1
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Gray B. Consent for teaching-response to Rennie et al. N Z Med J 2023; 136:78-80. [PMID: 36958325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- Ben Gray
- Professor Ben Gray: Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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2
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Gray B. Capacity and decision making. J Med Ethics 2022; 48:1054-1055. [PMID: 35396338 DOI: 10.1136/medethics-2022-108287] [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] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
Pickering et al's paper argues that the capacity of the decision-maker is the sole consideration in whether a decision should stand, and that the risk of the decision should not be considered. This argument ignores the existence of the player who is of the view that a decision is not wise. This paper argues that patient autonomy is not the sole determinant of whether a person is able to make an unwise decision, particularly in healthcare where there are always others affected by the patient decision. Rather than asserting that patients have an unfettered autonomous choice on clinical decisions this paper argues that these decisions should be looked at through the lens of quality in health care that has proposed four parameters to be balanced; the patient experience, wise use of resources, the effect on public health and the clinician experience.
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Affiliation(s)
- Ben Gray
- Department of Primary Care and General Practice, University of Otago Wellington, Wellington, 6021, New Zealand
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3
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Gray B. Lived Experience Research: A Guide to the Barriers and Facilitators From a Service User's Perspective. Schizophr Bull 2022:sbac186. [PMID: 36454661 DOI: 10.1093/schbul/sbac186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Ben Gray
- Research Ambassador and Service User Researcher, Healthwatch Essex, UK
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4
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Gray B. Lived experience research: a service user’s perspective. Psychosis 2022. [DOI: 10.1080/17522439.2022.2147984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ben Gray
- Research Ambassador and Service User Researcher, Healthwatch Essex
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5
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Gibbs A, Gray B, Wallis J, Kemp J, Taylor N, Hunter D, Barton C. Appraisal of clinical practice guidelines and recommendations for the management of hip and knee osteoarthritis: a systematic review. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.088] [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: 11/17/2022]
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6
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Gray B. Consent for teaching. N Z Med J 2022; 135:64-69. [PMID: 35772113] [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: 06/15/2023]
Abstract
Consent for teaching was introduced as a result of the Cartwright Inquiry and is part of the Health and Disability Code of Health and Disability Consumer Rights. A consensus statement developed by Otago and Auckland medical schools states that the need to gain consent cannot be set aside on the grounds of inadequate time or resource. This viewpoint argues that a singular focus on patient experience, whilst ignoring the other elements of the quality framework, is not appropriate. "Consent" is a poor word in most circumstances to describe the complex interaction with a patient over time. Rather than strengthening codes of behaviour, an approach of a broader view of the overall quality of the interaction and a focus on cultural safety holds more promise.
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Affiliation(s)
- Ben Gray
- Primary Health Care and General Practice, University of Otago, Wellington
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7
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Gray B. General Practitioners in leadership and governance. N Z Med J 2022; 135:140-141. [PMID: 35728227] [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: 06/15/2023]
Affiliation(s)
- Ben Gray
- Primary Health Care and General Practice, University of Otago, Wellington
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8
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Isbister J, Singh A, Gray B, Yeates L, Bowman M, Raju H, Semsarian C, Puranik R, Sy R. Longitudinal CMR Assessment of Structural Phenotype in Brugada Syndrome. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.684] [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: 10/16/2022]
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Butters A, Do J, Stafford F, Krishnan N, Brown J, Hespe S, Richardson E, Bagnall R, Bhaskaran A, Burns C, Driscoll T, Fatkin D, Gray B, Iglesias C, Isbister J, Jabbour A, Johnson R, Kumar S, Leslie F, MacArthur D, Nowak N, Pouliopoulos J, Puranik R, Semsarian C, Sweeting J, Sy R, Ugander M, Yeates L, Ingles J. NSW HEARTS: The NSW Inherited Cardiomyopathy Cohort Study protocol. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.010] [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: 11/16/2022]
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McKinlay E, Hilder J, Hood F, Morgan S, Barthow C, Gray B, Huthwaite M, Weatherall M, Crane J, Krebs J, Pullon S. Uncertainty and certainty: perceptions and experiences of prediabetes in New Zealand primary care – a qualitative study. J Prim Health Care 2022; 14:138-145. [DOI: 10.1071/hc21066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
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McKinlay E, Banks D, Coleman K, Darlow B, Dungey G, Farr T, Fyfe R, Gray B, Kemp L, Mitchell M, Morris C, Myers J, Neser H, Perry M, Price R, Thompson W, Westenra B, Pullon S. Keeping it going: the importance of delivering interprofessional education during the COVID-19 pandemic. J Prim Health Care 2021; 13:359-369. [PMID: 34937649 DOI: 10.1071/hc21070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/05/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND CONTEXT Globally, the coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for better interprofessional collaboration and teamwork. When disciplines have worked together to undertake testing, deliver care and administer vaccines, progress against COVID-19 has been made. Yet, teamwork has often not happened, wasting precious resources and stretching health-care workforces. Continuing to train health professionals during the pandemic is challenging, particularly delivering interprofessional education that often uses face-to-face delivery methods to optimise interactional learning. Yet, continuing to offer interprofessional education throughout the pandemic is critical to ensure a collaboration-ready health workforce. One example is continuing the established INVOLVE (Interprofessional Visits to Learn Interprofessional Values through Patient Experience) interprofessional education initiative. ASSESSMENT OF PROBLEM Educators have not always prioritised interprofessional education during the pandemic, despite its immediate and long-term benefits. The INVOLVE interprofessional education initiative, usually delivered face-to-face, was at risk of cancellation. RESULTS A quality improvement analysis of the strategies used to continue INVOLVE demonstrated that it is possible to deliver interprofessional education within the constraints of a pandemic by using innovative online and hybrid educational strategies. Educators and students demonstrated flexibility in responding to the sudden changes in teaching and learning modalities. STRATEGIES When pandemic alert levels change, interprofessional educators and administrators can now choose from a repertoire of teaching approaches. LESSONS Four key lessons have improved the performance and resilience of INVOLVE: hold the vision to continue interprofessional education; be nimble; use technology appropriately; and there will be silver linings and unexpected benefits to the changes.
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Affiliation(s)
- Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand; and Corresponding author.
| | | | | | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand
| | - Gay Dungey
- Department of Radiation Therapy, University of Otago Wellington, New Zealand
| | - Tracy Farr
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand
| | - Rebecca Fyfe
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand
| | - Ben Gray
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand
| | - Liz Kemp
- School of Physiotherapy, University of Otago Wellington, New Zealand
| | | | - Caroline Morris
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand
| | - Julia Myers
- Department of Medicine, University of Otago Wellington, New Zealand
| | | | - Meredith Perry
- School of Physiotherapy, University of Otago Wellington, New Zealand
| | - Rowena Price
- Acute Pain Management Service, Capital and Coast District Health Board, New Zealand
| | - Wendy Thompson
- Wellington Regional Hospital, Capital and Coast District Health Board, New Zealand
| | | | - Sue Pullon
- Centre for Interprofessional Education, University of Otago, New Zealand
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Lukey R, Gray B, Morris C. 'We're just seen as people that give out the methadone…': exploring the role of community pharmacists in the opioid substitution treatment team. J Prim Health Care 2021; 12:358-367. [PMID: 33349324 DOI: 10.1071/hc20108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION People receiving opioid substitution treatment are a vulnerable population who experience significant health inequities and stigma, but have regular interactions with community pharmacists. Many pharmacists now work collaboratively with other health providers to ensure effective and safe use of medicines, as well as being involved in the prevention and management of chronic health conditions. AIM To explore the role of New Zealand community pharmacists in the provision of opioid substitution treatment and how they perceive their role as part of the wider opioid substitution treatment team. METHODS Semi-structured video interviews with a purposive sample of 13 diverse pharmacists explored their current practices in providing opioid substitution treatment, and their perceived role in the treatment team. Interviews were audio-recorded and transcribed verbatim. Data were coded and analysed using an inductive thematic approach. RESULTS This study found that pharmacists are providing accessible support to a population with known barriers to accessing health care. However, participants also identified challenges with communication and a perceived lack of understanding of the pharmacist role as barriers to collaboration with the wider opioid substitution treatment team. DISCUSSION Collaboration within health-care teams has been shown to improve health outcomes, and pharmacists are well placed to provide health-care services as well as offer valuable insight into clients' mental and physical wellbeing. Improved communication channels that facilitate information sharing, as well as the opioid substitution treatment team's recognition of a pharmacist's role, may facilitate collaboration and, in turn, improve the quality of health care provided to this vulnerable population.
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Affiliation(s)
- Rebecca Lukey
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand; and Corresponding author.
| | - Ben Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Caroline Morris
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Ross S, Holliday M, Lim S, Mangala M, Perry M, Gray B, Fraser S, Hill A, Hudson J, Semsarian C. Functional Analysis of a Novel Heterozygous Variant in CASQ2 as a Distinct Cause of Catecholaminergic Polymorphic Ventricular Tachycardia. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.016] [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: 11/29/2022]
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Mohd ZN, Norman S, Gray B, Abdelmasih S, Shetty P, Danson E, Nguyendang T, Yeung A, Lee A. Safety and Efficacy of the Ultrathin Orsiro Sirolimus-Eluting Stent Use in ST Elevation Myocardial Infarct. An Analysis from a Large Australian Regional Centre. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gray B. COVID-19 from Wellington New Zealand. J Bioeth Inq 2020; 17:633-638. [PMID: 33169244 PMCID: PMC7651798 DOI: 10.1007/s11673-020-10038-3] [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] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
This paper examines the role of bioethics in the successful control of COVID-19 in New Zealand. After the severe acute respiratory syndrome (SARS) coronavirus episode in Toronto researchers developed a framework of values and principles to articulate values that were already commonly accepted "in the community of its intended users," to be used to inform decision-making. New Zealand subsequently developed its own framework that was embedded in its Pandemic Influenza Plan. These formed the basis of the New Zealand response to COVID-19. This paper illustrates the ways in which the bioethical framework was reflected in the decisions and actions made by the government.
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Affiliation(s)
- Ben Gray
- Primary Health Care and General Practice, University of Otago, Wellington, Wellington, 6021, New Zealand.
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Hall KH, Doolan-Noble F, McKinlay E, Currie O, Gray B, Gray L, Richard L, Stubbe M, Jaye C. Guest Editorial: Ethics and equity in the time of Coronavirus. J Prim Health Care 2020; 12:102-106. [PMID: 32594974 DOI: 10.1071/hcv12n2_ed2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Katherine H Hall
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand; and Corresponding author.
| | - Fiona Doolan-Noble
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Olivia Currie
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Ben Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Lauralie Richard
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Maria Stubbe
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Chrystal Jaye
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
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Femia G, Lanlois N, Raleigh J, Gray B, Othman F, Perumal S, Semsarian C, Puranik R. 304 Comparing Conventional Autopsy to Post-Mortem MR and CT in Determining the Cause of Sudden and/or Unexpected Death. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.311] [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: 11/30/2022]
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18
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Gray B. New Zealand needs a comprehensive interpreting service. N Z Med J 2019; 132:95-98. [PMID: 31647800] [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: 06/10/2023]
Affiliation(s)
- Ben Gray
- Senior Lecturer, Primary Health Care and General Practice, University of Otago, Wellington
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Gray B, Coker TR. When shared decision-making and evidence based practice clash: Infant sleep practices. J Paediatr Child Health 2019; 55:1009-1012. [PMID: 31355960 DOI: 10.1111/jpc.14577] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/14/2019] [Indexed: 12/12/2022]
Abstract
In complex decisions, there are times when there may be a conflict between the recommendations from clinical practice guidelines and the outcome of a shared decision-making process between the clinician and the patient. Sticking rigidly to practice guidelines can be seen as paternalistic and even dismissive of a patient's specific circumstances and preferences; however, failing to adhere to such guidelines can be troubling for many doctors. In this article, we present and discuss this conflict using the common problem of how to provide family-centred, yet evidence-based guidance on infant sleep practices. Infant sleep practices are a common discussion topic at well-baby visits, and family preferences for infant sleep practices are often at odds with national recommendations. With three cases as a backdrop, we discuss how cultural humility, complexity and trust can be key factors in how the clinician-parent discussion on infant sleep can incorporate safe sleep guidelines into a family-centred, culturally relevant discussion.
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Affiliation(s)
- Ben Gray
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States.,Department of Pediatrics, Seattle Children's Research Institute, Seattle, Washington, United States
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Barthow C, Hood F, McKinlay E, Hilder J, Cleghorn C, Huthwaite M, Weatherall M, Parry-Strong A, Pullon S, Gray B, Wickens K, Crane J, Krebs J. Food 4 Health - He Oranga Kai: Assessing the efficacy, acceptability and economic implications of Lactobacillus rhamnosus HN001 and β-glucan to improve glycated haemoglobin, metabolic health, and general well-being in adults with pre-diabetes: study protocol for a 2 × 2 factorial design, parallel group, placebo-controlled randomized controlled trial, with embedded qualitative study and economic analysis. Trials 2019; 20:464. [PMID: 31358022 PMCID: PMC6664750 DOI: 10.1186/s13063-019-3553-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/02/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The rates of pre-diabetes and type 2 diabetes mellitus are increasing worldwide, producing significant burdens for individuals, families, and healthcare systems. In New Zealand, type 2 diabetes mellitus and pre-diabetes disproportionally affect Māori, Pacific, and South Asian peoples. This research evaluates the efficacy, acceptability, and economic impact of a probiotic capsule and a prebiotic cereal intervention in adults with pre-diabetes on metabolic and mental health and well-being outcomes. METHODS Eligible adults (n = 152) aged 18-80 years with pre-diabetes (glycated haemoglobin 41-49 mmol/mol) will be enrolled in a 2 × 2 factorial design, randomised, parallel-group, placebo-controlled trial. Computer-generated block randomization will be performed independently. Interventions are capsulated Lactobacillus rhamnosus HN001 (6 × 109 colony-forming units/day) (A) and cereal containing 4 g β-glucan (B), placebo capsules (O1), and calorie-matched control cereal (O2). Eligible participants will receive 6 months intervention in the following groups: AB, AO1, BO2, and O1O2. The primary outcome is glycated haemoglobin after 6 months. Follow-up at 9 months will assess the durability of response. Secondary outcomes are glycated haemoglobin after 3 and 9 months, fasting glucose, insulin resistance, blood pressure, body weight, body mass index, and blood lipid levels. General well-being and quality of life will be measured by the Short-Form Health Survey 36 and Depression Anxiety Stress Scale 21 at 6 and 9 months. Outcome assessors will be blind to capsule allocation. An accompanying qualitative study will include 24 face-to-face semistructured interviews with an ethnically balanced sample from the β-glucan arms at 2 months, participant focus groups at 6 months, and three health professional focus groups. These will explore how interventions are adopted, their acceptability, and elicit factors that may support the uptake of interventions. A simulation model of the pre-diabetic New Zealand population will be used to estimate the likely impact in quality-adjusted life years and health system costs of the interventions if rolled out in New Zealand. DISCUSSION This study will examine the efficacy of interventions in a population with pre-diabetes. Qualitative components provide rich description of views on the interventions. When combined with the economic analysis, the study will provide insights into how to translate the interventions into practice. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12617000990325. Prospectively registered on 10 July 2017.
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Affiliation(s)
- Christine Barthow
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Fiona Hood
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Jo Hilder
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Christine Cleghorn
- Department of Public Health, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Amber Parry-Strong
- Centre for Endocrine, Diabetes and Obesity Research (CEDOR), PO Box 7902, Wellington South, Wellington, New Zealand
| | - Sue Pullon
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Ben Gray
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Kristin Wickens
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Jeremy Krebs
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
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Gray B. Sun protection policy in New Zealand. N Z Med J 2019; 132:78-79. [PMID: 31352479] [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: 06/10/2023]
Affiliation(s)
- Ben Gray
- Senior Lecturer, Department of Primary Health Care and General Practice, University Of Otago, Wellington
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LAU Y, Denis J, Gray B, Nathoo B. MON-078 IMPACT OF RAPID PERITONEAL DIALYSIS (PD) GROWTH ON PERITONITIS RATE IN A REGIONAL RENAL PROGRAM IN ONTARIO. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.867] [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] Open
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23
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Suddaby RJ, Morris CJ, Gray B. Role of New Zealand community pharmacists in opioid substitution treatment. Res Social Adm Pharm 2019. [DOI: 10.1016/j.sapharm.2019.03.128] [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: 10/26/2022]
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Osborn D, Burton A, Walters K, Atkins L, Barnes T, Blackburn R, Craig T, Gilbert H, Gray B, Hardoon S, Heinkel S, Holt R, Hunter R, Johnston C, King M, Leibowitz J, Marston L, Michie S, Morris R, Morris S, Nazareth I, Omar R, Petersen I, Peveler R, Pinfold V, Stevenson F, Zomer E. Primary care management of cardiovascular risk for people with severe mental illnesses: the Primrose research programme including cluster RCT. Programme Grants Appl Res 2019. [DOI: 10.3310/pgfar07020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Effective interventions are needed to prevent cardiovascular disease (CVD) in people with severe mental illnesses (SMI) because their risk of CVD is higher than that of the general population.
Objectives
(1) Develop and validate risk models for predicting CVD events in people with SMI and evaluate their cost-effectiveness, (2) develop an intervention to reduce levels of cholesterol and CVD risk in SMI and (3) test the clinical effectiveness and cost-effectiveness of this new intervention in primary care.
Design
Mixed methods with patient and public involvement throughout. The mixed methods were (1) a prospective cohort and risk score validation study and cost-effectiveness modelling, (2) development work (focus groups, updated systematic review of interventions, primary care database studies investigating statin prescribing and effectiveness) and (3) cluster randomised controlled trial (RCT) assessing the clinical effectiveness and cost-effectiveness of a new practitioner-led intervention, and fidelity assessment of audio-recorded appointments.
Setting
General practices across England.
Participants
All studies included adults with SMI (schizophrenia, bipolar disorder or other non-organic psychosis). The RCT included adults with SMI and two or more CVD risk factors.
Interventions
The intervention consisted of 8–12 appointments with a practice nurse/health-care assistant over 6 months, involving collaborative behavioural approaches to CVD risk factors. The intervention was compared with routine practice with a general practitioner (GP).
Main outcome measures
The primary outcome for the risk score work was CVD events, in the cost-effectiveness modelling it was quality-adjusted life-years (QALYs) and in the RCT it was level of total cholesterol.
Data sources
Databases studies used The Health Improvement Network (THIN). Intervention development work included focus groups and systematic reviews. The RCT collected patient self-reported and routine NHS GP data. Intervention appointments were audio-recorded.
Results
Two CVD risk score models were developed and validated in 38,824 people with SMI in THIN: the Primrose lipid model requiring cholesterol levels, and the Primrose body mass index (BMI) model with no blood test. These models performed better than published Cox Framingham models. In health economic modelling, the Primrose BMI model was most cost-effective when used as an algorithm to drive statin prescriptions. Focus groups identified barriers to, and facilitators of, reducing CVD risk in SMI including patient engagement and motivation, staff confidence, involving supportive others, goal-setting and continuity of care. Findings were synthesised with evidence from updated systematic reviews to create the Primrose intervention and training programme. THIN cohort studies in 16,854 people with SMI demonstrated that statins effectively reduced levels of cholesterol, with similar effect sizes to those in general population studies over 12–24 months (mean decrease 1.2 mmol/l). Cluster RCT: 76 GP practices were randomised to the Primrose intervention (n = 38) or treatment as usual (TAU) (n = 38). The primary outcome (level of cholesterol) was analysed for 137 out of 155 participants in Primrose and 152 out of 172 in TAU. There was no difference in levels of cholesterol at 12 months [5.4 mmol/l Primrose vs. 5.5 mmol/l TAU; coefficient 0.03; 95% confidence interval (CI) –0.22 to 0.29], nor in secondary outcomes related to cardiometabolic parameters, well-being or medication adherence. Mean cholesterol levels decreased over 12 months in both arms (–0.22 mmol/l Primrose vs. –0.39 mmol/l TAU). There was a significant reduction in the cost of inpatient mental health attendances (–£799, 95% CI –£1480 to –£117) and total health-care costs (–£895, 95% CI –£1631 to –£160; p = 0.012) in the intervention group, but no significant difference in QALYs (–0.011, 95% CI –0.034 to 0.011). A total of 69% of patients attended two or more Primrose appointments. Audiotapes revealed moderate fidelity to intervention delivery (67.7%). Statin prescribing and adherence was rarely addressed.
Limitations
RCT participants and practices may not represent all UK practices. CVD care in the TAU arm may have been enhanced by trial procedures involving CVD risk screening and feedback.
Conclusions
SMI-specific CVD risk scores better predict new CVD if used to guide statin prescribing in SMI. Statins are effective in reducing levels of cholesterol in people with SMI in UK clinical practice. This primary care RCT evaluated an evidence-based practitioner-led intervention that was well attended by patients and intervention components were delivered. No superiority was shown for the new intervention over TAU for level of cholesterol, but cholesterol levels decreased over 12 months in both arms and the intervention showed fewer inpatient admissions. There was no difference in cholesterol levels between the intervention and TAU arms, which might reflect better than standard general practice care in TAU, heterogeneity in intervention delivery or suboptimal emphasis on statins.
Future work
The new risk score should be updated, deployed and tested in different settings and compared with the latest versions of CVD risk scores in different countries. Future research on CVD risk interventions should emphasise statin prescriptions more. The mechanism behind lower costs with the Primrose intervention needs exploring, including SMI-related training and offering frequent support to people with SMI in primary care.
Trial registration
Current Controlled Trials ISRCTN13762819.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 2. See the NIHR Journals Library website for further project information. Professor David Osborn is supported by the University College London Hospital NIHR Biomedical Research Centre and he was also in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust.
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Affiliation(s)
- David Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Alexandra Burton
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lou Atkins
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Thomas Barnes
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Ruth Blackburn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Thomas Craig
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Hazel Gilbert
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ben Gray
- The McPin Foundation, London, UK
| | - Sarah Hardoon
- Department of Primary Care and Population Health, University College London, London, UK
| | - Samira Heinkel
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Richard Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Johnston
- School of Health and Education, Faculty of Professional and Social Sciences, Middlesex University, London, UK
| | - Michael King
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Judy Leibowitz
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK
| | - Susan Michie
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Richard Morris
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Morris
- Department of Allied Health Research, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
| | - Robert Peveler
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Fiona Stevenson
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ella Zomer
- Department of Primary Care and Population Health, University College London, London, UK
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Devyatko Y, Filipits M, Greil R, Balic M, Bago-Horvath Z, Singer C, Fitzal F, Steger G, Gray B, Ferree S, Fesl C, Soelkner L, von Minckwitz G, Gnant M. Abstract P1-17-05: The impact of clinical risk assessment versus PAM-50 ROR score on prognosis and therapeutic decision making in patients with hormone-receptor positive early stage breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-17-05] [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: 11/16/2022]
Abstract
Abstract
Background: Therapeutic recommendations for adjuvant treatment of hormone-receptor positive breast cancer patients depend on the individual recurrence risk. A number of genomic assays introduced to achieve this goal, but it's still questioned if they actually offer superior risk assessment compared to traditional risk evaluation by experienced clinicians. This study was designed to compare the prognostic accuracy of PAM-50 to clinical judgment.
Methods: Based on the real data of a large adjuvant trial cohort (ABCSG-8, postmenopausal HR positive breast cancer patients), we created online-questionnaires including demographic, histological, and local-therapy details, with and without results of PAM50 ROR score. Out of 14 international breast cancer experts asked for individual patient's risk evaluation (low, intermediate, high) and therapy recommendations, 9 completed the questionnaire.
Patient data were described by Kaplan-Meier estimates of distant disease free survival (DDFS) stratified by risk group. Cox regression models were compared using the Akaike Information Criterion (AIC).
Results: 10 years DDFS and hazard ratios for distant recurrences stratified by risk-group as estimated giving in Table 1:
10 years DDFS and hazard ratios for distant recurrences stratified by risk-group as estimated Low riskIntermediate riskHigh risk n (%)10y DDFS,%(95%CI)n (%)10y DDFS,%(95%CI)n (%)10y DDFS, %(95%CI) HR(95% CI) HR(95% CI) HR(95% CI)Clinical only: AIC 817.6269 (43)93.0(89.8-96.2)289 (46)89.7(85.9-93.5)73 (11)76.6(66.1-87.1) 0.68(0.39,1.20) 1 2.57(1.41,4.65)PAM50 ROR: AIC 804.8241 (34)96.5(93.1-99.1)210 (33)89.2(84.7-93.7)207 (33)82.5(76.9-88.2) 0.27(0.11,0.62) 1 1.66(0.99,2.78)Combined: AIC 813.4232 (37)95.7(93.0-98.5)282 (45)87.8(83.7-92.0)117 (18)81.7(74.2-89.2) 0.42(0.22,0.84) 1 1.90(1.11,3.24)
Adding genomic information to clinical risk factors leads to escalation of therapeutic recommendations (i.e. additional chemotherapy, extended adjuvant endocrine) in 20% of patients, and de-escalation in 13% of patients.
Conclusions: Clinical judgment accurately identified the patients at high risk of relapse, but was clearly inferior to multi-genomic testing using the PAM-50 ROR score in differentiating low from intermediate risk. Particularly when avoiding unnecessary escalated therapy is the strategic goal, the addition of PAM-50 testing to clinical judgment offers improved accuracy in predicting low vs. intermediate risk of breast cancer recurrence.
Citation Format: Devyatko Y, Filipits M, Greil R, Balic M, Bago-Horvath Z, Singer C, Fitzal F, Steger G, Gray B, Ferree S, Fesl C, Soelkner L, von Minckwitz G, Gnant M. The impact of clinical risk assessment versus PAM-50 ROR score on prognosis and therapeutic decision making in patients with hormone-receptor positive early stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-17-05.
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Affiliation(s)
- Y Devyatko
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - M Filipits
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - R Greil
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - M Balic
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - Z Bago-Horvath
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - C Singer
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - F Fitzal
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - G Steger
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - B Gray
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - S Ferree
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - C Fesl
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - L Soelkner
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - G von Minckwitz
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
| | - M Gnant
- Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Medical University of ViennaInstitute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute, Salzburg, Austria; Medical University of Graz, Graz, Austria; Clinical Institute of Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; NanoString Technologies, Seattle, WA; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; German Breast Group, Neu-Isenburg, Germany
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Hilder J, Gray B, Stubbe M. Health navigation and interpreting services for patients with limited English proficiency: a narrative literature review. J Prim Health Care 2019; 11:217-226. [DOI: 10.1071/hc18067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 08/12/2019] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONCulturally and linguistically diverse populations (CALD) have significant health outcome disparities compared to dominant groups in high-income countries. The use of both navigators and interpreters are strategies used to address these disparities, but the intersections between these two roles can be poorly understood.
AIMTo gain an overview of the literature on health navigation and similar roles, with particular reference to the New Zealand context, and to explore the interface between these roles and that of interpreters for CALD populations with limited English proficiency.
METHODSA narrative review of the literature was conducted using a range of search strategies and a thematic analysis was conducted.
RESULTSThere are several barriers to health-care access relating to health systems and CALD populations. For over 50 years, health workers who are members of these communities have been used to address these barriers, but there are many terms describing workers with wide-ranging roles. There is some evidence of efficacy in economic, psychosocial and functional terms. For health navigation services to work, they need to have staff who are well selected, trained and supported; are integrated into health-care teams; and have clearly defined roles. There may be a place for integrating interpreting more formally into the navigator role for members of communities who have limited English proficiency.
CONCLUSIONTo achieve better access to health care for CALD populations, there is an argument for adding another member to the health team who combines clearly defined aspects of the roles of interpreter, community health worker and navigator. Organisations considering setting up such a position should have a clear target population, carefully consider the barriers they are trying to address and define a role, scope of practice and training requirements best suited to addressing those barriers.
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Gray B. Acupuncture and the Medicines Act: a reply. N Z Med J 2018; 131:98-99. [PMID: 29879734] [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: 06/08/2023]
Affiliation(s)
- Ben Gray
- Senior Lecturer, Primary Health Care and General Practice, University of Otago, 23A Mein Street, Newtown, Wellington
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Gandhi S, Ewing J, Cooper E, Chaves J, Gray B. Comparison of Low-Dose Catheter-Directed Thrombolysis With and Without Pharmacomechanical Thrombectomy for Acute Lower Extremity Ischemia. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.02.018] [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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Gray B. Culture, cultural competence and the cross-cultural consultation. J Paediatr Child Health 2018; 54:343-345. [PMID: 29114955 DOI: 10.1111/jpc.13769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/10/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Ben Gray
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
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Gray B, Viljanto M, Menzies E, Vanhaecke L. Detection of prohibited substances in equine hair by ultra-high performance liquid chromatography-triple quadrupole mass spectrometry - application to doping control samples. Drug Test Anal 2018; 10:1050-1060. [PMID: 29430877 DOI: 10.1002/dta.2367] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 10/18/2017] [Revised: 01/12/2018] [Accepted: 01/31/2018] [Indexed: 11/09/2022]
Abstract
The detection of drugs in human hair samples has been performed by laboratories around the world for many years and the matrix is popular in disciplines, such as workplace drug testing. To date, however, hair has not become a routinely utilised matrix in sports drug detection. The analysis of hair samples offers several potential advantages to doping control laboratories, not least of which are the greatly extended detection window and the ease of sample collection and storage. This article describes the development, validation, and utilisation of a sensitive ultra-high performance liquid chromatography-triple quadrupole mass spectrometry (UHPLC-MS/MS) method for the detection of 50 compounds. This provides significantly improved coverage for those analytes which would be of particular interest if detected in hair, such as anabolic steroid esters and selective androgen receptor modulators (SARMs). Qualitative validation of the method resulted in estimated limits of detection as low as 0.1 pg/mg for the majority of compounds, with all being detected at 2 pg/mg or below. The suitability of the method for the detection of prohibited substances in incurred material was demonstrated by the successful detection of several compounds, such as stanozolol, boldenone undecylenate, clenbuterol, and GW-501516, in genuine equine hair samples. Estimated concentrations of the detected substances ranged from 0.27 to 8.6 pg/mg. The method has been shown to be fit-for-purpose for routine screening of equine hair samples by the analysis of over 400 genuine hair samples.
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Affiliation(s)
- B Gray
- LGC Ltd, Fordham, Cambridgeshire, UK
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Belgium
| | | | - E Menzies
- LGC Ltd, Fordham, Cambridgeshire, UK
| | - L Vanhaecke
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Belgium
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Gray B, Cadd V, Elliott M, Beard M. The in vitro detection of botulinum neurotoxin-cleaved endogenous VAMP is epitope-dependent. Toxicol In Vitro 2018; 48:255-261. [PMID: 29373835 DOI: 10.1016/j.tiv.2018.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/08/2017] [Revised: 01/17/2018] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
Abstract
The in vitro potency of botulinum neurotoxin (BoNT) serotypes is often measured by monitoring cleavage of their soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) protein substrates. A frequently used method is Western blot, whereby the full-length protein and cleaved form migrate at different molecular weights. Until now, it has been extremely difficult to detect the cleaved cellular form of the SNARE protein vesicle associated membrane protein 1, 2 or 3 (VAMP1, 2 or 3) by Western blot. These VAMP isoforms are the substrates of BoNT serotypes BoNT/B, D, F and G as well as tetanus neurotoxin. Using custom made anti-VAMP antibodies against epitopes either side of the cleavage sites for BoNT/B, BoNT/D and BoNT/F, we have successfully detected the cleaved C-terminal VAMP fragment in cortical neurons. These new antibodies enable quantitative assessment of the potency of VAMP-cleaving neurotoxins by a gain of signal Western blot assay.
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Affiliation(s)
- B Gray
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon OX14 4RY, UK.
| | - V Cadd
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon OX14 4RY, UK
| | - M Elliott
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon OX14 4RY, UK
| | - M Beard
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon OX14 4RY, UK
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Othman F, Raleigh J, Femia J, Semsarian C, Gray B, Langlois N, Puranik R. Utility of Postmortem CT and MR in the Diagnosis of Unexpected Death. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.541] [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: 10/28/2022]
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McKinlay E, Young J, Gray B. General practice and patients’ views of the social networks of patients with multimorbidity. J Prim Health Care 2018; 10:258-266. [DOI: 10.1071/hc17050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTION
For patients with multimorbidity to live well, they need the support of not only health professionals but family, friends and organisations. These social networks provide support, potentially enabling the formation of a Community of Clinical Practice approach to multimorbidity care.
AIM
This study aimed to explore general practice knowledge of the social networks of patients with multimorbidity.
METHODS
Social network maps were completed by both patients and general practice. The social network maps of 22 patients with multimorbidity were compared with corresponding social network maps completed by general practice staff.
RESULTS
In 60% (13/22) of the patients, general practice staff held a high or moderate knowledge of individual patients’ social networks. Information on social networks was recalled from staff memory and not systematically recorded in patients’ electronic health records.
DISCUSSION
Social network information is not routinely collected, recorded or used by general practice to understand the support available to patients with multimorbidity. General practice could take an active role in coordinating social network supporters for certain patient groups with complex multimorbidity. For these groups, there is value in systematically recording and regularly updating their social network information for general practice to use as part of a coordinated Community of Clinical Practice.
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Hamann-Borrero JE, Macke S, Gray B, Kareev M, Schierle E, Partzsch S, Zwiebler M, Treske U, Koitzsch A, Büchner B, Freeland JW, Chakhalian J, Geck J. Site-selective spectroscopy with depth resolution using resonant x-ray reflectometry. Sci Rep 2017; 7:13792. [PMID: 29061996 PMCID: PMC5653850 DOI: 10.1038/s41598-017-12642-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/25/2017] [Accepted: 09/13/2017] [Indexed: 11/21/2022] Open
Abstract
Combining dissimilar transition metal oxides (TMOs) into artificial heterostructures enables to create electronic interface systems with new electronic properties that do not exist in bulk. A detailed understanding of how such interfaces can be used to tailor physical properties requires characterization techniques capable to yield interface sensitive spectroscopic information with monolayer resolution. In this regard resonant x-ray reflectivity (RXR) provides a unique experimental tool to achieve exactly this. It yields the element specific electronic depth profiles in a non-destructive manner. Here, using a YBa2Cu3O7−δ (YBCO) thin film, we demonstrate that RXR is further capable to deliver site selectivity. By applying a new analysis scheme to RXR, which takes the atomic structure of the material into account, together with information of the local charge anisotropy of the resonant ions, we obtained spectroscopic information from the different Cu sites (e.g., chain and plane) throughout the film profile. While most of the film behaves bulk-like, we observe that the Cu-chains at the surface show characteristics of electron doping, whereas the Cu-planes closest to the surface exhibit an orbital reconstruction similar to that observed at La1−xCaxMnO3/YBCO interfaces.
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Affiliation(s)
- J E Hamann-Borrero
- Leibniz Institute for Solid State and Materials Research, IFW Dresden, 01171, Dresden, Germany.
| | - S Macke
- Quantum Matter Institute, University of British Columbia, 2355 East Mall, Vancouver, V6T 1Z4, Canada.,Max Planck Institute for Solid State Research, Heisenbergstraße 1, 70569, Stuttgart, Germany
| | - B Gray
- Department of Physics, University of Arkansas, Fayetteville, Arkansas, 70701, USA
| | - M Kareev
- Department of Physics and Astronomy, Rutgers University, Piscataway, New Jersey, 08854, USA
| | - E Schierle
- Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Str. 15, D-12489, Berlin, Germany
| | - S Partzsch
- Leibniz Institute for Solid State and Materials Research, IFW Dresden, 01171, Dresden, Germany
| | - M Zwiebler
- Leibniz Institute for Solid State and Materials Research, IFW Dresden, 01171, Dresden, Germany
| | - U Treske
- Leibniz Institute for Solid State and Materials Research, IFW Dresden, 01171, Dresden, Germany
| | - A Koitzsch
- Leibniz Institute for Solid State and Materials Research, IFW Dresden, 01171, Dresden, Germany
| | - B Büchner
- Leibniz Institute for Solid State and Materials Research, IFW Dresden, 01171, Dresden, Germany.,Institut für Festkörper- und Materialphysik, TU Dresden, D-01062, Dresden, Germany
| | - J W Freeland
- Advanced Photon Source, Argonne National Laboratory, Argonne, Illinois, 60439, USA
| | - J Chakhalian
- Department of Physics and Astronomy, Rutgers University, Piscataway, New Jersey, 08854, USA
| | - J Geck
- Institut für Festkörper- und Materialphysik, TU Dresden, D-01062, Dresden, Germany.
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Gray B, Gnanappa G, Bagnall R, Yeates L, Ingles J, Burns C, Puranik R, Grieve S, Semsarian C, Sy R. 1216Non-invasive multimodality assessment in brugada Syndrome: insights into pathogenic basis and risk stratification. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1216] [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: 11/13/2022] Open
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Gray B, Hardt EJ. A comparison of the use of interpreters in New Zealand and the US. N Z Med J 2017; 130:70-75. [PMID: 28571051] [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: 06/07/2023]
Abstract
Cultural competency in medicine is not possible unless language differences are addressed effectively. Many disparities that appear to be based on cultural, socioeconomic, demographic and other differences can be reduced or eliminated with the use of qualified medical interpretation and translation in multilingual situations. The development of this precious resource varies from country to country around the world as most developed countries face increasingly diverse groups of immigrants and refugees as well as inclusion of more indigenous groups of patients. The US has been one of the leaders in this area since the 1980s. Countries like New Zealand are in different stages of development and on different pathways. Increased international collaboration may facilitate evolution of cost-effective inclusion of professional medical interpreters as part of multidisciplinary health care teams.
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Affiliation(s)
- Ben Gray
- Senior Lecturer, Department of Primary Health Care & General Practice, University of Otago, Wellington
| | - Eric J Hardt
- Geriatrics Section, Boston Medical Center, Associate Professor of Medicine, Boston University School of Medicine, Boston, USA
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Gray B. Response to case study "A case based reflection on communicating end of life information in non-English speaking patients". Patient Educ Couns 2017; 100:1242-1243. [PMID: 28129929 DOI: 10.1016/j.pec.2017.01.007] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Affiliation(s)
- Ben Gray
- Primary Health Care and General Practice, University of Otago Wellington, P.O. Box 7343, 23A Mein Street, Wellington, 6021, New Zealand.
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Gray B. Unmet need and antenatal care. N Z Med J 2017; 130:133. [PMID: 28494488] [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: 06/07/2023]
Affiliation(s)
- Ben Gray
- Senior Lecturer, Primary Healthcare and General Practice, University of Otago, Wellington
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Abstract
The debate around the ethics of homeopathy in recent issues of the journal has been approached as a binary question; is homeopathy ethical or not? This paper suggests that this is an unhelpful question and instead discusses a framework to establish the extent to which the dominant (medical) culture should tolerate non-dominant health practices such as homeopathy. This requires a sophisticated understanding of the placebo effect, a critical evaluation of what evidence is available, a consideration of the harm that the non-dominant practice might cause, and a consideration of how this might be affected by the culture of the patient. This is presented as a matter of cultural competence. At a clinical level clinicians need to respect the values and beliefs of their patients and communicate with all the practitioners involved in a patient's care. At a societal level there are a number of factors to be considered when a community decides which practices to tolerate and to what extent.
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Affiliation(s)
- Ben Gray
- Otago University Wellington, 23A Mein Street, Newtown, Wellington, 6021, New Zealand.
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Gray B. Not-for-profit health services and hybridisation. J Prim Health Care 2017. [DOI: 10.1071/hc17021] [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: 11/23/2022] Open
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Hilder J, Gray B, Dowell A, Macdonald L, Tester R, Stubbe M. ‘It depends on the consultation’: revisiting use of family members as interpreters for general practice consultations – when and why? Aust J Prim Health 2017; 23:257-262. [DOI: 10.1071/py16053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/24/2016] [Indexed: 11/23/2022]
Abstract
Family members continue to be used as interpreters in medical consultations despite the well-known risks. This paper examines participant perceptions of this practice in three New Zealand clinics chosen for their frequent use of interpreters and their skill in using them. It is based on a detailed study of 17 video-recorded interpreted consultations and 48 post-consultation interviews with participants (5 doctors, 16 patients and 12 interpreters, including 6 family members). All participants expressed satisfaction with the communication. Analysis of the interviews explored what participants liked or valued about family member interpreters (FMIs). Key themes were the FMIs’ personal relationship and knowledge, patient comfort, trust, cultural norms, time efficiency and continued help outside the consultation. General practitioners (GPs) expressed awareness of potential risks and how to manage them, in contrast to patients and FMIs. Although the use of professional interpreters needs to be strongly promoted, a well-informed decision to use a family member is appropriate in some situations. GPs need to be well trained in how to assess and manage the risks. Rather than striving for ‘best practice’ (i.e. universal use of professional interpreters), it is better to aim for ‘good practice’ where a considered judgement is made about each situation on an individual basis.
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Pullon S, Morgan S, Macdonald L, McKinlay E, Gray B. Observation of interprofessional collaboration in primary care practice: A multiple case study. J Interprof Care 2016; 30:787-794. [DOI: 10.1080/13561820.2016.1220929] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Gray B, Hubbard J. A New Perspective to Predict Resting Energy Requirements Using a Validated Activity Questionnaire. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.246] [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: 12/01/2022]
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Gray B, Bagnall R, Lam L, Ingles J, Turner C, Haan E, Davis A, Yang P, Clancy C, Sy R, Semsarian C. A Novel Heterozygous Mutation in Cardiac Calsequestrin Causes Catecholaminergic Polymorphic Ventricular Tachycardia. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Allahwala U, Namkoong J, Gray B, Soo Hoo S, Choong C, Bhindi R, Tofler G. Acute Pericarditis: Predictors of the Presence of a Pericardial Effusion – The Experience in a Tertiary Centre. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.170] [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: 11/15/2022]
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Gray B. English as a second language and outcomes of patients presenting with acute coronary syndromes: results from the CONCORDANCE registry. Med J Aust 2016; 205:140. [DOI: 10.5694/mja16.00483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/20/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Ben Gray
- University of Otago Wellington, Wellington, New Zealand
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Abstract
Purpose: Aneurysms of the upper extremity arteries are uncommon and may be difficult to manage with standard surgical techniques. We report the exclusion of three axillary-subclavian aneurysms with covered stents. Methods and Results: Palmaz stents were covered with either polytetrafluoroethylene (2 cases) or brachial vein and deployed to exclude pseudoaneurysms in 1 axillary (ruptured) and 2 left subclavian arteries. Two of the patients had advanced cancer and died within 52 days and 3 months of treatment, but their aneurysms were occluded at the time of their death. The repair in the third patient is patent at 9 months. Conclusions: Endovascular exclusion of axillary and subclavian aneurysms with covered stents may offer a useful alternative to operative repair, particularly in patients with significant comorbidities.
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Affiliation(s)
- T M Sullivan
- Department of Vascular Surgery, Cleveland Clinic Foundation, Ohio 44195, USA
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Abstract
Research ethics guidelines grew out of several infamous episodes where research subjects were exploited. There is significant international synchronization of guidelines. However, indigenous groups in New Zealand, Canada and Australia have criticized these guidelines as being inadequate for research involving indigenous people and have developed guidelines from their own cultural perspectives. Whilst traditional research ethics guidelines place a lot of emphasis on informed consent, these indigenous guidelines put much greater emphasis on interdependence and trust. This article argues that traditional guidelines are premised on relationships of equal power, and that often the researcher has more power that is not fully equalized by providing information. Where there is a relationship of unequal power, then focusing on interdependence and trust is more likely to achieve ethical safety. We illustrate this thesis by describing the detail of a research project looking at the use of interpreters, where we video-recorded live consultations and then interviewed the patient, interpreter and doctor. We conclude by suggesting that mainstream research ethics guidelines should pay more attention to the development of a trustworthy relationship between subject and researcher, and that, following the lead from clinical medicine, we should develop a culturally competent ethical framework for research on human subjects.
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Affiliation(s)
- Ben Gray
- Primary Health Care and General Practice Department, University of Otago, Wellington, New Zealand
| | - Jo Hilder
- Primary Health Care and General Practice Department, University of Otago, Wellington, New Zealand
| | - Lindsay Macdonald
- Primary Health Care and General Practice Department, University of Otago, Wellington, New Zealand
| | - Rachel Tester
- Primary Health Care and General Practice Department, University of Otago, Wellington, New Zealand
| | - Anthony Dowell
- Primary Health Care and General Practice Department, University of Otago, Wellington, New Zealand
| | - Maria Stubbe
- Primary Health Care and General Practice Department, University of Otago, Wellington, New Zealand
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