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Ho TF, Zenger B, Mark B, Hiatt L, Sullivan E, Steinberg BA, Lyons A, Spivak AM, Agarwal C, Adelman M, Hotaling J, Kiraly B, Talboys S. Characteristics of a transgender and gender-diverse patient population in Utah: Use of electronic health records to advance clinical and health equity research. PLoS One 2024; 19:e0302895. [PMID: 38713697 DOI: 10.1371/journal.pone.0302895] [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] [Received: 12/19/2023] [Accepted: 04/15/2024] [Indexed: 05/09/2024] Open
Abstract
Transgender and gender-diverse (TGD) people, individuals whose gender identity differs from their sex assigned at birth, face unique challenges in accessing gender-affirming care and often experience disparities in a variety of health outcomes. Clinical research on TGD health is limited by a lack of standardization on how to best identify these individuals. The objective of this retrospective cohort analysis was to accurately identify and describe TGD adults and their use of gender-affirming care from 2003-2023 in a healthcare system in Utah, United States. International Classification of Disease (ICD)-9 and 10 codes and surgical procedure codes, along with sexual orientation and gender identity data were used to develop a dataset of 4,587 TGD adults. During this time frame, 2,985 adults received gender-affirming hormone therapy (GAHT) and/or gender-affirming surgery (GAS) within one healthcare system. There was no significant difference in race or ethnicity between TGD adults who received GAHT and/or GAS compared to TGD adults who did not receive such care. TGD adults who received GAHT and/or GAS were more likely to have commercial insurance coverage, and adults from rural communities were underrepresented. Patients seeking estradiol-based GAHT tended to be older than those seeking testosterone-based GAHT. The first GAS occurred in 2013, and uptake of GAS have doubled since 2018. This study provides a methodology to identify and examine TGD patients in other health systems and offers insights into emerging trends and access to gender-affirming care.
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Affiliation(s)
- Tiffany F Ho
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Brian Zenger
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Bayarmaa Mark
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Laurel Hiatt
- Department of Human Genetics, Us1niversity of Utah, Salt Lake City, Utah, United States of America
| | - Erika Sullivan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Benjamin A Steinberg
- Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Ann Lyons
- Data Science Services, University of Utah, Salt Lake City, Utah, United States of America
| | - Adam M Spivak
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Cori Agarwal
- Department of Surgery, Division of Plastic Surgery, University of Utah, Salt Lake City, Utah, United States of America
| | - Marisa Adelman
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, Utah, United States of America
| | - James Hotaling
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, United States of America
| | - Bernadette Kiraly
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Sharon Talboys
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
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Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
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Cooper T, Lyons A, Faber-Swensson A, Vestarkis L, Shakhovskoy R. Intracranial arachnoid cyst in pregnancy: case report, literature review and evaluation of neuraxial anaesthesia risk. Int J Obstet Anesth 2024; 57:103937. [PMID: 37919139 DOI: 10.1016/j.ijoa.2023.103937] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/03/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023]
Abstract
Choosing the type of intrapartum anaesthesia for pregnant women with intracranial arachnoid cysts can be challenging due to a lack of research. We report the intrapartum anaesthetic management of a 25-year-old woman with a known 10 cm arachnoid cyst. By means of a literature review and discussion of safety surrounding neuraxial techniques, this report will help to inform obstetric anaesthesia practice. Overall, in the absence of raised intracranial pressure, neuraxial analgesia and anaesthesia during the intrapartum period appears to be a safe option.
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Affiliation(s)
- T Cooper
- Sunshine Coast University Hospital, Queensland, Australia; Griffith University, Queensland, Australia; University of the Sunshine Coast, Sippy Downs and Griffith University, Queensland, Australia.
| | - A Lyons
- Sunshine Coast University Hospital, Queensland, Australia
| | - A Faber-Swensson
- Sunshine Coast University Hospital, Queensland, Australia; University of the Sunshine Coast, Sippy Downs and Griffith University, Queensland, Australia
| | - L Vestarkis
- Sunshine Coast University Hospital, Queensland, Australia
| | - R Shakhovskoy
- Sunshine Coast University Hospital, Queensland, Australia; Griffith University, Queensland, Australia; University of the Sunshine Coast, Sippy Downs and Griffith University, Queensland, Australia
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West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
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Bergquist JA, Zenger B, Brundage J, MacLeod RS, Bunch TJ, Shah R, Ye X, Lyons A, Ranjan R, Tasdizen T, Steinberg BA. Performance of Off-the-Shelf Machine Learning Architectures and Biases in Detection of Low Left Ventricular Ejection Fraction. medRxiv 2023:2023.06.10.23291237. [PMID: 37649910 PMCID: PMC10465010 DOI: 10.1101/2023.06.10.23291237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Artificial intelligence - machine learning (AI-ML) is a computational technique that has been demonstrated to be able to extract meaningful clinical information from diagnostic data that are not available using either human interpretation or more simple analysis methods. Recent developments have shown that AI-ML approaches applied to ECGs can accurately predict different patient characteristics and pathologies not detectable by expert physician readers. There is an extensive body of literature surrounding the use of AI-ML in other fields, which has given rise to an array of predefined open-source AI-ML architectures which can be translated to new problems in an "off-the-shelf" manner. Applying "off-the-shelf" AI-ML architectures to ECG-based datasets opens the door for rapid development and identification of previously unknown disease biomarkers. Despite the excellent opportunity, the ideal open-source AI-ML architecture for ECG related problems is not known. Furthermore, there has been limited investigation on how and when these AI-ML approaches fail and possible bias or disparities associated with particular network architectures. In this study, we aimed to: (1) determine if open-source, "off-the-shelf" AI-ML architectures could be trained to classify low LVEF from ECGs, (2) assess the accuracy of different AI-ML architectures compared to each other, and (3) to identify which, if any, patient characteristics are associated with poor AI-ML performance.
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Fitzpatrick P, Bhardwaj N, Masalkhi M, Lyons A, Frazer K, McCann A, Syed S, Niranjan V, Kelleher CC, Brennan S, Kavanagh P, Fox P. Provision of smoking cessation support for patients following a diagnosis of cancer in Ireland. Prev Med Rep 2023; 32:102158. [PMID: 36875512 PMCID: PMC9982599 DOI: 10.1016/j.pmedr.2023.102158] [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: 11/16/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
There is growing evidence that smoking cessation (SC) improves outcomes following diagnosis of cancer. Notwithstanding adverse outcomes, a significant number of those diagnosed with cancer continue to smoke. Our objective was to document the SC services provided for patients with cancer by specialist adult cancer hospitals across Ireland, a country with a stated tobacco endgame goal. A cross-sectional survey based on recent national clinical guidelines was used to determine SC care delivery across eight adult cancer specialist hospitals, and one specialist radiotherapy centre. Qualtrics was used. The response rate was 88.9% with data reported from seven cancer hospitals and one specialist radiotherapy centre, all indicating they had some SC related provision (100%). Stop smoking medications were provided to cancer inpatients in two hospitals, at outpatients and attending day ward services in one hospital. Smokers with cancer were referred automatically to the SC service in two hospitals at diagnosis. While stop smoking medications were available 24 h a day in five hospitals, most did not stock all three (Nicotine Replacement Therapy, Bupropion, Varenicline). One hospital advised they had data on uptake of SC services for smokers with cancer but were unable to provide detail. There is considerable variation in SC information and services provided to cancer patients across adult cancer specialist centres in Ireland, reflecting the suboptimal practice of smoking cessation for patients with cancer found in the limited international audits. Such audits are essential to demonstrate service gaps and provide a baseline for service improvement.
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Affiliation(s)
- P Fitzpatrick
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - N Bhardwaj
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - M Masalkhi
- School of Medicine, University College Dublin, Belfield Dublin 4, Ireland
| | - A Lyons
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland
| | - K Frazer
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield Dublin 4, Ireland
| | - A McCann
- School of Medicine, University College Dublin, Belfield Dublin 4, Ireland.,UCD Conway Institute of Biomolecular and Biomedical Research and UCD School of Medicine, Ireland
| | - S Syed
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland
| | - V Niranjan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - C C Kelleher
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland.,College of Health and Agricultural Science (CHAS), University College Dublin, Belfield Dublin 4, Ireland
| | - S Brennan
- St Luke's Hospital, Rathgar Dublin 6, Ireland
| | - P Kavanagh
- Health Service Executive Tobacco Free Ireland Programme, Strategy and Research, 4th Floor, Jervis House, Jervis Street, Dublin 1, D01 W596, Ireland
| | - P Fox
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield Dublin 4, Ireland
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Aliuddin F, Lyons A, O'Sullivan O, Kluzek S, Pearson R. Athlete's foot and associated risk factors: a cross-sectional mixed-methods study. BMJ Mil Health 2023:e002379. [PMID: 37001906 DOI: 10.1136/military-2023-002379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/02/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Fetty Aliuddin
- Academic Unit of Injury, Rehabilitation and Inflammation Science, University of Nottingham, Nottingham, UK
| | - A Lyons
- University of Oxford Medical Sciences Division, Oxford, UK
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - O O'Sullivan
- Academic Unit of Injury, Rehabilitation and Inflammation Science, University of Nottingham, Nottingham, UK
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, UK
| | - S Kluzek
- Academic Unit of Injury, Rehabilitation and Inflammation Science, University of Nottingham, Nottingham, UK
- Lady Margaret Hall, University of Oxford, Oxford, UK
| | - R Pearson
- Academic Unit of Injury, Rehabilitation and Inflammation Science, University of Nottingham, Nottingham, UK
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Parker J, Gupta S, Shenbagaraj L, Harborne P, Ramaraj R, Karandikar S, Mottershead M, Barbour J, Mohammed N, Lockett M, Lyons A, Vega R, Torkington J, Dolwani S. Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies-a multi-centre observational study. Int J Colorectal Dis 2023; 38:28. [PMID: 36735059 PMCID: PMC9898359 DOI: 10.1007/s00384-022-04299-0] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Team management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational study was to assess procedures and outcomes of patients managed using these approaches. METHOD This was a retrospective, observational study of patients managed by six UK sites. Information was collected regarding procedures and outcomes including length of stay, adverse events, readmissions and cancers. RESULTS Two thousand one hundred ninety-two complex polyps in 2109 patients were analysed with increasing referrals annually. Most presented symptomatically and the mean polyp size was 32.1 mm. Primary interventions included endoscopic therapy (75.6%), conservative management (8.3%), colonic resection (8.1%), trans-anal surgery (6.8%) or combined procedures (1.1%). The number of primary colonic resections decreased over the study period without a reciprocal increase in secondary procedures or recurrence. Secondary procedures were required in 7.8%. The median length of stay for endoscopic procedures was 0 days with 77.5% completed as day cases. Median length of stay was 5 days for colonic resections. Overall adverse event and 30-day readmission rates were 9.0% and 3.3% respectively. Malignancy was identified in 8.8%. Benign polyp recurrence occurred in 13.1% with a median follow up of 30.4 months. Screening detected lesions were more likely to undergo bowel resection. Colonic resection was associated with longer stays, higher adverse events and more cancers on final histology. CONCLUSION Multi-disciplinary team management of complex polyps is safe and effective. Standardisation of organisation and quality monitoring is needed to continue positive effects on outcomes and services.
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Affiliation(s)
- J. Parker
- School of Medicine and Cardiff and Vale University Health Board, Cardiff University, Cardiff, UK
| | - S. Gupta
- Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | | | - P. Harborne
- Cardiff and Vale University Health Board, Cardiff, UK
| | - R. Ramaraj
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S. Karandikar
- University Hospitals Birmingham Foundation NHS Trust, Birmingham, UK
| | - M. Mottershead
- University Hospitals Birmingham Foundation NHS Trust, Birmingham, UK
| | - J. Barbour
- Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - N. Mohammed
- Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | | | - A. Lyons
- North Bristol NHS Trust, Bristol, UK
| | - R. Vega
- University College London Hospitals NHS Foundation Trust, London, UK
| | - J. Torkington
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S. Dolwani
- School of Medicine and Cardiff and Vale University Health Board, Cardiff University, Cardiff, UK
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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10
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Fitzpatrick P, Bhardwaj N, Syed S, Fox P, Frazer K, Niranjan V, Lyons A, McCann A, Brennan S, Guerin S. Smoking cessation for cancer patients through the lens of cancer specialists: challenges & solutions. Eur J Public Health 2022. [PMCID: PMC9594757 DOI: 10.1093/eurpub/ckac131.017] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The benefits of smoking cessation (SC) for cancer patients are widely recognised. However, there has been a limited emphasis on SC in this context and it continues to be a challenge for cancer patients. As part of a larger feasibility study aiming to develop a structured SC pathway for cancer patients in Ireland, this qualitative study explored the SC practices, experiences and opinions of oncology healthcare professionals (HCPs). Methods Semi-structured interviews were conducted with 18 HCPs from lung, breast, cervical, head and neck and general oncology, across 4 specialist adult cancer hospitals in Ireland. Interview transcripts were analysed using thematic analysis. Results Four key themes emerged: (1) Frequently ask and advise but infrequently assist: most HCPs ask about smoking and many advise about available supports, but few refer patients to SC services. Where offered, referrals were to hospital SC services and/or nicotine replacement therapy was prescribed; no HCP prescribed varenicline or bupropion. Barriers included lack of time, ill-defined referral pathways and lack of knowledge. (2) Increased willingness but differing ability to quit: most patients were interested in quitting post diagnosis and had varying support needs, linked to cancer stage, social circumstances and stress levels. (3) Need for an integrated or parallel service: all HCPs suggested that a structured and defined referral pathway will facilitate SC. (4) Motivational counselling and pharmacotherapy combination: many HCPs suggested face to face as the best mode of intervention initially, with regular follow ups and ongoing support virtually, started pre-treatment, with an empathetic and empowering approach with provision of both motivational counselling and SC pharmacotherapy. Conclusions Smoking post cancer diagnosis has serious implications for cancer treatment and prognosis but is frequently overlooked. These findings will inform the design of a SC pathway for cancer patients. Key messages • Despite increased willingness to quit, there is inadequate and inconsistent SC support provision for cancer patients. • Tailored SC support should be an integral part of comprehensive cancer care.
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Affiliation(s)
- P Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - N Bhardwaj
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
| | - S Syed
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - P Fox
- School of Nursing, Midwifery & Health Systems, University College Dublin , Dublin, Ireland
| | - K Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin , Dublin, Ireland
| | - V Niranjan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
| | - A Lyons
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - A McCann
- Biomolecular & Biomedical Research Institute, University College Dublin , Dublin, Ireland
| | - S Brennan
- Department of Radiation Oncology, St. Luke’s Radiation Oncology Network , Dublin, Ireland
| | - S Guerin
- School of Psychology, University College Dublin , Dublin, Ireland
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11
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Brundage J, Barker S, Herrick J, Honholt T, Bress AP, Lyons A, Shah R. USING ANTICOAGULANT EXPOSURE TO MEASURE PRESCRIBING PATTERNS AND BLEEDING IN CANCER PATIENTS WITH ATRIAL FIBRILLATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02932-1] [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: 11/15/2022]
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12
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Baig M, Sayyed R, Fowler G, Lyons A, Sumrein H. Oncological outcomes and Quality of life in Locally Advanced and Recurrent Rectal cancer patients following Pelvic Exenteration. Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2021.12.128] [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] Open
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13
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Steinberg BA, Zhang M, Bensch J, Lyons A, Bunch TJ, Piccini JP, Siu A, Spertus JA, Stehlik J, Wohlfahrt P, Greene T, Hess R, Fang JC. Quantifying the Impact of Atrial Fibrillation on Heart Failure-Related Patient-Reported Outcomes in the Utah mEVAL Program. J Card Fail 2022; 28:13-20. [PMID: 34324927 PMCID: PMC8748275 DOI: 10.1016/j.cardfail.2021.07.009] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) frequently complicates heart failure (HF), and each is associated with lower overall health-related quality of life. We aimed to quantify the incremental burden of AF on the health-related quality of life of patients with HF in clinical practice. METHODS AND RESULTS We used data from the Utah mEVAL program to analyze patient-reported outcomes (PROs) among patients with HF with and without AF. The primary outcome was the HF-specific Kansas City Cardiomyopathy Questionnaire, with generic PROs as secondary outcomes. Among 1707 patients with HF, 36% had AF (n = 616). Those with HF and AF were older (mean age 69 years vs 58 years, P < .001), more likely to have prior stroke (29% vs 17%, P < .001) and ischemic cardiomyopathy (28% vs 23%, P = .01), but had similar ejection fractions (mean 44% each, P = .6). After adjustment, and compared with HF alone, HF with AF was associated with worse Kansas City Cardiomyopathy Questionnaire scores (adjusted mean difference -3.45, 95% confidence interval [CI] -6.24 to -0.65), and worse Patient-Reported Outcomes Measurement Information System physical function scores (adjusted mean difference -1.63, 95% CI -2.59 to -0.67). The difference in visual analog scale general health was borderline (adjusted mean difference -2.01, 95% CI -4.51 to 0.49), and Patient-Reported Outcomes Measurement Information System depression scores were similar (adjusted mean difference 0.54, 95% CI -0.48 to 1.57). CONCLUSIONS AF complicates nearly one-third of HF cases, and patients with HF and AF are substantially older and sicker. After adjustment, AF was independently associated with worse disease-specific and overall health-related quality of life than HF alone. Whether maintaining sinus rhythm can improve the HF-related health status of patients with HF in clinical practice should be explored further.
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Affiliation(s)
| | - Mingyuan Zhang
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jason Bensch
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Ann Lyons
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - T Jared Bunch
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jonathan P Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Alfonso Siu
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/UMKC, Kansas City MO
| | - Josef Stehlik
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Peter Wohlfahrt
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Tom Greene
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Rachel Hess
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - James C Fang
- University of Utah Health Sciences Center, Salt Lake City, Utah
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14
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Atkinson AM, Meadows BR, Emslie C, Lyons A, Sumnall HR. 'Pretty in Pink' and 'Girl Power': An analysis of the targeting and representation of women in alcohol brand marketing on Facebook and Instagram. Int J Drug Policy 2021; 101:103547. [PMID: 34906847 DOI: 10.1016/j.drugpo.2021.103547] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 08/18/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Alcohol marketing helps shape how gender roles and relations are understood, and the gendered nature of drinking learned. In recent years, changes in how women are presented and addressed in marketing, including alcohol marketing, have been observed. This reflects the shifting social, political and regulatory context, in which increased attention has been given to gender inequality and the damaging impact of gender stereotypes. Research is yet to explore the gendered nature of alcohol marketing within this contemporary context. METHODS A quantitative content and qualitative thematic analysis of alcohol marketing posts (N = 2600) by 20 alcohol brands on Facebook and Instagram pages over an 18 month period (1st January 2019-30th June 2020) was conducted. Marketing strategies were identified, and the way in which posts targeted, represented and engaged women analysed. FINDINGS New (e.g. 'influencer' collaborations) and established (e.g. competitions) strategies were being used to target both women and men. Drinking was presented as a feminine practice and as an important component of 'doing' a combination of traditional, post-feminist and feminist femininities. Women were assigned a range of gender roles that acknowledged their individual pleasures and achievements, and traditional gender roles and stereotypes were both reinforced and rejected to promote alcohol use. An important move away from sexualising and demeaning women to the appropriation of feminist and equality messages was observed, which may appeal to a wider range of women, including those embracing feminist identities. CONCLUSION Alcohol brand marketing encourages alcohol use to women through both perpetuating and challenging gender stereotypes. Claims by brands of a commitment to equality are at odds with the harms related to alcohol consumption that contribute to the widening of health and social inequalities. It is important that future work on women's drinking and alcohol marketing is situated within the shifting social-political climate in which traditional, post-feminist and new fourth wave feminist rhetoric and femininities co-exist.
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Affiliation(s)
- A M Atkinson
- Public Health Institute, Liverpool John Moores University UK.
| | - B R Meadows
- Public Health Institute, Liverpool John Moores University UK
| | - C Emslie
- Research Centre for Health, Glasgow Caledonian University UK
| | - A Lyons
- School of Health, Victoria University of Wellington New Zealand
| | - H R Sumnall
- Public Health Institute, Liverpool John Moores University UK
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15
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Bhardwaj N, Fox P, Frazer K, Lyons A, Doherty K, Fitzpatrick P. Has the national fall in smoking rate in Ireland been replicated in cancer patients? a 5-year report. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.232] [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
Background
Population smoking rates are falling in Ireland, however many cancer patients continue smoking post diagnosis, despite its association with poorer treatment and clinical outcomes. As part of a feasibility study of smoking cessation for cancer patients in Ireland, a review of smoking rates in cancer patients was undertaken.
Methods
The Hospital Inpatient Enquiry system (HIPE), a national database which collects administrative, demographic & clinical data on discharges from public hospitals in Ireland, provided data (2014-2018) on smoking status of adult discharges with a cancer diagnosis (overall, breast, lung, cervical and head & neck (H&N). Smoking trends were compared with Healthy Ireland data (2015-2018), from a national survey for adults on health & wellbeing.
Results
During 2014-18, current smoking rose for all cancers (10.5%-11.4%), cervical cancer (11%-19.8%) and initially (2014-2016) for H&N (3%-12.7%) and lung (24.7%-27.2%), which dropped to 7.6% and 24% respectively in 2018; breast was stable at 6 ± 0.6%. Rates are lower than the general population (23%-20%). During 2014-17, past smoking rates demonstrated an upward trend among all cancers and specific cancers, with the highest prevalence among lung (30.3-39%) and lowest among breast (7.3-11%); comparative general population data was 23-28%. Current smoking rates for all cancers were highest among 50-59-year-olds (14-16%), which contrasts with the general population (24-35 years at 32-28%). Current and past smoking rates for all cancers were consistently higher among males, similar to the general population.
Conclusions
HIPE data is limited by duplicate episodes of care, and it is recognised that smoking documentation may be an underestimate. However, it is useful to analyse trends, as these limitations should be stable over the 5-year study period. Rates remain high; our further research will document barriers and facilitators to smoking cessation among cancer patients.
Key messages
Smoking rates in cancer patients are high despite proven benefits of smoking cessation. Supportive smoking cessation services as part of routine cancer care are indicated.
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Affiliation(s)
- N Bhardwaj
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - P Fox
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - K Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - A Lyons
- Department of Preventive Medicine & Health Promotion, St Vincent's University Hospital, Dublin, Ireland
| | - K Doherty
- Department of Preventive Medicine & Health Promotion, St Vincent's University Hospital, Dublin, Ireland
| | - P Fitzpatrick
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
- Department of Preventive Medicine & Health Promotion, St Vincent's University Hospital, Dublin, Ireland
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16
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Browning N, Okocha M, Doe M, Lyons A, Sumrien H. 1431 Stoma Intubation, Isolation and Negative Pressure Wound Therapy for Complex Stoma-Associated Wounds: New Technique and Case Series. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.377] [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]
Abstract
Abstract
Background
The use of negative pressure wound therapy (NPWT) in colorectal surgery has been demonstrated for treating perineal defects, enterocutaneous fistula and stoma dehiscence. Here we describe a technique for closure of complex stoma-associated wounds using a novel commercial intubation device alongside NPWT to protect the surrounding wound from the stoma effluent. The device has previously described for use with enterocutaneous fistula. We present two cases that have been successfully treated with this technique.
Technique and Cases
The first case is of 88-year-old women with a retracted loop ileostomy and the second a 48 year-old male with a retracted end colostomy. Both patients underwent significant emergency peristomal debridement and in both cases the commercial device was deployed to intubate the stoma. VAC foam and standard adhesive dressings were used to form a quality seal and the pressure set to 125mmHg. In both cases near complete healing was achieved to the point that standard stoma bags and management could be used.
Conclusions
This is the first description of the use of an isolation device in complex stoma associated wounds. We have found the Fistula Funnel to be highly effective in this context.
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Affiliation(s)
- N Browning
- Southmead Hospital, Bristol, United Kingdom
| | - M Okocha
- Southmead Hospital, Bristol, United Kingdom
| | - M Doe
- Southmead Hospital, Bristol, United Kingdom
| | - A Lyons
- Southmead Hospital, Bristol, United Kingdom
| | - H Sumrien
- Southmead Hsopital, Bristol, United Kingdom
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17
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Steinberg BA, Turner J, Lyons A, Biber J, Chelu MG, Fang JC, Freedman RA, Han FT, Hardisty B, Marrouche NF, Ranjan R, Shah RU, Spertus JA, Stehlik J, Zenger B, Piccini JP, Hess R. Systematic collection of patient-reported outcomes in atrial fibrillation: feasibility and initial results of the Utah mEVAL AF programme. Europace 2021; 22:368-374. [PMID: 31702780 DOI: 10.1093/europace/euz293] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/19/2019] [Accepted: 10/02/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Incorporating patient-reported outcomes (PROs) into routine care of atrial fibrillation (AF) enables direct integration of symptoms, function, and health-related quality of life (HRQoL) into practice. We report our initial experience with a system-wide PRO initiative among AF patients. METHODS AND RESULTS All patients with AF in our practice undergo PRO assessment with the Toronto AF Severity Scale (AFSS), and generic PROs, prior to electrophysiology clinic visits. We describe the implementation, feasibility, and results of clinic-based, electronic AF PRO collection, and compare AF-specific and generic HRQoL assessments. From October 2016 to February 2019, 1586 unique AF patients initiated 2379 PRO assessments, 2145 of which had all PRO measures completed (90%). The median completion time for all PRO measures per visit was 7.3 min (1st, 3rd quartiles: 6, 10). Overall, 38% of patients were female (n = 589), mean age was 68 (SD 12) years, and mean CHA2DS2-VASc score was 3.8 (SD 2.0). The mean AFSS symptom score was 8.6 (SD 6.6, 1st, 3rd quartiles: 3, 13), and the full range of values was observed (0, 35). Generic PROs of physical function, general health, and depression were impacted at the most severe quartiles of AF symptom score (P < 0.0001 for each vs. AFSS quartile). CONCLUSION Routine clinic-based, PRO collection for AF is feasible in clinical practice and patient time investment was acceptable. Disease-specific AF PROs add value to generic HRQoL instruments. Further research into the relationship between PROs, heart rhythm, and AF burden, as well as PRO-guided management, is necessary to optimize PRO utilization.
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Affiliation(s)
- Benjamin A Steinberg
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Jeffrey Turner
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Ann Lyons
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Joshua Biber
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Mihail G Chelu
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - James C Fang
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Roger A Freedman
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Frederick T Han
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Benjamin Hardisty
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Nassir F Marrouche
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Ravi Ranjan
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Rashmee U Shah
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | | | - Josef Stehlik
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Brian Zenger
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | | | - Rachel Hess
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
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18
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Aleri JW, Lyons A, Laurence M, Coiacetto F, Fisher AD, Stevenson MA, Irons PC, Robertson ID. A descriptive retrospective study on mortality and involuntary culling in beef and dairy cattle production systems of Western Australia (1981-2018). Aust Vet J 2021; 99:395-401. [PMID: 34169510 DOI: 10.1111/avj.13096] [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: 01/10/2021] [Revised: 05/15/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022]
Abstract
Identifying and quantifying the relative frequency of involuntary losses is an essential first step in developing fit-for-purpose herd health programmes. The objective of this study was to provide an estimate of the relative frequency of reasons for mortality among south-west Western Australian beef and dairy cattle, based on necropsy findings from a university-based veterinary pathology referral centre over 38 years. A total of 904 cattle were submitted for postmortem examination throughout the study period. Gastrointestinal, cardiopulmonary and reproductive conditions were the most common causes of mortality in cattle submitted for necropsy at Murdoch University for the period 1981-2018. In dairy cattle, the common problems were gastrointestinal (bloat, abomasal displacements) 18% (59/320), cardiovascular (traumatic reticulo-pericarditis) 9% (30/320) and respiratory conditions (pneumonia) 8% (27/320). In beef cattle, the most common conditions were gastrointestinal (bloat, rumen acidosis) 11% (39/358), reproductive (metritis) 11% (38/358), cardiovascular (traumatic reticulo-pericarditis) 7% (25/358), respiratory (pneumonia) 7% (24/358), lameness (fractures) 6%, (21/358) and hepatobiliary conditions (blue-green algae poisoning, hepatotoxicity) 6% (21/358). Selection bias and missing data were potential confounders in this study. Although necropsy investigations provide useful information on animal mortalities and avenues for future herd health programmes, there is a need to standardise data capture methods and disease definition criteria, and conduct more detailed recording of data both at the farm level and at necropsy diagnostic centres.
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Affiliation(s)
- J W Aleri
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia.,Centre for Animal Production and Health, Future Foods Institute, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia
| | - A Lyons
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia
| | - M Laurence
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia
| | - F Coiacetto
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia
| | - A D Fisher
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia.,Animal Welfare Science Centre, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - M A Stevenson
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia
| | - P C Irons
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia
| | - I D Robertson
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
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19
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Callenberg C, Lyons A, Brok DD, Fatima A, Turpin A, Zickus V, Machesky L, Whitelaw J, Faccio D, Hullin MB. Super-resolution time-resolved imaging using computational sensor fusion. Sci Rep 2021; 11:1689. [PMID: 33462284 PMCID: PMC7813875 DOI: 10.1038/s41598-021-81159-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022] Open
Abstract
Imaging across both the full transverse spatial and temporal dimensions of a scene with high precision in all three coordinates is key to applications ranging from LIDAR to fluorescence lifetime imaging. However, compromises that sacrifice, for example, spatial resolution at the expense of temporal resolution are often required, in particular when the full 3-dimensional data cube is required in short acquisition times. We introduce a sensor fusion approach that combines data having low-spatial resolution but high temporal precision gathered with a single-photon-avalanche-diode (SPAD) array with data that has high spatial but no temporal resolution, such as that acquired with a standard CMOS camera. Our method, based on blurring the image on the SPAD array and computational sensor fusion, reconstructs time-resolved images at significantly higher spatial resolution than the SPAD input, upsampling numerical data by a factor \documentclass[12pt]{minimal}
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\begin{document}$$4 \times 4$$\end{document}4×4 upsampling of experimental data. We demonstrate the technique for both LIDAR applications and FLIM of fluorescent cancer cells. This technique paves the way to high spatial resolution SPAD imaging or, equivalently, FLIM imaging with conventional microscopes at frame rates accelerated by more than an order of magnitude.
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Affiliation(s)
- C Callenberg
- Institute of Computer Science, University of Bonn, Bonn, Germany
| | - A Lyons
- School of Physics & Astronomy, University of Glasgow, Glasgow, G12 8QQ, United Kingdom.
| | - D den Brok
- Institute of Computer Science, University of Bonn, Bonn, Germany
| | - A Fatima
- School of Physics & Astronomy, University of Glasgow, Glasgow, G12 8QQ, United Kingdom
| | - A Turpin
- School of Computing Science, University of Glasgow, G12 8LT, Glasgow, United Kingdom
| | - V Zickus
- School of Physics & Astronomy, University of Glasgow, Glasgow, G12 8QQ, United Kingdom
| | - L Machesky
- Cancer Research UK, Beatson Institute, Glasgow, United Kingdom
| | - J Whitelaw
- Cancer Research UK, Beatson Institute, Glasgow, United Kingdom
| | - D Faccio
- School of Physics & Astronomy, University of Glasgow, Glasgow, G12 8QQ, United Kingdom.
| | - M B Hullin
- Institute of Computer Science, University of Bonn, Bonn, Germany.
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20
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Kirk R, Ratcliffe A, Noonan G, Uosis-Martin M, Lyth D, Bardell-Cox O, Massam J, Schofield P, Lyons A, Clare D, Maclean J, Smith A, Savage V, Mohmed S, Charrier C, Salisbury AM, Moyo E, Ooi N, Chalam-Judge N, Cheung J, Stokes NR, Best S, Craighead M, Armer R, Huxley A. Rational design, synthesis and testing of novel tricyclic topoisomerase inhibitors for the treatment of bacterial infections part 2. RSC Med Chem 2020; 11:1379-1385. [PMID: 34095845 PMCID: PMC8126889 DOI: 10.1039/d0md00175a] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/07/2020] [Indexed: 11/21/2022] Open
Abstract
Building on our previously-reported novel tricyclic topoisomerase inhibitors (NTTIs), we disclose the discovery of REDX07965, which has an MIC90 of 0.5 μg mL-1 against Staphylococcus aureus, favourable in vitro pharmacokinetic properties, selectivity versus human topoisomerase II and an acceptable toxicity profile. The results herein validate a rational design approach to address the urgent unmet medical need for novel antibiotics.
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Affiliation(s)
- R Kirk
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - A Ratcliffe
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - G Noonan
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - M Uosis-Martin
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - D Lyth
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - O Bardell-Cox
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - J Massam
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - P Schofield
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - A Lyons
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - D Clare
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - J Maclean
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - A Smith
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - V Savage
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - S Mohmed
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - C Charrier
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - A-M Salisbury
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - E Moyo
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - N Ooi
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - N Chalam-Judge
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - J Cheung
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - N R Stokes
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - S Best
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - M Craighead
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - R Armer
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - A Huxley
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
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21
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Vallejo-Vaz A, Dharmayat K, Stevens C, Lyons A, Brandts J, Catapano A, Freiberger T, Hovingh K, Kastelein J, Mata P, Raal F, Santos R, Soran H, Watts G, Ray K. Characteristics of adults with heterozygous familial hypercholesterolaemia stratified by gender: Preliminary analysis from the EAS FHSC global registry on over 36,000 cases of familial hypercholesterolaemia. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Dharmayat K, Stevens C, Lyons A, Catapano A, Freiberger T, Hovingh K, Kastelein J, Mata P, Raal F, Santos R, Soran H, Watts G, Ray K, Vallejo-Vaz A, Behalf Of The Fhsc XO. Heterozygous familial hypercholesterolaemia in children: Preliminary analysis from the EAS FHSC global registry on over 7,900 children with familial hypercholesterolaemia. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.236] [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: 11/29/2022]
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23
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Zenger B, Zhang M, Lyons A, Bunch TJ, Fang JC, Freedman RA, Navaravong L, Piccini JP, Ranjan R, Spertus JA, Stehlik J, Turner JL, Greene T, Hess R, Steinberg BA. Patient-reported outcomes and subsequent management in atrial fibrillation clinical practice: Results from the Utah mEVAL AF program. J Cardiovasc Electrophysiol 2020; 31:3187-3195. [PMID: 33124710 DOI: 10.1111/jce.14795] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) significantly reduces health-related quality of life (HRQoL), previously measured in clinical trials using patient-reported outcomes (PROs). We examined AF PROs in clinical practice and their association with subsequent clinical management. METHODS The Utah My Evaluation (mEVAL) program collects the Toronto AF Symptom Severity Scale (AFSS) in AF outpatients at the University of Utah. Baseline factors associated with worse AF symptom score (range 0-35, higher is worse) were identified in univariate and multivariable analyses. Secondary outcomes included AF burden and AF healthcare utilization. We also compared subsequent clinical management at 6 months between patients with better versus worse AF HRQoL. RESULTS Overall, 1338 patients completed the AFSS symptom score, which varied by sex (mean 7.26 for males vs. 10.27 for females; p < .001), age (<65, 9.73; 65-74, 7.66; ≥75, 7.58; p < .001), heart failure (9.39 with HF vs. 7.67 without; p < .001), and prior ablation (7.28 with prior ablation vs. 8.84; p < .001). In multivariable analysis, younger age (mean difference 2.92 for <65 vs. ≥75; p < .001), female sex (mean difference 2.57; p < .001), pulmonary disease (mean difference 1.88; p < .001), and depression (mean difference 2.46; p < .001) were associated with higher scores. At 6-months, worse baseline symptom score was associated with the use of rhythm control (37.1% vs. 24.5%; p < .001). Similar cofactors and results were associated with increased AF burden and health care utilization scores. CONCLUSIONS AF PROs in clinical practice identify highly-symptomatic patients, corroborating findings in more controlled, clinical trials. Increased AFSS score correlates with more aggressive clinical management, supporting the utility of disease-specific PROs guiding clinical practice.
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Affiliation(s)
- Brian Zenger
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Mingyuan Zhang
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Ann Lyons
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - T Jared Bunch
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - James C Fang
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Roger A Freedman
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | - Jonathan P Piccini
- Department of Internal Medicine, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Ravi Ranjan
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - John A Spertus
- Department of Internal Medicine, Mid America Heart Institute, Kansas City, Missouri, USA
| | - Josef Stehlik
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Jeffrey L Turner
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Tom Greene
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Rachel Hess
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Benjamin A Steinberg
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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24
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Sambasivan K, Michaelidou A, Ross G, Oakley R, Lyons A, Cascarini L, Fry A, Jeannon J, Ferreira MR, Lei M, Urbano TG. PO-0800: Outcomes of patients with locally advanced oral cavity SCC treated radically at Guys' Cancer Centre. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00817-3] [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: 11/27/2022]
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25
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Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham‐Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin KK, Aziz O, Baker RP, Bali M, Baseckas G, Bebington B, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Boyle K, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo‐Marulanda A, Chan KKL, Chang GJ, Chew MH, Chong PC, Christensen HK, Clouston H, Codd M, Collins D, Colquhoun A, Corr A, Coscia M, Coyne PE, Creavin B, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Enrique‐Navascues JM, Espin‐Basany E, Evans MD, Fearnhead NS, Flatmark K, Fleming F, Frizelle FA, Gallego MA, Garcia‐Granero E, Garcia‐Sabrido JL, Gentilini L, George ML, Ghouti L, Giner F, Ginther N, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Jenkins JT, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kristensen HØ, Kroon HM, Kusters M, Lago V, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Lydrup ML, Lyons A, Lynch AC, Mantyh C, Mathis KL, Margues CFS, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McArthur DR, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Morton JR, Mullaney TG, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, O’Dwyer ST, Palmer G, Pappou E, Park J, Patsouras D, Pellino G, Peterson AC, Poggioli G, Proud D, Quinn M, Quyn A, Radwan RW, van Ramshorst GH, Rasheed S, Rasmussen PC, Regenbogen SE, Renehan A, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Ryan ÉJ, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu V, Selvasekar C, Shaikh I, Hellawell G, Shida D, Simpson A, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Sumrien H, Sutton PA, Swartking T, Taylor C, Tekkis PP, Teras J, Thurairaja R, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Vasquez‐Jimenez W, Verhoef C, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Wheeler JMD, Wild J, Wilson M, de Wilt JHW, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, van Zoggel D, Winter DC. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative. Colorectal Dis 2020; 22:1258-1262. [PMID: 32294308 DOI: 10.1111/codi.15064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/24/2020] [Indexed: 02/08/2023]
Abstract
AIM At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. METHOD Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. RESULTS Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). CONCLUSION Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
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Crabb BT, Lyons A, Bale M, Martin V, Berger B, Mann S, West WB, Brown A, Peacock JB, Leung DT, Shah RU. Comparison of International Classification of Diseases and Related Health Problems, Tenth Revision Codes With Electronic Medical Records Among Patients With Symptoms of Coronavirus Disease 2019. JAMA Netw Open 2020; 3:e2017703. [PMID: 32797176 PMCID: PMC7428802 DOI: 10.1001/jamanetworkopen.2020.17703] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes are used to characterize coronavirus disease 2019 (COVID-19)-related symptoms. Their accuracy is unknown, which could affect downstream analyses. OBJECTIVE To compare the performance of fever-, cough-, and dyspnea-specific ICD-10 codes with medical record review among patients tested for COVID-19. DESIGN, SETTING, AND PARTICIPANTS This cohort study included patients who underwent quantitative reverse transcriptase-polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 at University of Utah Health from March 10 to April 6, 2020. Data analysis was performed in April 2020. MAIN OUTCOMES AND MEASURES The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD-10 codes for fever (R50*), cough (R05*), and dyspnea (R06.0*) were compared with manual medical record review. Performance was calculated overall and stratified by COVID-19 test result, sex, age group (<50, 50-64, and >64 years), and inpatient status. Bootstrapping was used to generate 95% CIs, and Pearson χ2 tests were used to compare different subgroups. RESULTS Among 2201 patients tested for COVD-19, the mean (SD) age was 42 (17) years; 1201 (55%) were female, 1569 (71%) were White, and 282 (13%) were Hispanic or Latino. The prevalence of fever was 66% (1444 patients), that of cough was 88% (1930 patients), and that of dyspnea was 64% (1399 patients). For fever, the sensitivity of ICD-10 codes was 0.26 (95% CI, 0.24-0.29), specificity was 0.98 (95% CI, 0.96-0.99), PPV was 0.96 (95% CI, 0.93-0.97), and NPV was 0.41 (95% CI, 0.39-0.43). For cough, the sensitivity of ICD-10 codes was 0.44 (95% CI, 0.42-0.46), specificity was 0.88 (95% CI, 0.84-0.92), PPV was 0.96 (95% CI, 0.95-0.97), and NPV was 0.18 (95% CI, 0.16-0.20). For dyspnea, the sensitivity of ICD-10 codes was 0.24 (95% CI, 0.22-0.26), specificity was 0.97 (95% CI, 0.96-0.98), PPV was 0.93 (95% CI, 0.90-0.96), and NPV was 0.42 (95% CI, 0.40-0.44). ICD-10 code performance was better for inpatients than for outpatients for fever (χ2 = 41.30; P < .001) and dyspnea (χ2 = 14.25; P = .003) but not for cough (χ2 = 5.13; P = .16). CONCLUSIONS AND RELEVANCE These findings suggest that ICD-10 codes lack sensitivity and have poor NPV for symptoms associated with COVID-19. This inaccuracy has implications for any downstream data model, scientific discovery, or surveillance that relies on these codes.
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Affiliation(s)
- Brendan T. Crabb
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Ann Lyons
- Data Science Services, University of Utah Health Sciences Center, Salt Lake City
| | - Margaret Bale
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Valerie Martin
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Ben Berger
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Sara Mann
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - William B. West
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Alyssa Brown
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Jordan B. Peacock
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Daniel T. Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City
| | - Rashmee U. Shah
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City
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Orchard P, Arvind N, Wint A, Kynaston J, Lyons A, Loveday E, Pullyblank A. Removing hospital-based triage from suspected colorectal cancer pathways: the impact and learning from a primary care-led electronic straight-to-test pathway. BMJ Qual Saf 2020; 30:467-474. [PMID: 32527979 DOI: 10.1136/bmjqs-2019-009975] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 04/13/2020] [Accepted: 05/03/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The 2-week wait referral pathway for suspected colorectal cancer was introduced in England to improve time from referral from a general practitioner (GP) to diagnosis and treatment. Patients are required to be seen by a hospital clinician within 2 weeks if their symptoms meet the criteria set by the National Institute for Health and Care Excellence (NICE) and to start cancer treatment within 62 days. To achieve this, many hospitals have introduced a straight-to-test (STT) strategy requiring hospital-based triage of referrals. We describe the impact and learning from a new pathway which has removed triage and moved the process of requesting tests from hospital to GPs in primary care. METHOD An electronic STT pathway was introduced allowing GPs to book tests supported by a decision aid based on NICE guidance eliminating the need for a standard referral form or triage process. The hospital identified referrals as being on a cancer pathway and dealt with all ongoing management. Routinely collected cancer data were used to identify time to cancer diagnosis compared with national data RESULTS: 11357 patients were referred via the new pathway over 3 years. Time from referral to diagnosis reduced from 39 to 21 days and led to a dramatic improvement in patients starting treatment within 62 days. Challenges included adapting to a change in referral criteria and developing a robust hospital system to monitor the pathway. CONCLUSION We have changed the way patients with suspected colorectal cancer are managed within the National Health Service by giving GPs the ability to order tests electronically within a monitored cancer pathway halving time from referral to diagnosis.
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Affiliation(s)
| | | | - Alison Wint
- NHS South Gloucestershire Clinical Commissioning Group, Bristol, UK
| | - James Kynaston
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Ann Lyons
- North Bristol NHS Trust, Bristol, UK
| | | | - Anne Pullyblank
- North Bristol NHS Trust, Bristol, UK.,West of England Academic Health Science Network, Bristol, UK
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Abstract
This cross-sectional study describes the sensitivity and specificity of patient self-assessment for atrial arrhythmia compared with 12-lead electrocardiogram and describes the association of patient perception of arrhythmia with symptom burden.
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Affiliation(s)
- Jeffrey L. Turner
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, University of Utah, Salt Lake City
| | - Ann Lyons
- Data Science Services, University of Utah Health Sciences Center, Salt Lake City
| | - Rashmee U. Shah
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, University of Utah, Salt Lake City
| | - Brian Zenger
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, University of Utah, Salt Lake City
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Benjamin A. Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, University of Utah, Salt Lake City
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Fitzpatrick P, Flood C, Cuniffe E, Doherty K, Lyons A, Stynes S, Pilkington A, Barnes L, Peare T, Kelleher CC. Learning from calorie posting/traffic light systems introduction in a University hospital canteen. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Calorie posting is now policy in hospitals in Ireland and restaurants will be required to display calorie counts on menus by end of 2019. The Health Promotion, Dietetics and Catering teams worked together to introduce calorie posting and a traffic light system (TLS) for all foodstuffs available in the staff canteen of a large University teaching hospital in Dublin, Ireland. A calorie posting launch took place in September 2018. The aim of this study was to determine staff perception of calorie posting and TLS.
One month after the launch, 343 staff members were surveyed using a short pre-designed Sphynx-software questionnaire at 3 time points daily over one week, at breakfast, lunch and evening mealtimes. SPSS was used for analysis.
Of the 353 respondents (65.3% female; 18-44 years 65.3%, 45+ 32.1%, unknown 2.6%), more staff found calorie posting helpful compared to TLS (66.5% vs 43.7%; p = 0.001). Staff stated they made themselves aware of calorie count always/mostly (46%) and sometimes (26.2%). More females than men found both calorie posting (72.3% vs 53.3%; p = 0.001) and TLS (49.1% vs 31.8%; p = 0.001) helpful. More respondents identified calorie posting than TLS as influencing food choice at least sometimes (60.3% vs 36%; p = 0.0001). Females were more likely to make a food choice change based on TLS (39.7 vs 20.6%; p = 0.01). Age and frequency of canteen use were not associated with either.
The results suggest calorie posting is used rather than TLS by all hospital staff and female hospital staff are likelier to use both. Learning from this study, the positioning of TLS in relation to individual foodstuffs has been reviewed, further promotion of TLS/calorie posting has taken place in the hospital and a regular audit has been established. Notwithstanding the challenges, important moves towards healthier choices were seen.
Key messages
Introduction of traffic light system and calorie posting needs evaluation. Females appear more likely to avail of traffic light systems and calorie posting in relation to food choices.
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Affiliation(s)
- P Fitzpatrick
- Department of Preventive Medicine & Health Promotion, St Vincent’s University Hospital, Dublin, Ireland
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - C Flood
- Department of Preventive Medicine & Health Promotion, St Vincent’s University Hospital, Dublin, Ireland
| | - E Cuniffe
- Department of Preventive Medicine & Health Promotion, St Vincent’s University Hospital, Dublin, Ireland
| | - K Doherty
- Department of Preventive Medicine & Health Promotion, St Vincent’s University Hospital, Dublin, Ireland
| | - A Lyons
- Department of Preventive Medicine & Health Promotion, St Vincent’s University Hospital, Dublin, Ireland
| | - S Stynes
- Department of Preventive Medicine & Health Promotion, St Vincent’s University Hospital, Dublin, Ireland
| | - A Pilkington
- Department of Dietetics, St Vincent’s University Hospital, Dublin, Ireland
| | - L Barnes
- Department of Dietetics, St Vincent’s University Hospital, Dublin, Ireland
| | - T Peare
- Department of Catering, St Vincent’s University Hospital, Dublin, Ireland
| | - C C Kelleher
- Department of Preventive Medicine & Health Promotion, St Vincent’s University Hospital, Dublin, Ireland
- College of Health & Agricultural Sciences, University College Dublin, Dublin, Ireland
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Rosenthal A, Lyons A, Wilson A, Yee N, Moy R. LB1057 Ultraviolet B light induces rapid changes in gene expression as detected by non-invasive, adhesive skin biopsies. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.06.017] [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: 10/26/2022]
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Rozbroj T, Lyons A, Lucke J. The mad leading the blind: Perceptions of the vaccine-refusal movement among Australians who support vaccination. Vaccine 2019; 37:5986-5993. [PMID: 31451326 DOI: 10.1016/j.vaccine.2019.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 03/13/2019] [Revised: 07/10/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Vaccine refusal is shaped by the social ecology in which it occurs. How people who refuse vaccines are communicated to and treated may affect the nature and strength of their negative vaccine beliefs, and their responsiveness to health promotion messages. Yet little is known about how people who refuse vaccines are perceived by the public. Our research examined perceptions among pro-vaccine Australians of the vaccine-refusal movement. METHODS Descriptions of the vaccine-refusal movement by 2666 pro-vaccine Australians were analysed using thematic discourse analysis. Descriptive themes were identified via inductive, iterative coding. Discourse analysis techniques were then used to interpret latent beliefs about the vaccine-refusal movement. RESULTS Participants had negative and stigmatising perceptions of the vaccine-refusal movement. They believed the movement is dangerous, misinformed, and comprised of charlatans and fools who are unintelligent, selfish, overly emotional, conspiratorial and scientifically illiterate. Discursive analysis showed that these perceptions were underpinned by beliefs that people would have to be defective in some way to believe anti-vaccine rhetoric. Furthermore, perceptions were underpinned by beliefs that the movement spreads not only disease, but also dangerous ideas that were seen to attack the social order, institutions, values and reason. Participants' intensely-negative views related to their inability to imagine why someone would refuse vaccines. CONCLUSIONS This research provides a focused, qualitative account of public perceptions of the vaccine-refusal movement. The findings are concerning: stigma towards vaccine-refusing people may adversely affect their wellbeing and entrench their negative vaccine beliefs. The research suggests that more compassionate, nuanced discussion of vaccine refusal in the public sphere is needed. It also supports the need to systematically examine public attitudes towards vaccine refusal as a determinant of vaccine confidence.
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Affiliation(s)
- T Rozbroj
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC 3086, Australia.
| | - A Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC 3086, Australia
| | - J Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC 3086, Australia; School of Public Health, The University of Queensland, St Lucia, QLD 4072, Australia
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Rozbroj T, Lyons A, Lucke J. Vaccine-Hesitant and Vaccine-Refusing Parents’ Reflections on the Way Parenthood Changed Their Attitudes to Vaccination. J Community Health 2019; 45:63-72. [DOI: 10.1007/s10900-019-00723-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Quinlan D, Dahm M, Lyons A, Collins C. Patient Texting in General Practice: Who, Why, Why Not? A National Survey of Text Messaging in Irish General Practice. Ir Med J 2018; 111:729. [PMID: 30465598] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction The benefits of text messaging patients are well documented. The General Medical Council recently published guidance endorsing text messaging. The use of text messaging by GPs in Ireland is currently unknown. The survey aims to address this knowledge deficit and ascertain the extent, benefits, risks, barriers and clinical role of text messaging in Irish general practice. Methods An online survey was emailed to 1,375 members of the Irish College of General Practitioners (ICGP). Results A total of 536 GPs completed the questionnaire; a response rate of 40%. Overall, 66% (n=353) of respondents text patients and 27% have a written policy for texting patients. Texting is used primarily to send test results (71%), to advise the patient to phone the practice (52%) and as appointment reminders (43%). Discussion GPs text messaging patients is widespread. Complex issues to resolve include consent, confidentiality, children/young adults and the clinical content of text messages. Guidance is required to enable GPs and patients harness the benefits of text messaging, while minimising potential risks.
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Affiliation(s)
- D Quinlan
- Woodview Family Doctors, Kearney's Cross, Sallybrook, Riverstown, Glanmire, Co. Cork
| | - M Dahm
- Clonakilty Family Health Clinic, Faxbridge Shopping Complex, Clonakilty, Co Cork
| | - A Lyons
- General Practitioner, HSE South
| | - C Collins
- Director of Research & Innovation, Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2
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Abstract
Osteoradionecrosis (ORN) remains a difficult clinical problem. In large refractory cases surgery appears to be the only option but it does not guarantee a cure and is expensive. Cost analysis of 31 patients who had resection with or without reconstruction of their mandible was £892,357. The largest cost was in-patient stay, which accounted for 62% of the total. This article explores in detail the expenditure associated with major ORN surgery and its subsequent implications.
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Affiliation(s)
- V Patel
- Oral Surgery Dept, Floor 23, Guy's Dental Hospital, London Bridge, London, SE1 9RT
| | - L Ormondroyd
- Oral Surgery Dept, Floor 23, Guy's Dental Hospital, London Bridge, London, SE1 9RT
| | - A Lyons
- Head and Neck Dept, Floor 3, Guy's Hospital, London Bridge, London, SE1 9RT
| | - M McGurk
- Head and Neck Dept, Floor 3, Guy's Hospital, London Bridge, London, SE1 9RT
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Lyons A, Narciandi F, Donnellan E, Romero-Aguirregomezcorta J, Farrelly CO, Lonergan P, Meade KG, Fair S. Recombinant β-defensin 126 promotes bull sperm binding to bovine oviductal epithelia. Reprod Fertil Dev 2018; 30:1472-1481. [DOI: 10.1071/rd17415] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/12/2018] [Indexed: 12/11/2022] Open
Abstract
Primate β-defensin 126 regulates the ability of spermatozoa to bind to oviductal epithelial cells in vitro. Bovine β-defensin 126 (BBD126) exhibits preferential expression in the cauda epididymis of the bull, but there have been few studies on its functional role in cattle. The aim of the present study was to examine the role of BBD126 in bull sperm binding to bovine oviductal epithelial cell (BOEC) explants. BBD126 has been shown to be highly resistant to the standard methods of dissociation used in other species and, as a result, corpus epididymal spermatozoa, which have not been exposed to the protein, were used to study the functional role of BBD126. Corpus epididymal spermatozoa were incubated with recombinant (r) BBD126 in the absence or presence of anti-BBD126 antibody. Addition of rBBD126 significantly enhanced the ability of epididymal spermatozoa to bind to BOEC explants (P < 0.05). Anti-BBD126 antibody blocked the BBD126-mediated increase in sperm binding capacity. Ejaculated spermatozoa, which are coated with native BBD126 protein but also a large number of seminal plasma proteins in vivo, were incubated with rBBD126 in the absence or presence of the anti-BBD126 antibody. Addition of rBBD126 significantly enhanced the ability of ejaculated spermatozoa to bind to BOEC explants (P < 0.05), whereas rBBD126 also reduced corpus sperm agglutination (P < 0.05). These results suggest that, similar to the role of its analogue in the macaque, spermatozoa with more BBD126 in their acrosome may represent spermatozoa with more oviduct binding capacity.
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Lyons A, Church S. Postnatal depression: Can visual media and dramatisation of a young woman's experiences, enable student health care professionals develop knowledge to enhance clinical practice skills? Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionSince the presentation of the symptoms of postnatal depression (PND) can vary; healthcare professionals must receive the appropriate level of training to develop the knowledge required for the effective assessment and referral of women. Yet, healthcare professionals may have limited knowledge in perinatal mental health and students may lack practice opportunities to develop the knowledge and clinical skills. For these reasons, the use of alternative learning resources within perinatal mental health education is vital.ObjectivesTo explore the use of visual media in perinatal mental health education.AimsAgainst the background of increasing concerns about the ability of professionals to assess women with PND, this paper will consider how using dramatisation as a teaching approach can enable students to develop their knowledge and guide clinical skill development.MethodsThree separate groups of senior student midwives and health visitors were asked to evaluate a dramatisation developed from women's lived experience of PND. Pre and post verbal evaluation of the drama were undertaken with the use of focus groups guided by semi-structured questions. Ethical approval was granted by the university.ResultsFollowing thematic analysis three issues were identified:–the role of the healthcare professional;–improvements needed in care;–issues of education and training.ConclusionsAgainst the background of limited placement experience and opportunity for assessment of PND, the use of visual media can improve student healthcare professionals’ learning; with the use of structured facilitation, there is a great potential for multidisciplinary learning.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Silva DM, Holden SA, Lyons A, Souza JC, Fair S. In vitro addition of docosahexaenoic acid improves the quality of cooled but not frozen-thawed stallion semen. Reprod Fertil Dev 2017; 29:2021-2027. [PMID: 28171739 DOI: 10.1071/rd16473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/09/2016] [Indexed: 11/23/2022] Open
Abstract
The aim of the present study was to assess the effect of the addition of docosahexaenoic acid (DHA) on the in vitro quality of cooled and frozen-thawed stallion semen. In Experiment 1, semen from 10 stallions was collected (three ejaculates per stallion). Semen was diluted to 100×106 spermatozoa mL-1 with 0.02mM vitamin E (VE) and 0, 1, 10 or 20ng mL-1 DHA and frozen. Semen was thawed and total motility (TM), rapid progressive motility (PM), acrosome integrity, membrane fluidity and morphology were assessed. In Experiment 2, semen from three stallions was collected (three ejaculates per stallion) and frozen as in Experiment 1, but VE and DHA were added after thawing. TM and PM were assessed at 30, 60 and 120min and viability, acrosome integrity and membrane fluidity were evaluated at 30min. In Experiment 3, semen from five stallions was collected (one to three ejaculates per stallion), diluted to 20×106 spermatozoa mL-1 and stored at 4°C. After 1, 24, 48 and 72h, TM, PM, viability, membrane fluidity and lipid peroxidation were assessed. The addition of DHA had no effect on frozen semen (Experiments 1 and 2) but improved TM, PM and membrane fluidity in cooled stallion semen.
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Affiliation(s)
- D M Silva
- Instituto Federal de Educação, Ciência e Tecnologia do Sul de Minas Gerais - Campus Machado, Machado, Minas Gerais, Brazil
| | - S A Holden
- Laboratory of Animal Reproduction, Department of Biological Sciences, Faculty of Science and Engineering, University of Limerick, Castletroy, Co Limerick, Ireland
| | - A Lyons
- Laboratory of Animal Reproduction, Department of Biological Sciences, Faculty of Science and Engineering, University of Limerick, Castletroy, Co Limerick, Ireland
| | - J C Souza
- Department of Animal Science, Universidade Federal de Lavras, Lavras, Minas Gerais, Brazil
| | - S Fair
- Laboratory of Animal Reproduction, Department of Biological Sciences, Faculty of Science and Engineering, University of Limerick, Castletroy, Co Limerick, Ireland
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Haria S, Patel V, Sproat C, Kwok J, Ormondroyd L, McGurk M, Burke M, Reilly D, Lyons A, Cascarini L, Townley W, Oakley R, Guerrero Urbano T, Lei M, Jeannon J, Simo R. Is Osteoradionecrosis Evolving with Improved Radiotherapy Delivery System? J Oral Maxillofac Surg 2016. [DOI: 10.1016/j.joms.2016.06.059] [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: 10/21/2022]
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Sumrien H, Newman P, Burt C, McCarthy K, Dixon A, Pullyblank A, Lyons A. The use of a negative pressure wound management system in perineal wound closure after extralevator abdominoperineal excision (ELAPE) for low rectal cancer. Tech Coloproctol 2016; 20:627-31. [PMID: 27380256 DOI: 10.1007/s10151-016-1495-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 11/01/2015] [Accepted: 05/04/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Perineal wound healing is a significant challenge after extralevator abdominoperineal excision (ELAPE) due to a high rate of wound breakdown. Negative pressure therapy has proven benefits in open wounds, and recently a negative pressure system has been developed for use on closed wounds at high risk of breakdown, such as apronectomy and hysterectomy. The aim of the present study was to determine whether negative pressure therapy applied to closed perineal wounds after ELAPE improved wound healing and compare outcomes to the published literature and outcomes from a historical cohort of patients who had undergone 'standard' abdominoperineal resection (APR) and primary closure of the perineal wounds. METHODS Prospective data on consecutive patients having ELAPE in the period from November 2012 to April 2015 were collected. The pelvic floor defect was reconstructed with biologic mesh. The adipose tissue layer was closed with vicryl sutures, a suction drain was left in the deep layer, the subcuticular layer and skin were closed, and the negative pressure system was applied. Any wound breakdown within the first 30 days postoperatively was recorded. RESULTS Of the 32 consecutive ELAPE patients whose perineal wounds were closed within 30 days with the use of the negative pressure system, there was 1 patient with major perineal wound breakdown and 2 patients with a 1 cm superficial wound defect, which needed no further treatment. In the remaining 29 (90 %) patients, the perineal wounds healed fully without complications. Twenty-five patients underwent standard APR in 2010-2011 with primary closure of their perineal wounds. Ten out of 25(40 %) of patients who had undergone standard APR and primary closure of perineal wounds had major wound complications (p = 0.01). CONCLUSIONS Our results suggest that after ELAPE the application of a negative pressure system to the perineal wound closed with biologic mesh may reduce perineal wound complications and may reduce the need for major perineal reconstruction.
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Affiliation(s)
- H Sumrien
- Department of Colorectal Surgery, Southmead Hospital, Bristol, UK.
| | - P Newman
- Department of Colorectal Surgery, Southmead Hospital, Bristol, UK
| | - C Burt
- Department of Colorectal Surgery, Southmead Hospital, Bristol, UK
| | - K McCarthy
- Department of Colorectal Surgery, Southmead Hospital, Bristol, UK
| | - A Dixon
- Department of Colorectal Surgery, Southmead Hospital, Bristol, UK
| | - A Pullyblank
- Department of Colorectal Surgery, Southmead Hospital, Bristol, UK
| | - A Lyons
- Department of Colorectal Surgery, Southmead Hospital, Bristol, UK
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Power J, Lyons A, Brown G, Dowsett GW, Lucke J. Use of antiretroviral treatment among people living with HIV in Australia between 1997 and 2012. AIDS Care 2016; 29:61-66. [PMID: 27327874 DOI: 10.1080/09540121.2016.1198751] [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: 10/21/2022]
Abstract
Current international targets aim for 90% of people diagnosed with HIV to be on antiretroviral treatment (ART). This paper aims to identify sociodemographic and attitudinal factors associated with ART non-use over time in three samples of Australian people living with HIV (PLHIV). Data for this paper were derived from an Australian cross-sectional survey of PLHIV that was repeated at three different time points: 1997, 2003, and 2012. There were approximately 1000 respondents to each survey (n = 3042 in total). The survey included approximately 250 items related broadly to health and well-being, ART use, and attitudes towards ART use. Univariate and multivariate logistic regression analyses were used. While the proportion of participants using ART increased between 1997 and 2012 (78.8-87.6%, p < .001), there was a decrease between 1997 and 2003 to 70.6% (p < .001). Factors linked to ART non-use remained steady over those 15 years. In all cohorts, people less likely to be using ART were younger and had a more recent diagnosis of HIV. In 2003 and 2012, people in full-time employment were less likely to be using ART, while those whose main source of income was a pension or social security were more likely to be using ART. Multivariate models showed that, at each time point, a belief in the health benefits of delayed ART uptake was associated with non-use. These findings suggest that there may be barriers to ART uptake that have persisted over time despite changes to clinical guidelines that now encourage early uptake.
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Affiliation(s)
- J Power
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - A Lyons
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - G Brown
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - G W Dowsett
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - J Lucke
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
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Bird T, De Felice F, Michaelidou A, Thavaraj S, Jeannon JP, Lyons A, Oakley R, Simo R, Lei M, Guerrero Urbano T. Outcomes of intensity-modulated radiotherapy as primary treatment for oropharyngeal squamous cell carcinoma - a European singleinstitution analysis. Clin Otolaryngol 2016; 42:115-122. [DOI: 10.1111/coa.12674] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/12/2022]
Affiliation(s)
- T. Bird
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - F. De Felice
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - A. Michaelidou
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - S. Thavaraj
- Department of Pathology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - J.-P. Jeannon
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - A. Lyons
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - R. Oakley
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - R. Simo
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - M. Lei
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - T. Guerrero Urbano
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
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De Zoysa N, Lee A, Joshi A, Guerrero-Urbano T, Lei M, McGurk M, Lyons A, Cascarini L, Jeannon J, Simo R, Ali S, Oakley R. Developing a follow-up surveillance protocol in head and neck oncological surgery: enhanced ‘traffic light’ surveillance - a prospective feasibility study. Clin Otolaryngol 2016; 42:446-450. [DOI: 10.1111/coa.12613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- N. De Zoysa
- Department of Head and Neck Surgery-Guys & St Thomas; NHS Trust; London UK
| | - A. Lee
- Department of Head and Neck Surgery-Guys & St Thomas; NHS Trust; London UK
| | - A. Joshi
- Department of Head and Neck Surgery-Guys & St Thomas; NHS Trust; London UK
| | | | - M. Lei
- Department of Clinical Oncology-Guy's & St Thomas; NHS Trust; London UK
| | - M. McGurk
- Department of Head and Neck Surgery-Guys & St Thomas; NHS Trust; London UK
| | - A. Lyons
- Department of Head and Neck Surgery-Guys & St Thomas; NHS Trust; London UK
| | - L. Cascarini
- Department of Head and Neck Surgery-Guys & St Thomas; NHS Trust; London UK
| | - J.P. Jeannon
- Department of Head and Neck Surgery-Guys & St Thomas; NHS Trust; London UK
| | - R.S. Simo
- Department of Head and Neck Surgery-Guys & St Thomas; NHS Trust; London UK
| | - S. Ali
- Department of Head and Neck Surgery-Guys & St Thomas; NHS Trust; London UK
| | - R. Oakley
- Department of Head and Neck Surgery-Guys & St Thomas; NHS Trust; London UK
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Boyle M, Lyons A, Ryan S, Malone F, Poran A. Postnatal MRI Brain in Infants Treated for Twin-Twin Transfusion Syndrome. Ir Med J 2015; 108:240-243. [PMID: 26485832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Untreated twin-twin transfusion syndrome (TTTS) is associated with significant mortality and neurological impairment. Fetoscopic laser surgery (FLS) is the treatment of choice. We sought to assess intracranial abnormalities in TTTS twins following treatment. In this prospective, blinded study MRI scans were performed on 3 groups; (1) monochorionic diamniotic (MCDA) twins with TTTS who had undergone FLS (n = 10), (2) MCDA twins without TTTS (n = 8) and (3) dichorionic twins (n = 8). Scans were scored as either normal or abnormal. The primary outcome was a composite of abnormal MRI brain or intrauterine fetal demise. The primary outcome occurred in 6/10 (60%) of the TTTS group versus 3/8 (37.5%) in the MCDA group. The primary outcome was significantly different across all study groups [p = 0.029; X2 = 7.112]. We found that twins treated for TTTS are more likely to have abnormalities on MRI brain at term than other twin groups. This group merits term-corrected MRI as part of their postnatal assessment.
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O’Neill K, Lyons A, Larkin L, Kelly G. Muscle thickness and pennation angle of the medial gastrocnemius and tibialis anterior in spastic diplegia versus typically developing children. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.3602] [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: 10/23/2022]
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Mammen MP, Lyons A, Innis BL, Sun W, McKinney D, Chung RCY, Eckels KH, Putnak R, Kanesa-thasan N, Scherer JM, Statler J, Asher LV, Thomas SJ, Vaughn DW. Evaluation of dengue virus strains for human challenge studies. Vaccine 2014; 32:1488-94. [PMID: 24468542 DOI: 10.1016/j.vaccine.2013.12.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/06/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Abstract
Discordance between the measured levels of dengue virus neutralizing antibody and clinical outcomes in the first-ever efficacy study of a dengue tetravalent vaccine (Lancet, Nov 2012) suggests a need to re-evaluate the process of pre-screening dengue vaccine candidates to better predict clinical benefit prior to large-scale vaccine trials. In the absence of a reliable animal model and established correlates of protection for dengue, a human dengue virus challenge model may provide an approach to down-select vaccine candidates based on their ability to reduce risk of illness following dengue virus challenge. We report here the challenge of flavivirus-naïve adults with cell culture-passaged dengue viruses (DENV) in a controlled setting that resulted in uncomplicated dengue fever (DF). This sets the stage for proof-of-concept efficacy studies that allow the evaluation of dengue vaccine candidates in healthy adult volunteers using qualified DENV challenge strains well before they reach field efficacy trials involving children. Fifteen flavivirus-naïve adult volunteers received 1 of 7 DENV challenge strains (n=12) or placebo (n=3). Of the twelve volunteers who received challenge strains, five (two DENV-1 45AZ5 and three DENV-3 CH53489 cl24/28 recipients) developed DF, prospectively defined as ≥2 typical symptoms, ≥48h of sustained fever (>100.4°F) and concurrent viremia. Based on our study and historical data, we conclude that the DENV-1 and DENV-3 strains can be advanced as human challenge strains. Both of the DENV-2 strains and one DENV-4 strain failed to meet the protocol case definition of DF. The other two DENV-4 strains require additional testing as the illness approximated but did not satisfy the case definition of DF. Three volunteers exhibited effusions (1 pleural/ascites, 2 pericardial) and 1 volunteer exhibited features of dengue (rash, lymphadenopathy, neutropenia and thrombocytopenia), though in the absence of fever and symptoms. The occurrence of effusions in milder DENV infections counters the long-held belief that plasma leakage syndromes are restricted to dengue hemorrhagic fever/dengue shock syndromes (DHF/DSS). Hence, the human dengue challenge model may be useful not only for predicting the efficacy of vaccine and therapeutic candidates in small adult cohorts, but also for contributing to our further understanding of the mechanisms behind protection and virulence.
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Affiliation(s)
- M P Mammen
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - A Lyons
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - B L Innis
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - W Sun
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - D McKinney
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - R C Y Chung
- Infectious Disease Service, Walter Reed Army Medical Center (WRAMC), Washington, DC 20307, United States.
| | - K H Eckels
- Translational Medicine Branch, WRAIR, Silver Spring, MD 20910, United States.
| | - R Putnak
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - N Kanesa-thasan
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - J M Scherer
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - J Statler
- Radiology Service, Walter Reed Army Medical Center (WRAMC), Washington, DC 20307, United States.
| | - L V Asher
- Translational Medicine Branch, WRAIR, Silver Spring, MD 20910, United States.
| | - S J Thomas
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - D W Vaughn
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
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Boston T, Eicher R, Ellison-Brown E, Spring D, Venegas M, Kern N, Lyons A. Youth smoking prevention: promotion of evidence-based practice ideas for primary care providers in Kentucky. Ky Nurse 2013; 61:5-7. [PMID: 24260846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Tiffany Boston
- Spalding University School of Nursing, Louisville, Kentucky, USA
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47
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Corrigan G, O' Neill C, Connolly N, Deeney O, Fanning E, Guiden H, Hannon R, Lyons A, McElligott K, McMahon S, Moreau C, Shaw A. PP166-MON AN AUDIT OF THE DIETETIC MANAGEMENT OF REFEEDING SYNDROME IN A DUBLIN TEACHING HOSPITAL. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60477-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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48
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49
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Pena Murillo C, Huang X, Hills A, McGurk M, Lyons A, Jeannon JP, Odell E, Brown A, Lavery K, Barrett W, Sherriff M, Brakenhoff R, Partridge M. The utility of molecular diagnostics to predict recurrence of head and neck carcinoma. Br J Cancer 2012; 107:1138-43. [PMID: 22918395 PMCID: PMC3461148 DOI: 10.1038/bjc.2012.213] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 10/13/2011] [Revised: 04/18/2012] [Accepted: 04/24/2012] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Locoregional recurrence is the major cause of treatment failure after surgery for oral squamous cell carcinoma. Molecular diagnostics have the potential to improve on clinicopathological parameters to predict this recurrence and plan adjuvant treatment. The test most frequently applied is based on detecting TP53 mutations, but alternative methodology is required for cases that harbour the wild-type gene. METHODS One hundred and two cases with tumour-adjacent margins, considered to be clear margins by microscopy, were examined using carefully optimised molecular diagnostics based on detection of the TP53 and Ly-6D markers. The markers were also combined to provide a dual approach. RESULTS The dual molecular diagnostic identified cases with a significant increase in the probablility of developing locoregional recurrence when tumour-adjacent positive and clear margins were compared (P=0.0001). These tests were most useful when the clearance at the resection margins was 5 mm or less. The TP53-based diagnostic was a better predictor of locoregional recurrence than established clinicopathological parameters. CONCLUSION The optimised TP53-based diagnostic rapidly identifies an important subgroup of cases with close margins that will benefit from new treatment modalities to reduce the risk of recurrence.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Carcinoma, Squamous Cell/blood
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/pathology
- Female
- Genes, p53
- Head and Neck Neoplasms/blood
- Head and Neck Neoplasms/diagnosis
- Head and Neck Neoplasms/genetics
- Head and Neck Neoplasms/pathology
- Humans
- Male
- Middle Aged
- Mutation
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Pathology, Molecular/methods
- Prospective Studies
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Affiliation(s)
- C Pena Murillo
- Head and Neck Unit, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - X Huang
- Head and Neck Unit, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - A Hills
- Head and Neck Unit, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - M McGurk
- Head and Neck Unit, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - A Lyons
- Head and Neck Unit, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - J-P Jeannon
- Head and Neck Unit, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - E Odell
- King’s College London, Department of Oral Pathology, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - A Brown
- The Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead RH19 3QF, UK
| | - K Lavery
- The Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead RH19 3QF, UK
| | - W Barrett
- The Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead RH19 3QF, UK
| | - M Sherriff
- King’s College London, Department of Dental Biomaterial Science and Biomimetics, Great Maze Pond, London SE1 9RT, UK
| | - R Brakenhoff
- Department of Otolaryngology/Head-Neck Surgery, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - M Partridge
- Head and Neck Unit, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
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50
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James D, Hopkins G, Hamilton N, Hamilton N, Hitchin J, Lyons A, Thomson G, Waddell I, Jordan A, Ogilvie D. 1068 Potent, Cellular Inhibitors of Glucose-6-phosphate Dehydrogenase – Potential for Novel Therapeutic Intervention in Cancer. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71677-5] [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: 11/25/2022]
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