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Granjon D, Bonny O, Edwards A. Conséquences de l’hyperparathyroïdie primitive sur l’excrétion rénale de calcium. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Davies F, Edwards A, Brain K, Edwards M, Jones R, Wallbank R, Robertson NP, Wood F. 'You are just left to get on with it': qualitative study of patient and carer experiences of the transition to secondary progressive multiple sclerosis. BMJ Open 2015; 5:e007674. [PMID: 26201723 PMCID: PMC4513516 DOI: 10.1136/bmjopen-2015-007674] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Although the transition to secondary progressive multiple sclerosis (SPMS) is known to be a period of uncertainty for clinicians, who may find progressive disease challenging to objectively identify, little research has explored the experiences of patients and carers specifically during this transition period. Our objective was to explore what patients and their carers understand about their disease stage and describe their experiences and perspectives on the transition to SPMS. DESIGN Semistructured qualitative interviews and subsequent validation focus groups were analysed using inductive thematic analysis. SETTING South East Wales, UK. PARTICIPANTS 20 patients with MS and 13 carers were interviewed. Eight patients and two carers participated in focus groups. RESULTS Four main themes around disease progression were identified. 'Realisation' describes how patients came to understand they had SPMS while 'reaction' describes their response to this realisation. The 'realities' of living with SPMS, including dealing with the healthcare system during this period, were described along with 'future challenges' envisaged by patients and carers. CONCLUSIONS Awareness that the transition to SPMS has occurred, and subsequent emotional reactions and coping strategies, varied widely between patients and their carers. The process of diagnosing the transition was often not transparent and some individuals wanted information to help them understand what the transition to SPMS meant for them.
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Kendler KS, Edwards A, Myers J, Cho SB, Adkins A, Dick D. The predictive power of family history measures of alcohol and drug problems and internalizing disorders in a college population. Am J Med Genet B Neuropsychiatr Genet 2015; 168B:337-46. [PMID: 25946510 PMCID: PMC4466079 DOI: 10.1002/ajmg.b.32320] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/15/2015] [Indexed: 11/10/2022]
Abstract
A family history (FH) of psychiatric and substance use problems is a potent risk factor for common internalizing and externalizing disorders. In a large web-based assessment of mental health in college students, we developed a brief set of screening questions for a FH of alcohol problems (AP), drug problems (DP) and depression-anxiety in four classes of relatives (father, mother, aunts/uncles/grandparents, and siblings) as reported by the student. Positive reports of a history of AP, DP, and depression-anxiety were substantially correlated within relatives. These FH measures predicted in the student, in an expected pattern, dimensions of personality and impulsivity, alcohol consumption and problems, smoking and nicotine dependence, use of illicit drugs, and symptoms of depression and anxiety. Using the mean score from the four classes of relatives was more predictive than using a familial/sporadic dichotomy. Interactions were seen between the FH of AP, DP, and depression-anxiety and peer deviance in predicting symptoms of alcohol and tobacco dependence. As the students aged, the FH of AP became a stronger predictor of alcohol problems. While we cannot directly assess the validity of these FH reports, the pattern of findings suggest that our brief screening items were able to assess, with some accuracy, the FH of substance misuse and internalizing psychiatric disorders in relatives. If correct, these measures can play an important role in the creation of developmental etiologic models for substance and internalizing psychiatric disorders which constitute one of the central goals of the overall project.
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Collins MS, Edwards A, Roby RE, Mehton NS, Ladehoff D. Pseudomonas immune globulin therapy improves survival in experimental Pseudomonas aeruginosa bacteremic pneumonia. ANTIBIOTICS AND CHEMOTHERAPY 2015; 42:184-92. [PMID: 2596836 DOI: 10.1159/000417619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Koti M, Siu A, Clément I, Bidarimath M, Turashvili G, Edwards A, Rahimi K, Mes-Masson AM, Masson AMM, Squire JA. A distinct pre-existing inflammatory tumour microenvironment is associated with chemotherapy resistance in high-grade serous epithelial ovarian cancer. Br J Cancer 2015; 112:1215-22. [PMID: 25826225 PMCID: PMC4385963 DOI: 10.1038/bjc.2015.81] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/23/2015] [Accepted: 01/29/2015] [Indexed: 12/15/2022] Open
Abstract
Background: Chemotherapy resistance is a major determinant of poor overall survival rates in high-grade serous ovarian cancer (HGSC). We have previously shown that gene expression alterations affecting the NF-κB pathway characterise chemotherapy resistance in HGSC, suggesting that the regulation of an immune response may be associated with this phenotype. Methods: Given that intrinsic drug resistance pre-exists and is governed by both tumour and host factors, the current study was performed to examine the cross-talk between tumour inflammatory microenvironment and cancer cells, and their roles in mediating differential chemotherapy response in HGSC patients. Expression profiling of a panel of 184 inflammation-related genes was performed in 15 chemoresistant and 19 chemosensitive HGSC tumours using the NanoString nCounter platform. Results: A total of 11 significantly differentially expressed genes were found to distinguish the two groups. As STAT1 was the most significantly differentially expressed gene (P=0.003), we validated the expression of STAT1 protein by immunohistochemistry using an independent cohort of 183 (52 resistant and 131 sensitive) HGSC cases on a primary tumour tissue microarray. Relative expression levels were subjected to Kaplan–Meier survival analysis and Cox proportional hazard regression models. Conclusions: This study confirms that higher STAT1 expression is significantly associated with increased progression-free survival and that this protein together with other mediators of tumour–host microenvironment can be applied as a novel response predictive biomarker in HGSC. Furthermore, an overall underactive immune microenvironment suggests that the pre-existing state of the tumour immune microenvironment could determine response to chemotherapy in HGSC.
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Rees P, Edwards A, Powell C, Panesar S, Evans H, Carter B, Williams H, Hibbert P, Luff D, Parry G, Carson-Stevens A. Identifying drivers for improvement using a mixed methods analysis of
pediatric vaccine-related safety incidents from England and Wales
(2003-2013). Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kaushal R, Edwards A, Kern LM. Association between electronic health records and health care utilization. Appl Clin Inform 2015; 6:42-55. [PMID: 25848412 DOI: 10.4338/aci-2014-10-ra-0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/22/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited. OBJECTIVE To determine any association between EHRs and health care utilization. METHODS We conducted a cohort study (2008-2009) in the Hudson Valley, a multi-payer, multiprovider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics. RESULTS Approximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions. CONCLUSIONS Patients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs.
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Peters K, Reardon D, Randazzo D, Dutton S, Edwards A, Lipp E, Herndon J, McSherry F, Desjardins A, Ranjan T, Vlahovic G, Friedman H. AT-46 * VORINOSTAT AND BEVACIZUMAB FOR RECURRENT HIGH-GRADE GLIOMA: INTERIM ANALYSIS OF A PHASE II CLINICAL TRIAL. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou237.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Edwards A, Williams H, Anderson H. Translation And Cultural Adaptation Difficulties Encountered During Linguistic Validation Of The Bristol Stool Scale. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A369. [PMID: 27200781 DOI: 10.1016/j.jval.2014.08.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Lecky F, Woodford M, Edwards A, Bouamra O, Coats T. Trauma scoring systems and databases. Br J Anaesth 2014; 113:286-94. [DOI: 10.1093/bja/aeu242] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Beachler TM, Bailey CS, McKelvey KA, Davis JL, Edwards A, Diaw M, Vasgaard JM, Whitacre MD. Haemoperitoneum in a pregnant mare with an ovarian haematoma. EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Anstey A, Edwards A. Shared decision making in dermatology: asking patients, ‘What is important to you?’. Br J Dermatol 2014; 170:759-60. [DOI: 10.1111/bjd.12984] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Berthon B, Marshall C, Edwards A, Evans M, Spezi E. Influence of cold walls on PET image quantification and volume segmentation: a phantom study. Med Phys 2014; 40:082505. [PMID: 23927350 DOI: 10.1118/1.4813302] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Commercially available fillable plastic inserts used in positron emission tomography phantoms usually have thick plastic walls, separating their content from the background activity. These "cold" walls can modify the intensity values of neighboring active regions due to the partial volume effect, resulting in errors in the estimation of standardized uptake values. Numerous papers suggest that this is an issue for phantom work simulating tumor tissue, quality control, and calibration work. This study aims to investigate the influence of the cold plastic wall thickness on the quantification of 18F-fluorodeoxyglucose on the image activity recovery and on the performance of advanced automatic segmentation algorithms for the delineation of active regions delimited by plastic walls. METHODS A commercial set of six spheres of different diameters was replicated using a manufacturing technique which achieves a reduction in plastic walls thickness of up to 90%, while keeping the same internal volume. Both sets of thin- and thick-wall inserts were imaged simultaneously in a custom phantom for six different tumor-to-background ratios. Intensity values were compared in terms of mean and maximum standardized uptake values (SUVs) in the spheres and mean SUV of the hottest 1 ml region (SUVmax, SUVmean, and SUVpeak). The recovery coefficient (RC) was also derived for each sphere. The results were compared against the values predicted by a theoretical model of the PET-intensity profiles for the same tumor-to-background ratios (TBRs), sphere sizes, and wall thicknesses. In addition, ten automatic segmentation methods, written in house, were applied to both thin- and thick-wall inserts. The contours obtained were compared to computed tomography derived gold standard ("ground truth"), using five different accuracy metrics. RESULTS The authors' results showed that thin-wall inserts achieved significantly higher SUVmean, SUVmax, and RC values (up to 25%, 16%, and 25% higher, respectively) compared to thick-wall inserts, which was in agreement with the theory. This effect decreased with increasing sphere size and TBR, and resulted in substantial (>5%) differences between thin- and thick-wall inserts for spheres up to 30 mm diameter and TBR up to 4. Thinner plastic walls were also shown to significantly improve the delineation accuracy for the majority of the segmentation methods tested, by increasing the proportion of lesion voxels detected, although the errors in image quantification remained non-negligible. CONCLUSIONS This study quantified the significant effect of a 90% reduction in the thickness of insert walls on SUV quantification and PET-based boundary detection. Mean SUVs inside the inserts and recovery coefficients were particularly affected by the presence of thick cold walls, as predicted by a theoretical approach. The accuracy of some delineation algorithms was also significantly improved by the introduction of thin wall inserts instead of thick wall inserts. This study demonstrates the risk of errors deriving from the use of cold wall inserts to assess and compare the performance of PET segmentation methods.
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Woodford M, Lawrence T, Bouamra O, Edwards A, Lecky F. Major trauma audit: Metrics for improving care. Afr J Emerg Med 2013. [DOI: 10.1016/j.afjem.2013.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Pronovost PJ, Demski R, Callender T, Winner L, Miller MR, Austin JM, Berenholtz SM, Abundo C, Allen S, Applestein M, Atha W, Baca K, Baker D, Baxter J, Bessman E, Brinkman M, Brown J, Brown T, Bryant B, Carmody B, Carroll K, Carver B, Castellani J, Choi YH, Clarke C, Coker M, Cuccia M, Dalgetty R, Day R, DelRosario A, Deruggiero K, Duda D, Dudas R, Dunn J, Duquaine D, Dwyer J, Edwards A, Flowers D, Garger C, Goldsborough K, Groman S, Guzman F, Hack L, Hackett M, Hagan L, Haynos J, Heck E, Heitmiller G, Hill P, Hoffman A, Horvath K, Jensen R, Johnson P, Jonas I, Kelly K, Kemmerer T, Khan S, Landrum M, Leonard B, Lieberman K, Lobien J, Maritim C, Markovich G, Marquis B, McClammer B, McDonough D, McGuiness B, McIntyre J, McQuigg D, Means M, Michaels K, Miller J, Minor V, Morton R, Moyer J, Nimako H, Owens S, Park E, Peck J, Petrucci P, Petty B, Post M, Rasmussen S, Raynor J, Renjel J, Resar J, Rossi S, Rotello L, Russell S, Saheed M, Schultz J, Schwartz P, Servis K, Shrout A, Sidone L, Smith N, Smith R, Smith T, Martin ES, Taffe E, Thomas C, Tolson T, Trost J, Walters C, Ware C, Wessels R, Whitman G, Wyman C. Demonstrating High Reliability on Accountability Measures at The Johns Hopkins Hospital. Jt Comm J Qual Patient Saf 2013; 39:531-44. [DOI: 10.1016/s1553-7250(13)39069-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Healy K, Peterson T, Rogers J, Edwards A. Comparison of Sealants’ Ease of Use for Dental Fractures in the Emergency Department. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lokey B, Peterson T, Rogers J, Edwards A. Does Simulation Improve Resident Confidence in Treating Dental Fractures? Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Edwards A, Springett A, Padfield J, Dorling J, Bugg G, Mansell P. Differences in post-mortem findings after stillbirth in women with and without diabetes. Diabet Med 2013; 30:1219-24. [PMID: 23815606 DOI: 10.1111/dme.12272] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 05/20/2013] [Accepted: 06/26/2013] [Indexed: 11/27/2022]
Abstract
AIMS The reason for the fivefold increased risk of stillbirth in women with diabetes is not known. Further understanding of the underlying mechanisms may facilitate identification of pregnancies at increased risk. We have compared post-mortem reports in matched pairs of stillbirths in women with and without diabetes. METHODS Post-mortem reports were provided by the Centre for Maternal and Child Enquiries. Stillbirths as a result of lethal congenital and genetic abnormalities were excluded. Whole body, placenta and organ weights and histo-pathological findings in cases and controls were compared and also related to published reference values. RESULTS We analysed post-mortem reports on 23 matched pairs of stillbirths from 2009 to 2010. Mean placental weight in women with diabetes was 75 g less than in control subjects (95% CI -143 to -7 g; P = 0.032). In maternal diabetes, the thymus was often small and showed a 'starry sky' pattern on histology in 11 of 20 cases compared with four of 22 controls (P = 0.03). This histological finding was associated with a particularly low mean placental weight z-score -2.1 (1.1) standard deviations below a reference population corrected for gestational age. CONCLUSIONS In over half of the stillbirths occurring in women with diabetes, there was a 'starry sky' appearance in the fetal thymus on histology, this being associated with a small placenta. These findings are consistent with a critical subacute metabolic disturbance being a prominent cause of the increased risk of stillbirth in pregnancies complicated by maternal diabetes.
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Reiser I, Edwards A, Nishikawa RM. Validation of a power-law noise model for simulating small-scale breast tissue. Phys Med Biol 2013; 58:6011-27. [PMID: 23938858 DOI: 10.1088/0031-9155/58/17/6011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We have validated a small-scale breast tissue model based on power-law noise. A set of 110 patient images served as truth. The statistical model parameters were determined by matching the radially averaged power-spectrum of the projected simulated tissue with that of the central tomosynthesis patient breast projections. Observer performance in a signal-known exactly detection task in simulated and actual breast backgrounds was compared. Observers included human readers, a pre-whitening observer model and a channelized Hotelling observer model. For all observers, good agreement between performance in the simulated and actual backgrounds was found, both in the tomosynthesis central projections and the reconstructed images. This tissue model can be used for breast x-ray imaging system optimization. The complete statistical description of the model is provided.
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Kendler KS, Gardner CO, Edwards A, Hickman M, Heron J, Macleod J, Lewis G, Dick DM. Dimensions of parental alcohol use/problems and offspring temperament, externalizing behaviors, and alcohol use/problems. Alcohol Clin Exp Res 2013; 37:2118-27. [PMID: 23895510 DOI: 10.1111/acer.12196] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 04/16/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol consumption (AC) and alcohol problems (AP) are complex traits. How many factors reflecting parental AC and AP are present in the large prospectively followed Avon Longitudinal Study of Parents and Children cohort? Would these factors be uniquely associated with various temperamental and alcohol-related outcomes in the children? METHODS We factor-analyzed multiple items reflecting maternal and paternal AC and AP measured over a 12-year period from before the birth of the child (n = 14,093 families). We examined, by linear regression controlling for socioeconomic status, the relationship between scales derived from these factors and offspring early childhood temperament, externalizing traits, and adolescent AC and AP (ns ranging from 9,732 to 3,454). RESULTS We identified 5 coherent factors: typical maternal AC, maternal AC during pregnancy, maternal AP, paternal AC, and paternal AP. In univariate analyses, maternal and paternal AC and AP were modestly and significantly associated with low shyness, sociability, hyperactivity, and conduct problems in childhood and early adolescence; delinquent behavior at age 15; and AC and AP at ages 15 and 18. AC and AP at age 18 were more strongly predicted by parental factors than at age 15. Maternal AC during pregnancy uniquely predicted externalizing traits at ages 4, 13, and 15. CONCLUSIONS Parental AC and AP are complex multidimensional traits that differ in their association with a range of relevant measures in their children. Controlling for background AC and AP, self-reported levels of maternal AC during pregnancy uniquely predicted externalizing behaviors in childhood and adolescence.
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DeSimone C, Elder J, Edwards A, Slone S, Feddock J, Miller R, Baldwin L, van Nagell J, Ueland F. Endometrial cancer lesion size is predictive of disease recurrence and long-term survival. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Brownsberger J, Edwards A, Crowther R, Cottrell D. Impact of Mental Fatigue on Self-paced Exercise. Int J Sports Med 2013; 34:1029-36. [DOI: 10.1055/s-0033-1343402] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Maharaj R, Alexander C, Bridglal CH, Edwards A, Mohammed H, Rampaul T, Sanchez S, Tanwing G, Thomas K. Somatoform disorders among patients attending walk-in clinics in Trinidad: prevalence and association with depression and anxiety. MENTAL HEALTH IN FAMILY MEDICINE 2013; 10:81-88. [PMID: 24427174 PMCID: PMC3822639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 06/20/2013] [Indexed: 06/03/2023]
Abstract
Objectives Somatoform disorders are common in international primary care settings, but have been little studied in the developing world. The objective of this study was to determine the prevalence of severe undifferentiated somatoform disorder, and its relationship to depression and anxiety, among patients attending walk-in clinics in Trinidad. Methods The study participants, who were all aged 18 years or older and attending walk-in clinics at 16 randomly selected health centres, were surveyed between May and August 2007 using the PRIME-MD questionnaire. Results There were 594 participants (the response rate was 92%), of whom 72.7% were female. Their ages ranged from 18 to 93 years, and 54.5% were over 50 years of age. In total, 37.2% were married and 25.9% were single. Indo-Trinidadians represented 43.1% and Afro-Trinidadians represented 36% of the study sample; 56.5% of the participants reported that their income was less than US$ 400 per month, and 65.7% were unemployed. At walk-in clinics in Trinidad, the estimated prevalence of severe undifferentiated somatoform disorder was 10.3% (95% CI: 7.86-12.74), that of hypochondriasis was 28.5% (95% CI: 24.9-32.1), and that of body dysmorphic disorder was 15.8% (95% CI: 11.9-18.7). Severe undifferentiated somatoform disorder was statistically significantly associated with gender and ethnicity but not with age, level of education, employment status or income. Chi-square testing found significant associations between the presence of severe undifferentiated somatoform disorder and both depression and anxiety (P < 0.05), between hypochondriasis and both anxiety and depression (P < 0.05), and between body dysmorphic disorder and depression (P < 0.05) but not anxiety. Regression analysis suggested that the demographic features that predicted severe undifferentiated somatoform disorder were being female or Indo-Trinidadian. Conclusions Walk-in clinics in Trinidad that serve older patients on a lower income have a high proportion of patients with somatoform disorders as measured by the PRIME-MD scale. These patients exhibit many features of anxiety and depression. These findings have implications for medical training and service delivery.
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Ancker JS, Singh MP, Thomas R, Edwards A, Snyder A, Kashyap A, Kaushal R. Predictors of success for electronic health record implementation in small physician practices. Appl Clin Inform 2013; 4:12-24. [PMID: 23650484 DOI: 10.4338/aci-2012-09-ra-0033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 12/19/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. OBJECTIVES Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. METHODS This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. RESULTS Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 - 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. CONCLUSIONS A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them.
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Hodgekiss C, Edwards A, Clifton IJ. P232 Communication and End of Life Care (EoLC) in People with Respiratory Disease. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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