams B, Gidal BE, Resnick T, Baker J, Holtzman M, Sparling N, Maher J, Plauschinat C. Influence of titration of antiseizure medications on treatment selection: Results of an online survey with clinicians in the United States. Epilepsy Behav 2021; 117:107840. [PMID: 33626489 DOI: 10.1016/j.yebeh.2021.107840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Most antiseizure medications (ASM) need to be titrated before the optimal dose is achieved. Titration can last several weeks to months. We assessed the impact titration schedules have on ASM treatment-related decisions in the United States (US). METHODS An online survey was conducted with different healthcare providers (HCPs) in the US involved in the treatment and management of patients with epilepsy. The survey contained three sections: the first section with screening questions; the second on key factors that influence a HCP's decision-making when selecting treatments for different types of seizures and different treatment lines; and the third on the HCP's knowledge and perceptions regarding ASM titration for the treatment of patients with epilepsy. RESULTS One-hundred and fifty HCPs (63% neurologists) completed the survey. Most HCPs considered titration schedule to be important, with only 1-3% of HCPs, depending on type of seizure, considering the titration schedule to be "not important at all" when prescribing therapy. Healthcare providers' acceptance of titration increased with shorter durations (≥50% accepted titration periods of ≤2 weeks), and lower number of tablets/capsules per dose (≥50% accepted ≤3 tablets/capsules per dose), doses (≥50% accepted ≤2 doses/day), and steps (≥50% accepted ≤3 steps/dose change). Most HCPs (68-91% depending on type of seizure) considered a titration duration of 6 or more weeks only somewhat acceptable or somewhat or highly unacceptable. Almost all HCPs selected "somewhat familiar", "familiar", or "very familiar" as the attribute that best defines their knowledge level of titration, with only 4% selecting "a little familiar". While 87% of HCPs agreed or strongly agreed that they could easily understand titration schedules, only 27% of them agreed or strongly agreed that patients could easily understand titration schedules and 58% of HCPs considered that adhering to the titration schedule was difficult for patients. Most HCPs agreed or strongly agreed that a complex or long titration schedule renders it difficult to achieve their treatment objectives. CONCLUSIONS Healthcare providers take into account the duration and complexity of the titration period in their ASM prescribing decision-making and prefer shorter and simpler titration schedules, particularly for patients who are experiencing convulsive seizures and starting monotherapy. There was a clear difference between the HCP's belief in their own ability to understand a titration schedule, and their belief that the patient would be able to follow the titration schedule appropriately.
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Affiliation(s)
| | - Barry E Gidal
- University of Wisconsin School of Pharmacy, Madison, WI, United States
| | - Trevor Resnick
- University of Miami School of Medicine, FL, United States; Nicklaus Children's Hospital, Department of Neurology, FL, United States
| | - John Baker
- Colonial Healthcare, Colonial Neurology, SC, United States
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Liu R, Burkett K, Rapinski M, Arnason JT, Johnson F, Hintz P, Baker J, Harris CS. Biochemometric Analysis of Fatty Acid Amide Hydrolase Inhibition by Echinacea Root Extracts. Planta Med 2021; 87:294-304. [PMID: 33296937 DOI: 10.1055/a-1289-9569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Recent research demonstrates that Echinacea possesses cannabimimetic activity with potential applications beyond common contemporary uses for relief of cold and flu symptoms. In this study, we investigated the in vitro inhibitory effect of root extracts of Echinacea purpurea and Echinacea angustifolia on fatty acid amide hydrolase, the main enzyme that degrades the endocannabinoid anandamide. The objective was to relate variation in bioactivity between commercial Echinacea genotypes to their phytochemical profiles and to identify determinants of activity using biochemometric analysis. Forty root extracts of each of species were tested for inhibition of fatty acid amide hydrolase and analyzed by HPLC-DAD/MS to identify and quantitate alkylamides and caffeic acid derivatives. Fatty acid amide hydrolase inhibition ranged from 34 - 80% among E. angustifolia genotypes and from 33 - 87% among E. purpurea genotypes. Simple linear regression revealed the caffeic acid derivatives caftaric acid and cichoric acid, and the alkylamide dodeca-2E,4Z-diene-8,10-diynioc acid 2-methylbutylamide, as the strongest determinants of inhibition in E. purpurea (r* = 0.53, 0.45, and 0.20, respectively) while in E. angustifolia, only CADs were significantly associated with activity, most notably echinacoside (r* = 0.26). Regression analysis using compound groups generated by hierarchical clustering similarly indicated that caffeic acid derivatives contributed more than alkylamides to in vitro activity. Testing pure compounds identified as determinants of activity revealed cichoric acid (IC50 = 45 ± 4 µM) and dodeca-2E,4E,8Z,10E-tetraenoic acid isobutylamide (IC50 = 54 ± 2 µM) as the most active. The results suggest that several phytochemicals may contribute to Echinacea's cannabimimetic activity and that ample variation in genotypes exists for selection of high-activity germplasm in breeding programs.
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Affiliation(s)
- Rui Liu
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
| | - Kelly Burkett
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, ON, Canada
| | - Michel Rapinski
- Institut de recheche en biologie végétale (IRBV), University of Montreal, Montreal, QC, Canada
| | - John T Arnason
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
| | | | - Phil Hintz
- Trout Lake Farm, LLC, Trout Lake, WA, USA
| | | | - Cory S Harris
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
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Gill T, Pollard AJ, Baker J, Tredwin C. Cracked Tooth Syndrome: Assessment, Prognosis and Predictable Management Strategies. Eur J Prosthodont Restor Dent 2021. [PMID: 33770422 DOI: 10.1922/ejprd_2232gill10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cracked tooth syndrome (CTS) is a common presentation in general practice. The diagnosis and management of teeth with CTS may be difficult due to the unknown extent of the crack. This article reviews the aetiology, diagnosis, management and prognosis of teeth with CTS. A thorough examination is required to effectively assess CTS. Intervention should aim to relieve symptoms and brace the remaining tooth structure effectively against further flexion. Restored teeth with CTS have a guarded prognosis due to the risk of further crack propagation, but the chances of survival at 5-years is acceptable (74.1-96.8%).
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Affiliation(s)
- T Gill
- Academic Clinical Fellow & Specialist Registrar Restorative Dentistry, Royal London Hospital, Whitechapel Rd, Whitechapel, London, E1 1FR.,Honorary Clinical Research Fellow, Centre of Oral Bioengineering, Queen Mary University of London, Whitechapel, London, E1 1FR
| | - A J Pollard
- Specialist Registrar Periodontology, University Hospitals Bristol, University of Bristol Dental School, Lower Maudlin St, Bristol BS1 2LY, UK
| | - J Baker
- Specialist in Fixed & Removable Prosthodontics, 55 Wimpole Street, London W1G 8YL
| | - C Tredwin
- Professor of Restorative Dentistry and Head of Peninsula Dental School, Peninsula Dental School, University of Plymouth, Drakes Circus, Plymouth, PL4 8AA
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Baker J, Savage S, Milton F, Butler C, Kapur N, Hodges J, Zeman A. The syndrome of transient epileptic amnesia: a combined series of 115 cases and literature review. Brain Commun 2021; 3:fcab038. [PMID: 33884371 PMCID: PMC8047097 DOI: 10.1093/braincomms/fcab038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/24/2022] Open
Abstract
The term transient epileptic amnesia was coined in 1990 to describe a form of epilepsy causing predominantly amnestic seizures which could be confused with episodes of Transient Global Amnesia. Subsequent descriptions have highlighted its association with ‘atypical’ forms of memory disturbance including accelerated long-term forgetting, disproportionate autobiographical amnesia and topographical amnesia. However, this highly treatment-responsive condition remains under-recognized and undertreated. We describe the clinical and neuropsychological features in 65 consecutive cases of transient epileptic amnesia referred to our study, comparing these to our previous cohort of 50 patients and to those reported in 102 literature cases described since our 2008 review. Findings in our two cohorts are substantially consistent: The onset of transient epileptic amnesia occurs at an average age of 62 years, giving rise to amnestic episodes at a frequency of around 1/month, typically lasting 15–30 min and often occurring on waking. Amnesia is the only manifestation of epilepsy in 24% of patients; olfactory hallucinations occur in 43%, motor automatisms in 41%, brief unresponsiveness in 39%. The majority of patients describe at least one of the atypical forms of memory disturbance mentioned above; easily provoked tearfulness is a common accompanying feature. There is a male predominance (85:30). Epileptiform changes were present in 35% of cases, while suspected causative magnetic resonance imaging abnormalities were detected in only 5%. Seizures ceased with anticonvulsant treatment in 93% of cases. Some clinical features were detected more commonly in the second series than the first, probably as a result of heightened awareness. Neuropsychological testing and comparison to two age and IQ-matched control groups (n = 24 and 22) revealed consistent findings across the two cohorts, namely elevated mean IQ, preserved executive function, mild impairment at the group level on standard measures of memory, with additional evidence for accelerated long-term forgetting and autobiographical amnesia, particularly affecting episodic recollection. Review of the literature cases revealed broadly consistent features except that topographical amnesia, olfactory hallucinations and emotionality have been reported rarely to date by other researchers. We conclude that transient epileptic amnesia is a distinctive syndrome of late-onset limbic epilepsy of unknown cause, typically occurring in late middle age. It is an important, treatable cause of memory loss in older people, often mistaken for dementia, cerebrovascular disease and functional amnesia. Its aetiology, the monthly occurrence of seizures in some patients and the mechanisms and interrelationships of the interictal features—amnestic and affective—all warrant further study.
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Affiliation(s)
- John Baker
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter EX1 2LU, UK
| | - Sharon Savage
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter EX1 2LU, UK.,School of Psychology, University of Newcastle, New South Wales 2308, Australia
| | - Fraser Milton
- Discipline of Psychology, University of Exeter, Washington Singer Laboratories, Exeter EX4 4QG, UK
| | - Christopher Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.,Department of Brain Sciences, Imperial College, London W12 0NN, UK.,Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago 833007, Chile
| | - Narinder Kapur
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - John Hodges
- Brain and Mind Centre, University of Sydney, Sydney 2050, Australia
| | - Adam Zeman
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter EX1 2LU, UK
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Hefler M, Baker J. Worldwide news and comment. Tob Control 2021. [DOI: 10.1136/tobaccocontrol-2021-056525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharda L, Baker J, Cahill J. A mixed methods study of the healthcare received by patients diagnosed with a personality disorder on acute general hospital wards. J Adv Nurs 2021; 77:2002-2011. [PMID: 33594716 DOI: 10.1111/jan.14797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 02/02/2023]
Abstract
AIM The study examined concurrent mental and physical healthcare received by patients diagnosed with a personality disorder on acute general hospital wards. The specific objectives were (i) to conduct a web based cross sectional survey and (ii) to explore experiences and perspectives with a subsection of the survey sample, using telephone interviews. DESIGN A convergent parallel mixed methods design, which comprised a web-based cross sectional survey (n = 65) with embedded qualitative telephone interviews (n = 12). Participants were social media users, with a self-reported diagnosis of personality disorder, admitted to an acute general hospital in the UK in the previous 2 years. METHODS Participants were recruited on social media between May 2017 and August 2017 by snowballing. Mixed data were integrated at the stage of analysis using a framework approach. Findings are reported thematically. RESULTS Most of the participants surveyed (94%, n = 61) reported distress during admission to the acute general hospital. However, the findings indicated the hospital environment was not conducive to mental health. Four interrelated themes were identified and related to: patient distress; the workforce; service delivery; and service design. CONCLUSION Findings indicated that patients with a personality disorder diagnosis received disadvantaged healthcare, might be at considerable risk of treatment noncompletion, and were languishing in the gaps between mental and physical health services. IMPACT This is one of the first studies to collect primary data on the concurrent mental and physical healthcare received by patients diagnosed with a personality disorder on acute general hospital wards. Ad hoc training and education focused on raising awareness of 'personality disorder' would not seem sufficient to address the deficits. This research may be of interest to people who use mental health services, acute general hospital and liaison clinicians, hospital managers and researchers.
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Baker J, Berzins K, Canvin K, Benson I, Kellar I, Wright J, Lopez RR, Duxbury J, Kendall T, Stewart D. Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review. Health Serv Deliv Res 2021. [DOI: 10.3310/hsdr09050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ObjectivesThe study aimed to provide a mapping review of non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings; classify intervention components using the behaviour change technique taxonomy; explore evidence of behaviour change techniques and interventions; and identify the behaviour change techniques that show most effectiveness and those that require further testing.BackgroundIncidents involving violence and aggression occur frequently in adult mental health inpatient settings. They often result in restrictive practices such as restraint and seclusion. These practices carry significant risks, including physical and psychological harm to service users and staff, and costs to the NHS. A number of interventions aim to reduce the use of restrictive practices by using behaviour change techniques to modify practice. Some interventions have been evaluated, but effectiveness research is hampered by limited attention to the specific components. The behaviour change technique taxonomy provides a common language with which to specify intervention content.DesignSystematic mapping study and analysis.Data sourcesEnglish-language health and social care research databases, and grey literature, including social media. The databases searched included British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CCRCT), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), EMBASE, Health Technology Assessment (HTA) Database, HTA Canadian and International, Ovid MEDLINE®, NHS Economic Evaluation Database (NHS EED), PsycInfo®and PubMed. Databases were searched from 1999 to 2019.Review methodsBroad literature search; identification, description and classification of interventions using the behaviour change technique taxonomy; and quality appraisal of reports. Records of interventions to reduce any form of restrictive practice used with adults in mental health services were retrieved and subject to scrutiny of content, to identify interventions; quality appraisal, using the Mixed Methods Appraisal Tool; and data extraction, regarding whether participants were staff or service users, number of participants, study setting, intervention type, procedures and fidelity. The resulting data set for extraction was guided by the Workgroup for Intervention Development and Evaluation Research, Cochrane and theory coding scheme recommendations. The behaviour change technique taxonomy was applied systematically to each identified intervention. Intervention data were examined for overarching patterns, range and frequency. Overall percentages of behaviour change techniques by behaviour change technique cluster were reported. Procedures used within interventions, for example staff training, were described using the behaviour change technique taxonomy.ResultsThe final data set comprised 221 records reporting 150 interventions, 109 of which had been evaluated. The most common evaluation approach was a non-randomised design. There were six randomised controlled trials. Behaviour change techniques from 14 out of a possible 16 clusters were detected. Behaviour change techniques found in the interventions were most likely to be those that demonstrated statistically significant effects. The most common intervention target was seclusion and restraint reduction. The most common strategy was staff training. Over two-thirds of the behaviour change techniques mapped onto four clusters, that is ‘goals and planning’, ‘antecedents’, ‘shaping knowledge’ and ‘feedback and monitoring’. The number of behaviour change techniques identified per intervention ranged from 1 to 33 (mean 8 techniques).LimitationsMany interventions were poorly described and might have contained additional behaviour change techniques that were not detected. The finding that the evidence was weak restricted the study’s scope for examining behaviour change technique effectiveness. The literature search was restricted to English-language records.ConclusionsStudies on interventions to reduce restrictive practices appear to be diverse and poor. Interventions tend to contain multiple procedures delivered in multiple ways.Future workPrior to future commissioning decisions, further research to enhance the evidence base could help address the urgent need for effective strategies. Testing individual procedures, for example, audit and feedback, could ascertain which are the most effective intervention components. Separate testing of individual components could improve understanding of content and delivery.Study registrationThe study is registered as PROSPERO CRD42018086985.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - Krysia Canvin
- School of Healthcare, University of Leeds, Leeds, UK
| | - Iris Benson
- Mersey Care NHS Foundation Trust, Prescot, UK
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Joy Duxbury
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | | | - Duncan Stewart
- Department of Health Sciences, University of York, York, UK
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Goldsweig AM, Tak HJ, Alraies MC, Park J, Smith C, Baker J, Lin L, Patel N, O'Neill WW, Basir MB. Mechanical Circulatory Support Following Out-of-Hospital Cardiac Arrest: Insights From the National Cardiogenic Shock Initiative. Cardiovasc Revasc Med 2020; 32:58-62. [PMID: 33358390 DOI: 10.1016/j.carrev.2020.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Evidence is limited regarding the role of mechanical circulatory support (MCS) in patients with acute coronary syndromes (ACS) complicated by cardiogenic shock (CGS). In particular, the role of MCS in patients with out-of-hospital cardiac arrest (OHCA) is unknown. METHODS The National Cardiogenic Shock Initiative (NCSI) is a multicenter United States registry of patients with ACS complicated by CGS treated with MCS. We compared the rate of survival to hospital discharge among patients with OHCA, in-hospital cardiac arrest (IHCA), or no cardiac arrest. We subsequently used multivariable analyses to determine independent predictors of OHCA survival. RESULTS Survival to hospital discharge occurred in 85.7% (42/49) of OHCA, 72.4% (50/69) of IHCA, and 74.5% (111/149) of non-cardiac arrest patients. By multivariable analysis, pre-procedural predictors of survival included younger age, female sex, fewer diseased vessels, left anterior descending coronary artery culprit, lower troponin, higher lactate, and delayed initiation of MCS. Procedural and post-procedural predictors of survival included fewer vessels treated, complete revascularization, higher post-MCS cardiac power output, and fewer inotropic medications required. CONCLUSIONS This study demonstrates that excellent outcomes may be achieved following OHCA when MCS is employed for patients appropriately selected by prognostic demographic, anatomic, and health status characteristics. A larger study population, currently being enrolled, is needed to validate the observation further.
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Affiliation(s)
- Andrew M Goldsweig
- University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Hyo Jung Tak
- University of Nebraska Medical Center, Omaha, NE, United States of America
| | - M Chadi Alraies
- Wayne State University and Detroit Medical Center, Detroit, MI, United States of America
| | - James Park
- Texas Health Presbyterian, Dallas, TX, United States of America
| | - Craig Smith
- University of Massachusetts Memorial Medical Center, Worcester, MA, United States of America
| | - John Baker
- Jackson General Hospital, Jackson, TN, United States of America
| | - Lang Lin
- Morton Plant Hospital, Clearwater, FL, United States of America
| | - Nainesh Patel
- Lehigh Valley Hospital, Allentown, PA, United States of America
| | | | - Mir B Basir
- Henry Ford Hospital, Detroit, MI, United States of America
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Hefler M, Baker J. Worldwide news and comment. Tob Control 2020. [DOI: 10.1136/tobaccocontrol-2020-056369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Watts G, Schwabe C, Scott R, Gladding P, Sullivan D, Baker J, Clifton P, Hamilton J, Given B, San Martin J, Melquist S, Knowles J, Goldberg I, Hegele R, Ballantyne C. RNAi inhibition of angiopoietin-like protein 3 (ANGPTL3) with ARO-ANG3 mimics the lipid and lipoprotein profile of familial combined hypolipidemia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3331] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Elevated LDL-C and triglyceride rich lipoproteins (TRLs) are independent risk factors for cardiovascular disease (CVD). Genetic deficiency of angiopoietin-like protein 3 (ANGPTL3) is associated with reduced circulating levels of LDL-C, triglycerides (TGs), VLDL-C, HDL-C and reduced CVD risk, with no described adverse phenotype. ARO-ANG3 is a RNA interference drug designed to silence expression of ANGPTL3. Single doses of ARO-ANG3 have been shown to reduce ANGPTL3, TGs, VLDL-C and LDL-C in healthy volunteers (HVs, AHA 2019). We report the effects of multiple doses of ARO-ANG3 in HVs with a focus on the duration of action.
Methods
ARO-ANG3 was administered subcutaneously to HVs on days 1 and 29 at doses of 100, 200 or 300 mg (n=4 per group). Measured parameters included ANGPTL3, LDL-C, TGs, VLDL-C and HDL-C. Follow up is ongoing.
Results
All HVs have received both doses and follow-up is currently through week 16 (12 weeks after second dose). Mean nadir for ANGPTL3 levels occurred 2 weeks after the second dose (−83–93%) with minimal change for 200 and 300 mg but 16% recovery for 100 mg at week 16. Mean TGs and VLDL-C reached nadir earlier (3 wks, −61–65%) without apparent dose response and minimal change for any dose at wk 16. LDL-C nadir occurred 4–6 wks after the second dose (−45–54%), again with minimal evidence for dose response or change through wk 16. HDL-C was reduced 14–37% at wk 16. ARO-ANG3 was well tolerated without serious or severe adverse events or dropouts related to drug. The most common adverse events have been headache and upper respiratory infections.
Conclusions
Genetic deficiency of ANGPTL3 is a cause of familial combined hypolipemia and is associated with a decreased risk of CVD. Using RNAi to selectively suppress ANGPTL3 production reproduces these genetic effects with a duration of at least 12 weeks following a second dose and with good tolerability over 16 wks. ANGPTL3 inhibition results in lowering of LDL-C and TRLs which may confer protection against CVD in patients with atherogenic mixed dyslipidemia.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Arrowhead Pharmaceuticals
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Affiliation(s)
- G.F Watts
- University of Western Australia, Perth, Australia
| | - C Schwabe
- Auckland Clinical Studies, Auckland, New Zealand
| | - R Scott
- Christchurch Diabetes Centre, Division of Endocrinology, Diabetes, and Metabolism, Christchurch, New Zealand
| | - P Gladding
- Auckland City Hospital, Auckland, New Zealand
| | - D Sullivan
- Royal Prince Alfred Hospital, Sydney, Australia
| | - J Baker
- Middlemore Hospital, Auckland, New Zealand
| | - P Clifton
- Royal Adelaide Hospital, Adelaide, Australia
| | - J Hamilton
- Arrowhead Pharmaceuticals, Pasadena, United States of America
| | - B Given
- Arrowhead Pharmaceuticals, Pasadena, United States of America
| | - J San Martin
- Arrowhead Pharmaceuticals, Pasadena, United States of America
| | - S Melquist
- Arrowhead Pharmaceuticals, Pasadena, United States of America
| | - J.W Knowles
- School of Medicine, Stanford, United States of America
| | - I Goldberg
- NYU School of Medicine, NYU Langone Health, New York City, United States of America
| | - R Hegele
- University of Western Ontario, London, Canada
| | - C Ballantyne
- Baylor College of Medicine, Houston, United States of America
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Watts GF, Schwabe C, Scott R, Gladding P, Sullivan D, Baker J, Clifton P, Hamilton J, Given B, San Martin J, Melquist S, Chang T, Rajicic N, Goldberg IJ, Gaudet D, Knowles JW, Hegele RA, Ballantyne CM. Abstract 15751: Pharmacodynamic Effect of ARO-ANG3, an Investigational RNA Interference Targeting Hepatic Angiopoietin-like Protein 3, in Patients With Hypercholesterolemia. Circulation 2020. [DOI: 10.1161/circ.142.suppl_3.15751] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Angiopoietin-like protein 3 (ANGPTL3) regulates triglyceride (TG) and lipoprotein (LP) metabolism by inhibiting liver and endothelial LP lipases and reduces plasma LDL-C. In Phase 1 Study AROANG1001 (NCT03747224), single and multiple doses of RNA interference therapeutic ARO-ANG3 (100, 200, or 300 mg; n=36) in healthy volunteers substantially reduced ANGPTL3, LDL-C, and other LPs (AHA 2019) compared with placebo (n=16).
Purpose:
We report preliminary results following repeat doses (days 1 and 29) of ARO-ANG3 in patients with heterozygous familial hypercholesterolemia (FH) with elevated LDL-C despite statin therapy and average LDL-C of 130 mg/dL. An additional group (non-FH patients) had LDL-C > 70 mg/dL despite statin therapy.
Methods:
Seventeen FH patients received open-label, subcutaneous, ARO-ANG3 100 mg (n=6), 200 mg (n=6), or 300 mg (n=5). Nine non-FH, high risk patients with elevated LDL-C not at goal received either 200 mg ARO-ANG3 (n=6) or placebo (n=3) using a randomized double-blind design. Pharmacodynamic markers included serum ANGPTL3, LDL-C, TG, and others.
Results:
Results are reported as of 04 May 2020. In FH patients, ARO-ANG3 significantly reduced mean ANGPTL3 levels between 62-92% at week 16 in a dose-dependent manner (Table). LDL-C (23-37%) and TG (25-43%) were consistently reduced at all doses (Table). The mean percent reductions in non-FH patients for ANGPTL3 (85%), LDL-C (28%), and TG (29%) were comparable to those in FH patients, despite their initially lower LDL-C at baseline. As of 15 May 2020, there were no drug-related serious or severe adverse events (AEs) or discontinuations and most AEs were mild. The most common AEs reported in subjects receiving ARO-ANG3 were respiratory tract infection (30% of subjects) and injection site AEs (13% of subjects).
Conclusions:
In FH and non-FH patients, repeat doses of ARO-ANG3 significantly reduced ANGPTL3, LDL-C, and TG, with favorable safety.
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Affiliation(s)
| | | | | | | | | | - John Baker
- Middlemore Clinical Trials, Auckland, New Zealand
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Hefler M, Baker J. Worldwide news and comment. Tob Control 2020. [DOI: 10.1136/tobaccocontrol-2020-056285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Schwabe C, Scott R, Sullivan D, Baker J, Clifton P, Hamilton J, Given B, San Martin J, Melquist S, Watts G, Goldberg I, Knowles J, Hegele R, Ballantyne C. RNA interference targeting apolipoprotein C-III with ARO-APOC3 in healthy volunteers mimics lipid and lipoprotein findings seen in subjects with inherited apolipoprotein C-III deficiency. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Individuals with triglycerides (TGs) ≥1,000 mg/dL (11.1 mmol/L) are at increased risk of acute pancreatitis. Genetic studies indicate that individuals with apolipoprotein C-3 (APOC3) loss-of-function mutations have low TGs, reduced cardiovascular risk and no observed adverse phenotype. RNA interference (RNAi) with ARO-APOC3 has shown deep and durable knockdown (KD) of APOC3 after single doses in healthy volunteers (HVs, presented at AHA 2019) with good tolerability. We report here initial results using multiple doses of ARO-APOC3 to silence APOC3 expression in HVs.
Methods
ARO-APOC3 was administered subcutaneously to HVs on days 1 and 29 at doses of 10, 25 or 50 mg (n=4 per group). Measured parameters included plasma concentrations of APOC3, LDL-C, TGs, VLDL-C and HDL-C.
Results
All HVs have received both doses and follow-up for most parameters is available through week (wk) 14 (10 wks after second dose) for the 10 and 25 mg doses and through wk 10 for 50 mg. Mean nadir for APOC3 levels occurred at wk 3 for 10 mg (−73%) and remained similar at wk 10 (−66%), at wk 6 for 25 mg (−90%) with no change at wk 10 and at wk 2 for 50 mg (−94%) unchanged at wk 8. TGs fell faster in the 50 mg group (wk 1: 10 mg −41%; 25 mg −47%; 50 mg −72%). By wk 6 the 25 and 50 mg results were similar (−68% and −74%, respectively) and remained similar through wk 14. 10 mg was less active with a nadir of −56% and mean reductions between 42% and 56% post-nadir. VLDL-C values mirrored TGs. LDL-C reductions were more modest and did not manifest a dose response. Mean nadirs (−23–26%) occurred 4–6 wks after the first dose, again with minimal change through 10–14 wks of follow-up. Consistent with genetic studies, HDL-C increased to a maximum at approximately wk 8 (10 mg +42%, 25 mg +48%, 50 mg +84%). ARO-APOC3 was well tolerated without serious or severe adverse events or dropouts related to drug. The most common adverse events were mild injection site AEs and headache.
Conclusions
Genetic deficiency of APOC3 is associated with substantial reductions in TGs, VLDL-C and increases in HDL-C without an adverse phenotype. Using RNAi to selectively suppress APOC3 production mimics these lipid and lipoprotein effects, with a duration of at least 10 weeks following a second dose and with good tolerability over 16 wks using doses ranging from 10 to 50 mg. Investigation of optimal dosing regimen is ongoing, especially with respect to dosing interval. This therapeutic approach has potential for treating patients with chylomicronemia at risk of pancreatitis.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Arrowhead Pharmaceuticals
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Affiliation(s)
- C Schwabe
- Auckland Clinical Studies, Auckland, New Zealand
| | - R Scott
- Christchurch Diabetes Centre, Diabetes Research Institute, Christchurch, New Zealand
| | - D Sullivan
- Royal Prince Alfred Hospital, Camperdown, New Zealand
| | - J Baker
- Middlemore Hospital, Auckland, New Zealand
| | - P Clifton
- Royal Adelaide Hospital, Adelaide, Australia
| | - J Hamilton
- Arrowhead Pharmaceuticals, Pasadena, United States of America
| | - B Given
- Arrowhead Pharmaceuticals, Pasadena, United States of America
| | - J San Martin
- Arrowhead Pharmaceuticals, Pasadena, United States of America
| | - S Melquist
- Arrowhead Pharmaceuticals, Pasadena, United States of America
| | - G.F Watts
- University of Western Australia, Perth, Australia
| | - I Goldberg
- NYU School of Medicine, NYU Langone Health, Division of Endocrinology, Diabetes, and Metabolism, New York City, United States of America
| | - J.W Knowles
- School of Medicine, Stanford, United States of America
| | - R Hegele
- University of Western Ontario, London, Canada
| | - C Ballantyne
- Baylor College of Medicine, Houston, United States of America
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Levin C, Baker J, Nolan P, Coffey A. A Survey of Medication-Related Osteonecrosis of the Jaw Reporting and Risk Assessment by Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Immanuel J, Eagleton C, Baker J, Simmons D. Pregnancy outcomes among multi-ethnic women with different degrees of hyperglycaemia during pregnancy in an urban New Zealand population and their association with postnatal HbA1c uptake. Aust N Z J Obstet Gynaecol 2020; 61:69-77. [PMID: 32880893 DOI: 10.1111/ajo.13231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adverse pregnancy outcomes are more common in women with hyperglycaemia. Many women have suboptimal uptake of HbA1c testing postdelivery. AIMS To compare pregnancy outcomes among multi-ethnic women with different degrees of hyperglycaemia during pregnancy, and their association with postnatal HbA1c uptake after the introduction of email reminders. MATERIALS AND METHODS A retrospective and prospective single-centre study was conducted in South Auckland in 2639 women with early gestational diabetes mellitus (GDM) (diagnosed < 20 weeks), late GDM (diagnosed ≥ 20 weeks), overt diabetes in pregnancy, or known type 2 diabetes (T2DM) during pregnancy. Automated email reminders were sent to general practitioners to increase postnatal HbA1c screening. RESULTS HbA1c during pregnancy increased across the late GDM (n = 1425), early GDM (n = 148), overt diabetes (n = 573) and T2DM (n = 493) groups (P < 0.001). Stillbirth was least common in the late GDM group (0, 0.7, 0.5, and 1.9%, respectively, P < 0.001), as were caesarean delivery (32.7, 45.1, 39.4, and 53.5%, respectively, P < 0.001), large for gestational age (LGA) (14.7, 18.2, 22.3, and 30.5%, respectively, P < 0.001), small for gestational age (8.8, 16.7, 11.0, and 11.1%, respectively, P = 0.02), and preeclampsia/eclampsia (7.7, 9.2, 13.0, and 14.8%, respectively, P < 0.001). LGA and preeclampsia/eclampsia were more common among Pacific and Māori women than European women (LGA, 30.1, 22.7, 10.3%, respectively, P < 0.001; preeclampsia/eclampsia, 13.5, 14.0, and 8.1%, respectively, P < 0.001). Postpartum HbA1c screening increased among women with GDM/overt diabetes after the introduction of the reminder emails (39.6% vs 34.0%, P = 0.03). CONCLUSIONS Women with late GDM are least likely to experience adverse outcomes. Email reminders to improve postpartum HbA1c screening warrant further investigation.
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Affiliation(s)
- Jincy Immanuel
- Western Sydney University, Sydney, New South Wales, Australia
| | - Carl Eagleton
- Counties Manukau District Health Board, Auckland, New Zealand
| | - John Baker
- Counties Manukau District Health Board, Auckland, New Zealand
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, New South Wales, Australia
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