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Bartosch C, Nadal A, Braga AC, Salerno A, Rougemont AL, Van Rompuy AS, Fitzgerald B, Joyce C, Allias F, Maher GJ, Turowski G, Tille JC, Alsibai KD, Van de Vijver K, McMahon L, Sunde L, Pyzlak M, Downey P, Wessman S, Patrier S, Kaur B, Fisher R. Practical guidelines of the EOTTD for pathological and genetic diagnosis of hydatidiform moles. Virchows Arch 2024; 484:401-422. [PMID: 37857997 DOI: 10.1007/s00428-023-03658-8] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/30/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
Hydatidiform moles are rare and thus most pathologists and geneticists have little experience with their diagnosis. It is important to promptly and correctly identify hydatidiform moles given that they are premalignant disorders associated with a risk of persistent gestational trophoblastic disease and gestational trophoblastic neoplasia. Improvement in diagnosis can be achieved with uniformization of diagnostic criteria and establishment of algorithms. To this aim, the Pathology and Genetics Working Party of the European Organisation for Treatment of Trophoblastic Diseases has developed guidelines that describe the pathological criteria and ancillary techniques that can be used in the differential diagnosis of hydatidiform moles. These guidelines are based on the best available evidence in the literature, professional experience and consensus of the experts' group involved in its development.
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Affiliation(s)
- Carla Bartosch
- Department of Pathology, Cancer Biology & Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC) and Centro Hospitalar Universitário S. João, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.
| | - Alfons Nadal
- Department of Pathology, Clínic Barcelona, Department of Basic Clinical Practice, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Ana C Braga
- Department of Pathology, University Hospital Centre of São João (CHUSJ) / Faculty of Medicine - University of Porto (FMUP) / School of Health (ESS) - Polytechnic Institute of Porto (P. PORTO), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Angela Salerno
- Anatomia Patologica, Ospedale Maggiore AUSL Bologna, Bologna, Italy
| | | | | | | | - Caroline Joyce
- Department of Clinical Biochemistry, Cork University Hospital, Ireland/ Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
| | - Fabienne Allias
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Geoffrey J Maher
- Trophoblastic Tumour Screening & Treatment Centre, Imperial College NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Gitta Turowski
- Department of Pathology, Oslo University Hospital, INNPATH Tirolkliniken, Innsbruck, Austria
| | | | - Kinan Drak Alsibai
- Department of Pathology and Center of Biological Resources (CRB Amazonie), Cayenne Hospital Center Andrée Rosemon, 97306, Cayenne, France
| | | | - Lesley McMahon
- Scottish Hydatidiform Mole Follow-Up Service, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Lone Sunde
- Department of Clinical Genetics, Aalborg University Hospital, Denmark/Department of Biomedicine, Aarhus University, Aalborg, Aarhus, Denmark
| | - Michal Pyzlak
- Department of Pathology, Institute of Mother and Child, Warsaw, Poland
| | - Paul Downey
- Department of Pathology, National Maternity Hospital, Dublin, D02YH21, Ireland
| | - Sandra Wessman
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Sophie Patrier
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Baljeet Kaur
- Department of Pathology, North West London Pathology, Imperial College NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Rosemary Fisher
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital. Fulham Palace Road, London, W6 8RF, UK
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Bartosch C, Nadal A, Braga AC, Salerno A, Rougemont AL, Van Rompuy AS, Fitzgerald B, Joyce C, Allias F, Maher GJ, Turowski G, Tille JC, Alsibai KD, Van de Vijver K, McMahon L, Sunde L, Pyzlak M, Downey P, Wessman S, Patrier S, Kaur B, Fisher R. Correction to: Practical guidelines of the EOTTD for pathological and genetic diagnosis of hydatidiform moles. Virchows Arch 2024; 484:539-548. [PMID: 38421406 DOI: 10.1007/s00428-023-03715-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Carla Bartosch
- Department of Pathology, Cancer Biology & Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@ CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC) and Centro HospitalarUniversitário S. João, Rua Dr. António Bernardino de Almeida, 4200‑072, Porto, Portugal.
| | - Alfons Nadal
- Department of Pathology, Clínic Barcelona, Department of Basic Clinical Practice, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Ana C Braga
- Department of Pathology, University Hospital Centre of São João (CHUSJ) / Faculty of Medicine - University of Porto (FMUP) / School of Health (ESS) - Polytechnic Institute of Porto (P. PORTO), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Angela Salerno
- Anatomia Patologica, Ospedale Maggiore AUSL Bologna, Bologna, Italy
| | | | | | | | - Caroline Joyce
- Department of Clinical Biochemistry, Cork University Hospital, Ireland/ Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
| | - Fabienne Allias
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Geoffrey J Maher
- Trophoblastic Tumour Screening & Treatment Centre, Imperial College NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Gitta Turowski
- Department of Pathology, Oslo University Hospital, INNPATH Tirolkliniken, Innsbruck, Austria
| | | | - Kinan Drak Alsibai
- Department of Pathology and Center of Biological Resources (CRB Amazonie), Cayenne Hospital Center Andrée Rosemon, 97306, Cayenne, France
| | | | - Lesley McMahon
- Scottish Hydatidiform Mole Follow‑Up Service, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Lone Sunde
- Department of Clinical Genetics, Aalborg University Hospital, Denmark/Department of Biomedicine, Aarhus University, Aalborg, Aarhus, Denmark
| | - Michal Pyzlak
- Department of Pathology, Institute of Mother and Child, Warsaw, Poland
| | - Paul Downey
- Department of Pathology, National Maternity Hospital, Dublin, D02YH21, Ireland
| | - Sandra Wessman
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Sophie Patrier
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Baljeet Kaur
- Department of Pathology, North West London Pathology, Imperial College NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Rosemary Fisher
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
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Meade T, Joyce C, Perich T, Manolios N, Conaghan PG, Katz P. Prevalence, Severity, and Measures of Anxiety in Rheumatoid Arthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2024; 76:171-180. [PMID: 37779491 DOI: 10.1002/acr.25245] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/07/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Many studies have reported high rates of anxiety in adults with rheumatoid arthritis (RA). The aim of this systematic review was to examine those findings and determine the overall prevalence, severity, and commonly used measures of anxiety in individuals with RA. METHODS Six databases were searched from January 2000 without restrictions on language/location, study design, or gray literature. All identified studies that examined anxiety prevalence and severity in adults with RA, as assessed with clinical diagnostic interview and/or standardized self-report measures, were considered for inclusion. Quality assessment of included studies was conducted using a modified Newcastle-Ottawa Evaluation Scale, and the findings were synthesized via a narrative approach. RESULTS Across the 47 studies (n = 11,085 participants), the sample size ranged from 60 to 1,321 participants with seven studies including healthy controls or groups with other health conditions. The studies were conducted across 23 countries, and anxiety prevalence ranged from 2.4% to 77%, predominantly determined with standardized self-report measures, of which Hospital Anxiety and Depression scale was used most frequently; only eight studies used a clinical diagnostic interview to confirm a specific anxiety diagnosis. Notable associations with anxiety in RA were physical disability, pain, disease activity, depression, and quality of life. CONCLUSION The reported prevalence of anxiety in RA varied widely potentially because of use of different self-report measures and cutoff points. Such cutoff points will need to be standardized to clinical thresholds to inform appropriate interventions for anxiety comorbidity in RA.
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Affiliation(s)
- Tanya Meade
- Western Sydney University, Sydney, New South Wales, Australia
| | - Caroline Joyce
- Western Sydney University, Sydney, New South Wales, Australia
| | - Tania Perich
- Western Sydney University, Sydney, New South Wales, Australia
| | - Nicholas Manolios
- The University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - Phillip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
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Hannon M, Plant WD, Joyce C, Russell NE. Rare case of steroid cell tumour presenting as resistant hypertension in early pregnancy. BMJ Case Rep 2023; 16:e255716. [PMID: 38123321 DOI: 10.1136/bcr-2023-255716] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
A woman 12 weeks and 3 days pregnant was referred to the emergency department with significant hypertension which, despite aggressive medical management, remained uncontrolled. Markedly elevated levels of renin and aldosterone beyond what is typical in early pregnancy were present, which together with the finding of a right ovarian cyst pointed to the possible diagnosis of an extrarenal reninoma.and the decision was made to perform a right-sided oophorectomy at 16 weeks gestation. Histology demonstrated a staining pattern most consistent with a steroid cell tumour leading to the diagnosis of refractory hypertension secondary to an ovarian steroid cell tumour. Post oophorectomy blood biochemistry rapidly returned to normal, and our patient's hypertension slowly resolved allowing for a large reduction in antihypertensive agent requirements and a successful pregnancy outcome.
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Affiliation(s)
- Maura Hannon
- Obstetrics and Gynacology, Cork University Maternity Hospital, Cork, Ireland
| | - William D Plant
- Department of Renal Medicine, Cork University Hospital, Cork, Cork, Ireland
- University College Cork College of Medicine and Health, Cork, Ireland
| | - Caroline Joyce
- Department of Biochemistry, Cork University Hospital, Cork, Ireland
| | - Noirin E Russell
- Obstetrics and Gynacology, Cork University Maternity Hospital, Cork, Ireland
- University College Cork College of Medicine and Health, Cork, Ireland
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Marjadi B, Chiavaroli N, Sorinola O, Milos Nymberg V, Joyce C, Parsons C, Ryan A. Diversity Audit of Medical School Examination Questions. Teach Learn Med 2023:1-9. [PMID: 37553852 DOI: 10.1080/10401334.2023.2240776] [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] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/22/2023] [Accepted: 07/14/2023] [Indexed: 08/10/2023]
Abstract
Phenomenon: This article reports the under-researched presentation of demographic, social, and economic diversity in medical school examination questions. Approach: The present study audited 3,566 pre-clinical and clinical multiple-choice and short answer examination questions in the same year (2018) from three medical schools in two continents to review the diversity of patients portrayed. The audit was based on an extension of Critical Race Theory beyond race and ethnicity to include pertinent social determinants of health. Findings: Patients were presented in 1,537 (43.1%) of the audited examination questions. Apart from age (89.4%) and binary genders (93.9%), other diversity characteristics were rarely portrayed (ethnicity 7.2%, relationship status 1.9%, sexual identity 1.1%, socio-economic status 0.5%, geographic residence 0.1%, disability 0.1%), or not at all (non-binary genders; residency status; religion/spirituality). Insights: While presenting excessive and unnecessary patient characteristics in examination questions should be avoided, the absence of many diversity aspects may reduce examination authenticity and defeat the teaching of diversity in medicine. Medical schools should consider a routine audit and reasonable improvement of the diversity features of patients in examination questions to support teaching and learning activities addressing patients' diversity.
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Affiliation(s)
- Brahmaputra Marjadi
- School of Medicine, Western Sydney University, Campbelltown, Australia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | | | | | - Caroline Joyce
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Carl Parsons
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Anna Ryan
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
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McMahon L, Maher GJ, Joyce C, Niemann I, Fisher R, Sunde L. When to consult a geneticist specialising in gestational trophoblastic disease. Gynecol Obstet Invest 2023:000531218. [PMID: 37245506 DOI: 10.1159/000531218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Gestational trophoblastic disease comprises hydatidiform moles and a rare group of malignancies that derive from trophoblasts. Although there are typical morphological features that may distinguish hydatidiform moles from non-molar products of conception, such features are not always present, especially at early stages of pregnancy. Furthermore, mosaic/chimeric pregnancies and twin pregnancies make pathological diagnosis challenging while trophoblastic tumours can also pose diagnostic problems in terms of their gestational or non-gestational origin. OBJECTIVES To show that ancillary genetic testing can be used to aid diagnosis and clinical management of GTD. METHODS Each author identified cases where genetic testing, including short tandem repeat (STR) genotyping, ploidy analysis, next generation sequencing and immunostaining for p57, the product of the imprinted gene CDKN1C, facilitated accurate diagnosis and improved patient management. Representative cases were chosen to illustrate the value of ancillary genetic testing in different scenarios. OUTCOME Genetic analysis of placental tissue can aid in determining the risk of developing gestational trophoblastic neoplasia, facilitating discrimination between low risk triploid (partial) and high risk androgenetic (complete) moles, discriminating between a hydatidiform mole twinned with a normal conceptus and a triploid conception and identification of androgenetic/biparental diploid mosaicism. STR genotyping of placental tissue and targeted gene sequencing of patients can identify women with an inherited predisposition to recurrent molar pregnancies. Genotyping can distinguish gestational from non-gestational trophoblastic tumours using tissue or circulating tumour DNA, and can also identify the causative pregnancy which is the key prognostic factor for placental site and epithelioid trophoblastic tumours. CONCLUSIONS AND OUTLOOK STR genotyping and P57 immunostaining have been invaluable to the management of gestational trophoblastic disease in many situations. The use of next generation sequencing and of liquid biopsies are opening up new pathways for GTD diagnostics. Development of these techniques has the potential to identify novel biomarkers of GTD and further refine diagnosis.
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Edmiston N, Hu W, Tobin S, Bailey J, Joyce C, Reed K, Mogensen L. Correction: "You're actually part of the team": a qualitative study of a novel transitional role from medical student to doctor. BMC Med Educ 2023; 23:165. [PMID: 36922837 PMCID: PMC10018816 DOI: 10.1186/s12909-023-04127-1] [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: 06/18/2023]
Affiliation(s)
- Natalie Edmiston
- School of Medicine, Western Sydney University, Sydney, Australia.
- University Centre for Rural Health, Lismore, Australia.
| | - Wendy Hu
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Stephen Tobin
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Jannine Bailey
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Caroline Joyce
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Krista Reed
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Lise Mogensen
- School of Medicine, Western Sydney University, Sydney, Australia
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Edmiston N, Hu W, Tobin S, Bailey J, Joyce C, Reed K, Mogensen L. "You're actually part of the team": a qualitative study of a novel transitional role from medical student to doctor. BMC Med Educ 2023; 23:112. [PMID: 36793053 PMCID: PMC9930018 DOI: 10.1186/s12909-023-04084-9] [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] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Optimizing transitions from final year of medical school and into first post graduate year has important implications for students, patients and the health care system. Student experiences during novel transitional roles can provide insights into potential opportunities for final year curricula. We explored the experiences of medical students in a novel transitional role and their ability to continue learning whilst working as part of a medical team. METHODS Novel transitional role for final year medical students were created in partnership by medical schools and state health departments in 2020 in response to the COVID-19 pandemic and the need for a medical surge workforce. Final year medical students from an undergraduate entry medical school were employed as Assistants in Medicine (AiMs) in urban and regional hospitals. A qualitative study with semi-structured interviews at two time points was used to obtain experiences of the role from 26 AiMs. Transcripts were analyzed using deductive thematic analysis with Activity theory as a conceptual lens. RESULTS This unique role was defined by the objective of supporting the hospital team. Experiential learning opportunities in patient management were optimized when AiMs had opportunities to contribute meaningfully. Team structure and access to the key instrument, the electronic medical record, enabled participants to contribute meaningfully, whilst contractual arrangements and payments formalized the obligations to contribute. CONCLUSIONS The experiential nature of the role was facilitated by organizational factors. Structuring teams to involve a dedicated medical assistant position with specific duties and access to the electronic medical record sufficient to complete duties are key to successful transitional roles. Both should be considered when designing transitional roles as placements for final year medical students.
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Affiliation(s)
- Natalie Edmiston
- School of Medicine, Western Sydney University, Sydney, Australia.
- University Centre for Rural Health, Lismore, Australia.
| | - Wendy Hu
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Stephen Tobin
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Jannine Bailey
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Caroline Joyce
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Krista Reed
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Lise Mogensen
- School of Medicine, Western Sydney University, Sydney, Australia
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Dadrass F, Joyce C, Lake E. LB958 A retrospective study of skin biopsy diagnostic accuracy among dermatologists throughout the day: Do physicians experience diagnostic or procedure fatigue? J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.978] [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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Bashir M, Joyce C, Bolduan A, Sehgal V, Smith M, Charous S. Revisiting CT Signs of Unilateral Vocal Fold Paralysis: A Single, Blinded Study. AJNR Am J Neuroradiol 2022; 43:592-596. [PMID: 35332018 PMCID: PMC8993190 DOI: 10.3174/ajnr.a7451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Several CT findings are thought to be indicative of vocal cord paralysis; however, these signs have never been validated in a blinded fashion. This study attempts to compare and validate these signs and determine their accuracy in predicting vocal cord paralysis. MATERIALS AND METHODS A retrospective chart review was performed, and CT scans from patients with known unilateral vocal cord paralysis and known normal vocal cord movement were reviewed by 3 radiologists who were blinded to the status of the patients' laryngeal function. The scans were reviewed and scored for 8 accepted signs of vocal cord paralysis as well as for predicting a final diagnostic conclusion. Statistical analysis using odds ratios for signs and the Fleiss κ for criterion agreement among the radiologists was performed for diagnostic accuracy. RESULTS The presence of medial displacement of the posterior ipsilateral vocal fold margin and ipsilateral laryngeal ventricular dilation yielded the greatest positive predictive value. Other signs demonstrated high specificity, but interrater discrepancy was greater than expected and diminished the reliability of these signs in predicting vocal cord paralysis. Overall, sensitivity and negative predictive values were low. CONCLUSIONS Predicting vocal cord paralysis on the basis of CT findings is not as accurate or straightforward in prospectively predicting vocal cord paralysis as implied in prior studies.
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Affiliation(s)
- M.H. Bashir
- From the Department of Radiology (M.H.B., V.S.)
| | - C. Joyce
- Loyola University Medical Center (C.J.), Maywood, Illinois
| | - A. Bolduan
- Vanderbilt University Medical Center (A.B.), Nashville, Tennessee
| | - V. Sehgal
- From the Department of Radiology (M.H.B., V.S.)
| | - M. Smith
- Diagnostic Imaging Alliance of Louisville (M.S.), Louisville, Kentucky
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Conti J, Joyce C, Natoli S, Skeoch K, Hay P. "I'm still here, but no one hears you": a qualitative study of young women's experiences of persistent distress post family-based treatment for adolescent anorexia nervosa. J Eat Disord 2021; 9:151. [PMID: 34772464 PMCID: PMC8588656 DOI: 10.1186/s40337-021-00496-4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family-based treatment (FBT) is the current treatment of choice for adolescent AN based on positive outcomes that include weight restoration in around two-thirds of adolescents. Nevertheless around a quarter drop-out from treatment, particularly in the earlier phases, and a notable proportion of treated adolescents are reported to experience ongoing psychological distress during and post-treatment. This study explores the under-researched experiences of these adolescents. METHOD Fourteen participants from Australia, New Zealand and the United Kingdom were interviewed about their experiences of FBT. An inductive thematic analysis of interview transcript data generated key themes related to their experiences, identity negotiations and the discursive materials these used to construct these. RESULTS The participants identified working as a family unit as key to their recovery, highlighting the importance of family therapy interventions for adolescent AN. However, they perceived an almost exclusive focus on weight restoration in the first phase of FBT was associated with experiences that included a relative neglect of their psychological distress and a loss of voice. Key within these experiences were processes whereby the adolescent engaged in identity negotiation and (re)claiming of their voice and implicit in their family standing with them in the treatment was that their life was worth saving. What was noted as most helpful was when therapists advocated and took into consideration their unique needs and preferences and tailored treatment interventions to these. CONCLUSIONS There is a need to develop and research treatments that address, from the outset of treatment, the adolescents' psychological distress (including as experienced in the context of their weight restoration). This should be with priority accorded to the adolescent's voice and identity negotiations, as they and their families take steps to address the physical crisis of AN and in doing so, support more holistic and durable recovery.
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Affiliation(s)
- Janet Conti
- School of Psychology and Translational Research Institute, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia.
| | - Caroline Joyce
- School of Psychology, Western Sydney University, Penrith, Australia
| | - Simone Natoli
- School of Psychology, Western Sydney University, Penrith, Australia
| | - Kelsey Skeoch
- School of Psychology, Western Sydney University, Penrith, Australia
| | - Phillipa Hay
- Chair of Mental Health, School of Medicine, Translational Health Research Institute, Western Sydney University, Penrith, Australia
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Edwards T, Banyard H, Pigott B, Haff G, Joyce C. Sprint acceleration profiles of junior Australian football players: Intra-individual determinants of performance. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.177] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zhou J, Azizan EAB, Cabrera CP, Fernandes-Rosa FL, Boulkroun S, Argentesi G, Cottrell E, Amar L, Wu X, O'Toole S, Goodchild E, Marker A, Senanayake R, Garg S, Åkerström T, Backman S, Jordan S, Polubothu S, Berney DM, Gluck A, Lines KE, Thakker RV, Tuthill A, Joyce C, Kaski JP, Karet Frankl FE, Metherell LA, Teo AED, Gurnell M, Parvanta L, Drake WM, Wozniak E, Klinzing D, Kuan JL, Tiang Z, Gomez Sanchez CE, Hellman P, Foo RSY, Mein CA, Kinsler VA, Björklund P, Storr HL, Zennaro MC, Brown MJ. Somatic mutations of GNA11 and GNAQ in CTNNB1-mutant aldosterone-producing adenomas presenting in puberty, pregnancy or menopause. Nat Genet 2021; 53:1360-1372. [PMID: 34385710 PMCID: PMC9082578 DOI: 10.1038/s41588-021-00906-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 06/29/2021] [Indexed: 01/05/2023]
Abstract
Most aldosterone-producing adenomas (APAs) have gain-of-function somatic mutations of ion channels or transporters. However, their frequency in aldosterone-producing cell clusters of normal adrenal gland suggests a requirement for codriver mutations in APAs. Here we identified gain-of-function mutations in both CTNNB1 and GNA11 by whole-exome sequencing of 3/41 APAs. Further sequencing of known CTNNB1-mutant APAs led to a total of 16 of 27 (59%) with a somatic p.Gln209His, p.Gln209Pro or p.Gln209Leu mutation of GNA11 or GNAQ. Solitary GNA11 mutations were found in hyperplastic zona glomerulosa adjacent to double-mutant APAs. Nine of ten patients in our UK/Irish cohort presented in puberty, pregnancy or menopause. Among multiple transcripts upregulated more than tenfold in double-mutant APAs was LHCGR, the receptor for luteinizing or pregnancy hormone (human chorionic gonadotropin). Transfections of adrenocortical cells demonstrated additive effects of GNA11 and CTNNB1 mutations on aldosterone secretion and expression of genes upregulated in double-mutant APAs. In adrenal cortex, GNA11/Q mutations appear clinically silent without a codriver mutation of CTNNB1.
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Affiliation(s)
- Junhua Zhou
- Endocrine Hypertension, Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elena A B Azizan
- Endocrine Hypertension, Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK.
- Department of Medicine, The National University of Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia.
| | - Claudia P Cabrera
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Centre for Translational Bioinformatics, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | | | - Giulia Argentesi
- Endocrine Hypertension, Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Emily Cottrell
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Laurence Amar
- Université de Paris, PARCC, Inserm, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité Hypertension Artérielle, Paris, France
| | - Xilin Wu
- Endocrine Hypertension, Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sam O'Toole
- Endocrine Hypertension, Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Emily Goodchild
- Endocrine Hypertension, Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alison Marker
- Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK
| | - Russell Senanayake
- Metabolic Research Laboratories, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Sumedha Garg
- Endocrine Hypertension, Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Metabolic Research Laboratories, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Tobias Åkerström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Samuel Backman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Suzanne Jordan
- Cellular Pathology Department, Royal London Hospital, London, UK
| | - Satyamaanasa Polubothu
- Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Daniel M Berney
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Anna Gluck
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Kate E Lines
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rajesh V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Antoinette Tuthill
- Department of Endocrinology and Diabetes, Cork University Hospital, Cork, Ireland
| | - Caroline Joyce
- Clinical Biochemistry, Cork University Hospital, Cork, Ireland
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital and University College London Institute of Cardiovascular Science, London, UK
| | - Fiona E Karet Frankl
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Lou A Metherell
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ada E D Teo
- Dept of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Gurnell
- Metabolic Research Laboratories, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Laila Parvanta
- Department of Surgery, St Bartholomew's Hospital, London, UK
| | - William M Drake
- Department of Endocrinology, St Bartholomew's Hospital, London, UK
| | - Eva Wozniak
- Barts and London Genome Centre, School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
| | - David Klinzing
- Cardiovascular Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jyn Ling Kuan
- Cardiovascular Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zenia Tiang
- Cardiovascular Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Celso E Gomez Sanchez
- G.V. (Sonny) Montgomery VA Medical Center and Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Per Hellman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Roger S Y Foo
- Cardiovascular Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Charles A Mein
- Barts and London Genome Centre, School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
| | | | - Peyman Björklund
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Helen L Storr
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Maria-Christina Zennaro
- Université de Paris, PARCC, Inserm, Paris, France.
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France.
| | - Morris J Brown
- Endocrine Hypertension, Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK.
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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14
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Kwak R, Joyce C, Werchniak AE, Lin JY, Tsibris HC. Clinical and histologic features associated with lentigo maligna clearance after imiquimod treatment. J DERMATOL TREAT 2021; 33:1995-1999. [PMID: 34315342 DOI: 10.1080/09546634.2021.1962001] [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: 10/20/2022]
Abstract
BACKGROUND Imiquimod cream may be used as a non-surgical treatment for lentigo maligna or as adjuvant therapy following excision to decrease the risk of recurrence. OBJECTIVES To evaluate histologic and clinical factors associated with clinical clearance of lentigo maligna treated with imiquimod. METHODS We performed a retrospective review of all patients diagnosed with lentigo maligna and treated with imiquimod between 1997 and 2019 at our academic institution. RESULTS We observed clinical clearance in 93% (66/71) of participants who received adjuvant imiquimod following surgery and 79% (19/24) in the primary non-surgical treatment group over a median of 38 months of follow-up. In the adjuvant therapy group, positive surgical margins were associated with a decreased rate of clinical clearance when compared to cases with close (<1 mm) margins or background melanocytic dysplasia (83.3 vs. 100%, p = .01). The presence of an inflammatory response during treatment was associated with increased clearance (94.1 vs. 66.7%, p = .02). CONCLUSIONS Adjuvant imiquimod treatment may decrease LM recurrence rates in cases with background melanocytic dysplasia or close margins. LM cases with positive surgical margins need close clinical follow-up given higher recurrence rates.
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Affiliation(s)
- R Kwak
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - C Joyce
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | | | - J Y Lin
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - H C Tsibris
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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15
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Kaninde A, Grace ML, Joyce C, Taylor NF, Ghataore L, Riordan MF, O’Grady MJ, O’Connell SM. The incidence of transient infantile pseudohypoaldosteronism in Ireland: A prospective study. Acta Paediatr 2021; 110:1257-1263. [PMID: 33245792 DOI: 10.1111/apa.15688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/31/2020] [Accepted: 11/23/2020] [Indexed: 01/20/2023]
Abstract
AIM To review the clinical course, outcome and incidence of infantile salt wasting associated with urinary tract infection (UTI) and/or urinary tract malformation (UTM) over a two-year surveillance period on the island of Ireland. METHODS A two-year (2013-14) prospective surveillance undertaken via the Irish and Ulster Paediatric Surveillance Units. Monthly prepaid postcards were circulated to consultant paediatricians (n = 260) at all paediatric units on the island of Ireland. Infants under one year of age presenting for the first time with hyponatraemia (Na < 130 mmol/L) and/or hyperkalaemia (K > 5.0 mmol/L) associated with urosepsis/UTM were reported. RESULTS All 7 reported patients (6 male) had culture-proven UTI, and 5 (71%) also had an underlying UTM (one diagnosed antenatally). Four (57%) patients had a documented elevated serum aldosterone supporting secondary pseudohypoaldosteronism (PHA) as the underlying diagnosis. Data on aldosterone were not reported in the other 3 patients, but clinical features were suggestive of secondary PHA. The estimated incidence for the Irish population of transient PHA is 1 per 13,200 total live births per year. CONCLUSIONS Salt wasting is a rare complication of UTI, especially if associated with underlying UTM. Boys appear to be at particular risk.
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Affiliation(s)
| | - Mariana L. Grace
- Department of Paediatrics and Child Health Cork University Hospital Cork Ireland
| | - Caroline Joyce
- Department of Clinical Biochemistry Cork University Hospital Cork Ireland
| | - Norman F. Taylor
- Department of Clinical Biochemistry King’s College London London UK
| | - Lea Ghataore
- Principal Clinical Scientist Department of Biochemistry King’s College London London UK
| | - Micheal F. Riordan
- Department of Paediatric Endocrinologist Children’s Health Ireland at Crumlin Dublin Ireland
| | - Michael J. O’Grady
- Department of Paediatrics Regional Hospital Mullingar Co Westmeath Ireland
| | - Susan M. O’Connell
- Department of Paediatric Endocrinologist Children’s Health Ireland at Crumlin Dublin Ireland
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16
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Watson CM, Crinnion LA, Lindsay H, Mitchell R, Camm N, Robinson R, Joyce C, Tanteles GA, Halloran DJO, Pena SDJ, Carr IM, Bonthron DT. Assessing the utility of long-read nanopore sequencing for rapid and efficient characterization of mobile element insertions. J Transl Med 2021; 101:442-449. [PMID: 32989232 DOI: 10.1038/s41374-020-00489-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022] Open
Abstract
Short-read next generation sequencing (NGS) has become the predominant first-line technique used to diagnose patients with rare genetic conditions. Inherent limitations of short-read technology, notably for the detection and characterization of complex insertion-containing variants, are offset by the ability to concurrently screen many disease genes. "Third-generation" long-read sequencers are increasingly being deployed as an orthogonal adjunct technology, but their full potential for molecular genetic diagnosis has yet to be exploited. Here, we describe three diagnostic cases in which pathogenic mobile element insertions were refractory to characterization by short-read sequencing. To validate the accuracy of the long-read technology, we first used Sanger sequencing to confirm the integration sites and derive curated benchmark sequences of the variant-containing alleles. Long-read nanopore sequencing was then performed on locus-specific amplicons. Pairwise comparison between these data and the previously determined benchmark alleles revealed 100% identity of the variant-containing sequences. We demonstrate a number of technical advantages over existing wet-laboratory approaches, including in silico size selection of a mixed pool of amplification products, and the relative ease with which an automated informatics workflow can be established. Our findings add to a growing body of literature describing the diagnostic utility of long-read sequencing.
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Affiliation(s)
- Christopher M Watson
- Yorkshire and North East Genomic Laboratory Hub, Central Lab, St. James's University Hospital, Leeds, LS9 7TF, UK.
- Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, LS9 7TF, UK.
| | - Laura A Crinnion
- Yorkshire and North East Genomic Laboratory Hub, Central Lab, St. James's University Hospital, Leeds, LS9 7TF, UK
- Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - Helen Lindsay
- Yorkshire and North East Genomic Laboratory Hub, Central Lab, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - Rowena Mitchell
- Yorkshire and North East Genomic Laboratory Hub, Central Lab, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - Nick Camm
- Yorkshire and North East Genomic Laboratory Hub, Central Lab, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - Rachel Robinson
- Yorkshire and North East Genomic Laboratory Hub, Central Lab, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - Caroline Joyce
- Department of Endocrinology, Cork University Hospital, Wilton, Cork, Ireland
| | - George A Tanteles
- Department of Clinical Genetics, The Cyprus Institute of Neurology and Genetics, 6 International Airport Avenue, PO Box 23462, CY1683, Nicosia, Cyprus
| | | | | | - Ian M Carr
- Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - David T Bonthron
- Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, LS9 7TF, UK
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17
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Conti JE, Joyce C, Hay P, Meade T. "Finding my own identity": a qualitative metasynthesis of adult anorexia nervosa treatment experiences. BMC Psychol 2020; 8:110. [PMID: 33092638 PMCID: PMC7583290 DOI: 10.1186/s40359-020-00476-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background The aim of this metasynthesis was to explore adult anorexia nervosa (AN) treatment experiences, including facilitators and barriers to treatment engagement and ways that questions of identity and personal agency were negotiated in treatment contexts.
Methods From 14 qualitative studies that met the search criteria, this thematic synthesis analyzed the sensitized concept of identity in the participants’ experiences of AN treatments, including their sense of personal agency, and implications for their recovery. The study was registered with Prospero (ID: CRD42018089259) and is reported according to PRISMA guidelines. Results Three meta-themes were generated with the following key findings: grappling with identity, where collaborative and tailored interventions were positively experienced; the quality of the therapeutic relationship, which existed in a recursive relationship; and, rebuilding identity that included therapists standing with the person in recovering a sense of identity outside the anorexic identity. Importantly, interventions that failed to be negotiated with the person were experienced as disempowering however, where a two-way trust existed in the therapeutic relationship, it critically empowered and shaped participants’ sense of identity, and broadened the perception that they were valuable as a person. Conclusions There was consensus across the range of treatment contexts that individuals with a lived AN experience preferred treatments where they experienced (1) a sense of personal agency through tailored interventions; and (2) therapists who treated them as a person who, in the face of their struggles, had skills and capacities in the processes of recovering and rebuilding sustainable and preferred identities outside the AN identity.
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Affiliation(s)
- Janet E Conti
- School of Psychology, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia. .,Translational Health Research Institute, Western Sydney University, Penrith, Australia.
| | - Caroline Joyce
- School of Medicine, Western Sydney University, Penrith, Australia
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Penrith, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Tanya Meade
- School of Psychology, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia
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18
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Gomez-Perez S, Barrett R, Bojko M, Buzzi G, Smith A, O'Connor P, Sclamberg J, Rao R, Cobleigh M, Joyce C, Lomasney L, Vasilopoulos V, Sheean P. Prevalence of Sarcopenia in Women with Metastatic Breast Cancer. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.241] [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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19
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Bojko M, Barrett R, Morales-Perez M, Buzzi G, Smith A, Klein E, Usha L, Swoboda A, O'Connor P, Joyce C, Lomasney L, Sheean P, Gomez-Perez S. Adherence to American Cancer Society (ACS) Guidelines in Women with Metastatic Breast Cancer. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.200] [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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20
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Kwak R, Joyce C, Werchniak A, Lin J, Tsibris H. LB958 Imiquimod treatment of lentigo maligna with positive margins, close margins, or field of dysplasia. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.05.053] [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: 10/24/2022]
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21
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Kwak P, Wesolowoski M, Baker K, Joyce C, Lowery E. Use of Cyclosporine Leads to Poorer Outcomes in Patients with Cystic Fibrosis Following Lung Transplant. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.725] [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] Open
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22
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Hartman R, Xue Y, Singer S, Markossian T, Joyce C, Mostaghimi A. Modelling the value of risk‐stratified skin cancer screening of asymptomatic patients by dermatologists. Br J Dermatol 2020; 183:509-515. [DOI: 10.1111/bjd.18816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 12/11/2022]
Affiliation(s)
- R.I. Hartman
- Department of Dermatology Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - Y. Xue
- Harvard Combined Dermatology Residency Training Program Boston MA USA
| | - S. Singer
- Department of Dermatology Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - T.W. Markossian
- Department of Public Health Sciences Loyola University Stritch School of Medicine Chicago IL USA
| | - C. Joyce
- Department of Public Health Sciences Loyola University Stritch School of Medicine Chicago IL USA
| | - A. Mostaghimi
- Department of Dermatology Brigham and Women's Hospital and Harvard Medical School Boston MA USA
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23
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Zameer M, Iqbal S, Macanovic B, Clarke DB, Joyce C, O’Reilly S, Bambury R, Power D, Collins D. Feasibility and impact of prospective DPYD screening in the Irish population. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.125] [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: 11/14/2022] Open
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24
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Elman SA, Joyce C, Costenbader KH, Merola JF. Time to progression from discoid lupus erythematosus to systemic lupus erythematosus: a retrospective cohort study. Clin Exp Dermatol 2019; 45:89-91. [PMID: 31120600 DOI: 10.1111/ced.14014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 11/29/2022]
Abstract
Determining the risk of progression to systemic lupus erythematosus (SLE) among patients diagnosed with discoid lupus erythematosus (DLE), and the time frame of this risk, are important clinical questions. Past reports have demonstrated a wide time frame of progression from DLE to SLE, with mean time to progression of approximately 8 years. Using data obtained from an academic lupus centre, we identified 32 patients who progressed from DLE to SLE. In our cohort, we found that the median time to progression from DLE to SLE was 453 days, much sooner than previously reported. We believe this information can help inform clinicians on monitoring visit intervals and how best to counsel patients on SLE progression.
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Affiliation(s)
- S A Elman
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - C Joyce
- Loyola University, Chicago, IL, USA
| | - K H Costenbader
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - J F Merola
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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25
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Hartman R, Xue Y, Karmouta R, Joyce C, Mostaghimi A. 270 Development and validation of a simple model to predict the risk of keratinocyte carcinoma on screening total body skin examination. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.346] [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: 10/27/2022]
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26
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Boots RJ, Joyce C, Mullany DV, Anstey C, Blackwell N, Garrett PM, Gillis S, Alexander N. Near-Hanging as Presenting to Hospitals in Queensland: Recommendations for Practice. Anaesth Intensive Care 2019; 34:736-45. [PMID: 17183891 DOI: 10.1177/0310057x0603400610] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Near-hanging is an increasing presentation to hospitals in Australasia. We reviewed the clinical management and outcome of these patients as they presented to public hospitals in Queensland. A retrospective clinical record audit was made at five public hospitals between 1991 and 2000. Of 161 patients enrolled, 82% were male, 8% were indigenous and 10% had made a previous hanging attempt. Chronic medical illnesses were documented in 11% and previous psychiatric disorders in 42%. Of the 38 patients with a Glasgow Coma Scale score (GCS) of 3 on arrival at hospital, 32% returned to independent living and 63% died. Fifty-two patients received CPR, of whom 46% had an independent functional outcome. Independent predictors of mortality were a GCS on hospital arrival of 3 (AOR 150, CI 95% 12.4–1818, P<0.001), taking plain X-rays of the cervical spine (AOR 0.06, CI 95% 0.004–0.97, P=0.047) and contact with the ground (AOR 0.03, CI 95% 0.002–0.62, P=0.02). Only 66% had imaging of the cervical spine performed with other imaging performed infrequently. There were three laryngeal, two hyoid bone and three cervical spine injuries and one carotid dissection. The number of cervical spine X-rays required to find a significant cervical spine fracture was 54. Near-hanging presenting to hospital with a poor conscious state or even cardiac arrest can have a favourable clinical outcome. Radiological investigations are infrequently performed despite a low GCS precluding early accurate assessment. Given the general favourable outcome, an aggressive approach to searching for correctable injuries is recommended.
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Affiliation(s)
- R J Boots
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane
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27
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Logan CV, Murray JE, Parry DA, Robertson A, Bellelli R, Tarnauskaitė Ž, Challis R, Cleal L, Borel V, Fluteau A, Santoyo-Lopez J, Aitman T, Barroso I, Basel D, Bicknell LS, Goel H, Hu H, Huff C, Hutchison M, Joyce C, Knox R, Lacroix AE, Langlois S, McCandless S, McCarrier J, Metcalfe KA, Morrissey R, Murphy N, Netchine I, O’Connell SM, Olney AH, Paria N, Rosenfeld JA, Sherlock M, Syverson E, White PC, Wise C, Yu Y, Zacharin M, Banerjee I, Reijns M, Bober MB, Semple RK, Boulton SJ, Rios JJ, Jackson AP, Aitman TJ, Biankin AV, Cooke SL, Humphrey WI, Martin S, Mennie L, Meynert A, Miedzybrodzka Z, Murphy F, Nourse C, Santoyo-Lopez J, Semple CA, Williams N. DNA Polymerase Epsilon Deficiency Causes IMAGe Syndrome with Variable Immunodeficiency. Am J Hum Genet 2018; 103:1038-1044. [PMID: 30503519 PMCID: PMC6288413 DOI: 10.1016/j.ajhg.2018.10.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/26/2018] [Indexed: 01/19/2023] Open
Abstract
During genome replication, polymerase epsilon (Pol ε) acts as the major leading-strand DNA polymerase. Here we report the identification of biallelic mutations in POLE, encoding the Pol ε catalytic subunit POLE1, in 15 individuals from 12 families. Phenotypically, these individuals had clinical features closely resembling IMAGe syndrome (intrauterine growth restriction [IUGR], metaphyseal dysplasia, adrenal hypoplasia congenita, and genitourinary anomalies in males), a disorder previously associated with gain-of-function mutations in CDKN1C. POLE1-deficient individuals also exhibited distinctive facial features and variable immune dysfunction with evidence of lymphocyte deficiency. All subjects shared the same intronic variant (c.1686+32C>G) as part of a common haplotype, in combination with different loss-of-function variants in trans. The intronic variant alters splicing, and together the biallelic mutations lead to cellular deficiency of Pol ε and delayed S-phase progression. In summary, we establish POLE as a second gene in which mutations cause IMAGe syndrome. These findings add to a growing list of disorders due to mutations in DNA replication genes that manifest growth restriction alongside adrenal dysfunction and/or immunodeficiency, consolidating these as replisome phenotypes and highlighting a need for future studies to understand the tissue-specific development roles of the encoded proteins.
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28
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Lockwood S, Li D, Butler D, Tsiaras W, Joyce C, Mostaghimi A. The validity of the diagnostic code for pyoderma gangrenosum in an electronic database. Br J Dermatol 2018; 179:216-217. [DOI: 10.1111/bjd.16446] [Citation(s) in RCA: 11] [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: 11/26/2022]
Affiliation(s)
- S.J. Lockwood
- Clinical Unit for Research Trials in Skin; Department of Dermatology; Massachusetts General Hospital; Harvard Medical School; Boston MA U.S.A
| | - D.G. Li
- Department of Dermatology; Brigham and Women's Hospital; Boston MA U.S.A
| | - D. Butler
- Department of Dermatology; Brigham and Women's Hospital; Boston MA U.S.A
| | - W. Tsiaras
- Department of Dermatology; Brigham and Women's Hospital; Boston MA U.S.A
| | - C. Joyce
- Loyola University Chicago Department of Public Health Sciences; Chicago IL U.S.A
| | - A. Mostaghimi
- Department of Dermatology; Brigham and Women's Hospital; Boston MA U.S.A
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Hartman R, Xue Y, Markossian T, Joyce C, Mostaghimi A. 253 Modeling the value of risk stratified skin cancer screening by dermatologists in the U.S. population. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.259] [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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Deane FP, Gonsalvez C, Joyce C, Britt E. Developmental trajectories of competency attainment amongst clinical psychology trainees across field placements. J Clin Psychol 2018. [PMID: 29537080 DOI: 10.1002/jclp.22619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/07/2022]
Abstract
OBJECTIVE This research aimed to describe the developmental trajectories of clinical psychology trainees across competency domains over multiple placements. METHOD Competency reviews of 252 trainees were completed at mid-placement and end-placement for up to four consecutive placements by 143 field supervisors. Competency was measured across multiple domains using the Clinical Psychology Practicum Competencies Rating Scale. RESULTS There was an overall ascending stepped pattern occurring across all competency domains from early to late placements. The starting point of competency ratings varied across domains with the largest discrepancy between Response to supervision (highest) and Intervention competencies (lowest). There were significant increases from mid-placement to end-placement for all competencies within each of the four placements. There were few significant decreases in competency between different placements and these were largely restricted to the transition from placement one to placement two. CONCLUSIONS This research has the potential to be used as a benchmark to indicate expected levels of competency attainment for trainees across their training, allowing for early identification of difficulties and more targeted remediation plans.
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Affiliation(s)
- Frank P Deane
- School of Psychology, University of Wollongong.,Illawarra Institute for Mental Health, University of Wollongong
| | - Craig Gonsalvez
- School of Social Sciences and Psychology, Western Sydney University
| | - Caroline Joyce
- School of Social Sciences and Psychology, Western Sydney University
| | - Eileen Britt
- Department of Psychology, University of Canterbury
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White K, Scott IA, Bernard A, McCulloch K, Vaux A, Joyce C, Sullivan CM. Patient characteristics, interventions and outcomes of 1151 rapid response team activations in a tertiary hospital: a prospective study. Intern Med J 2017; 46:1398-1406. [PMID: 27600063 DOI: 10.1111/imj.13248] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 06/30/2016] [Revised: 08/23/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The characteristics of mature contemporary rapid response systems are unclear. AIM To determine the patient characteristics, processes and outcomes, both in-hospital and post-discharge, of a well-established rapid response system in a tertiary adult hospital. METHODS This is a prospective study of consecutive rapid response team (RRT) activations between 1 July and 25 November 2015. Variables included patient characteristics, timing, location and triggers of RRT activations, interventions undertaken, mortality and readmission status at 28 days post-discharge. RESULTS A total of 1151 RRT activations was analysed (69.1 per 1000 admissions), involving 800 patients, of whom 81.5% were emergency admissions. A total of 351 (30.5%) activations comprised repeat activations for the same patient. Most activations (723; 62.8%) occurred out of hours, and 495 (43%) occurred within 48 h of admission. Hypotension, decreased level of consciousness and oxygen desaturation were the most common triggers. Advanced life support was undertaken in less than 7%; 198 (17.2%) responses led to transfer to higher-level care units. Acute resuscitation plans were noted for only 29.1% of RRT activations, with 80.3% stipulating supportive care only. A total of 103 (12.6%) patients died in hospital, equalling 14 deaths per 100 RRT activations. At 28 days, 150 (18.8%) patients had died, significantly more among those with multiple versus single RRT activations (24.9 vs 16.6%; odds ratio 1.66, 95% confidence interval 1.31-2.44; P = 0.013). CONCLUSION Relatively few RRT activations are associated with acute resuscitation plans, and most interventions during RRT responses are low level. The high rate of post-RRT deaths and transfers to higher-level care units calls for the prospective identification of such patients in targeting appropriate care.
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Affiliation(s)
- K White
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - I A Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - A Bernard
- Queensland Facility for Advanced Bioinformatics, Brisbane, Queensland, Australia
| | - K McCulloch
- Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - A Vaux
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - C Joyce
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - C M Sullivan
- Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Hutten R, Surucu M, Joyce C, Alite F, Stang K, Small C, Sethi A, Emami B, Harkenrider M. Association of Lung Stereotactic Body Radiation Therapy Conformality Index and Posttreatment Radiation Pneumonitis in Early Stage Non–small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1711] [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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Earley C, Joyce C, McElvaney J, Richards D, Timulak L. Preventing depression: Qualitatively examining the benefits of depression-focused iCBT for participants who do not meet clinical thresholds. Internet Interv 2017; 9:82-87. [PMID: 30135841 PMCID: PMC6096201 DOI: 10.1016/j.invent.2017.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/01/2017] [Indexed: 01/19/2023] Open
Abstract
•First qualitative study on the benefits of iCBT for those who do not meet clinical thresholds•Successful application of cognitive and behavioural strategies reported•Increased insight/awareness and improved self-efficacy reported•The format of online delivery was reported as helpful.•Findings align with previous face-to-face and iCBT treatments.
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Affiliation(s)
- C. Earley
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Ireland
| | - C. Joyce
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
| | - J. McElvaney
- School of Psychology, Trinity College Dublin, Ireland
| | - D. Richards
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Ireland
| | - L. Timulak
- School of Psychology, Trinity College Dublin, Ireland
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Charrow A, Xia F, Lu J, Waul M, Joyce C, Mostaghimi A. 384 iPledge disproportionately affects women, minorities, and low-income patients: a retrospective-cohort study. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.401] [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: 11/26/2022]
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Joyce C, Honey E, Leekam SR, Barrett SL, Rodgers J. Anxiety, Intolerance of Uncertainty and Restricted and Repetitive Behaviour: Insights Directly from Young People with ASD. J Autism Dev Disord 2017; 47:3789-3802. [DOI: 10.1007/s10803-017-3027-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [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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Hanley A, Walsh KA, Joyce C, McLellan MA, Clauss S, Hagen A, Shea MA, Tucker NR, Lin H, Fahy GJ, Ellinor PT. Mutation of a common amino acid in NKX2.5 results in dilated cardiomyopathy in two large families. BMC Med Genet 2016; 17:83. [PMID: 27855642 PMCID: PMC5114776 DOI: 10.1186/s12881-016-0347-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/10/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND The genetic basis for dilated cardiomyopathy (DCM) can be difficult to determine, particularly in familial cases with complex phenotypes. Next generation sequencing may be useful in the management of such cases. METHODS We report two large families with pleiotropic inherited cardiomyopathy. In addition to DCM, the phenotypes included atrial and ventricular septal defects, cardiac arrhythmia and sudden death. Probands underwent whole exome sequencing to identify potentially causative variants. RESULTS Each whole exome sequence yielded over 18,000 variants. We identified distinct mutations affecting a common amino acid in NKX2.5. Segregation analysis of the families support the pathogenic role of these variants. CONCLUSION Our study emphasizes the utility of next generation sequencing in identifying causative mutations in complex inherited cardiac disease. We also report a novel pathogenic NKX2.5 mutation.
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Affiliation(s)
- Alan Hanley
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Populations Genetics, Broad Institute, Cambridge, MA, USA
| | | | | | - Michael A McLellan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Sebastian Clauss
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Amaya Hagen
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Marisa A Shea
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nathan R Tucker
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Populations Genetics, Broad Institute, Cambridge, MA, USA
| | - Honghuang Lin
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Patrick T Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA. .,Program in Medical and Populations Genetics, Broad Institute, Cambridge, MA, USA.
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Dommasch E, Joyce C, Mostaghimi A. 158 Trends in emergency department visits for herpes zoster from 2006-2012. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.185] [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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Mahon N, Joyce C, Joyce K, Dockery P, Kelly J. A novel barbed suture tie-over dressing for skin grafts: a comparison with traditional techniques. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.126] [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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39
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Mahon N, Joyce C. The 50 most cited papers in cleft lip and palate. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.050] [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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Ponsford M, Carne E, Kingdon C, Joyce C, Price C, Williams C, El-Shanawany T, Williams P, Jolles S. Facilitated subcutaneous immunoglobulin (fSCIg) therapy--practical considerations. Clin Exp Immunol 2015; 182:302-13. [PMID: 26288095 DOI: 10.1111/cei.12694] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 12/30/2022] Open
Abstract
There is an increasing range of therapeutic options for primary antibody-deficient patients who require replacement immunoglobulin. These include intravenous immunoglobulin (IVIg), subcutaneous immunoglobulin (SCIg), rapid push SCIg and most recently recombinant human hyaluronidase-facilitated SCIg (fSCIg). Advantages of fSCIg include fewer needle punctures, longer infusion intervals and an improved adverse effect profile relative to IVIg. Limited real-life experience exists concerning the practical aspects of switching or starting patients on fSCIg. We describe the first 14 patients who have been treated with fSCIg at the Immunodeficiency Centre for Wales (ICW), representing more than 6 patient-years of experience. The regimen was well tolerated, with high levels of satisfaction and no increase in training requirement, including for a treatment-naive patient. Two patients discontinued fSCIg due to pain and swelling at the infusion site, and one paused therapy following post-infusion migraines. Ultrasound imaging of paired conventional and facilitated SCIg demonstrated clear differences in subcutaneous space distribution associated with a 10-fold increase in rate and volume delivery with fSCIg. Patient profiles for those choosing fSCIg fell into two main categories: those experiencing clinical problems with their current treatment and those seeking greater convenience and flexibility. When introducing fSCIg, consideration of the type and programming of infusion pump, needle gauge and length, infusion site, up-dosing schedule, home training and patient information are important, as these may differ from conventional SCIg. This paper provides guidance on practical aspects of the administration, training and outcomes to help inform decision-making for this new treatment modality.
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Affiliation(s)
- M Ponsford
- Immunodeficiency Centre for Wales, Department of Immunology
| | - E Carne
- Immunodeficiency Centre for Wales, Department of Immunology
| | - C Kingdon
- Immunodeficiency Centre for Wales, Department of Immunology
| | - C Joyce
- Immunodeficiency Centre for Wales, Department of Immunology
| | - C Price
- Immunodeficiency Centre for Wales, Department of Immunology
| | - C Williams
- Department of Radiology, University Hospital of Wales, Cardiff, UK
| | - T El-Shanawany
- Immunodeficiency Centre for Wales, Department of Immunology
| | - P Williams
- Immunodeficiency Centre for Wales, Department of Immunology
| | - S Jolles
- Immunodeficiency Centre for Wales, Department of Immunology
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O'Connell SM, Proks P, Kramer H, Mattis KK, Sachse G, Joyce C, Houghton JAL, Ellard S, Hattersley AT, Ashcroft FM, O'Riordan SMP. The value of in vitro studies in a case of neonatal diabetes with a novel Kir6.2-W68G mutation. Clin Case Rep 2015; 3:884-7. [PMID: 26509030 PMCID: PMC4614663 DOI: 10.1002/ccr3.370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/19/2015] [Accepted: 08/06/2015] [Indexed: 11/20/2022] Open
Abstract
In infants, especially with novel previously undescribed mutations of the KATP channel causing neonatal diabetes, in vitro studies can be used to both predict the response to sulphonylurea treatment and support a second trial of glibenclamide at higher than standard doses if the expected response is not observed.
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Affiliation(s)
- Susan M O'Connell
- Department of Paediatrics and Child Health, Cork University Hospital Cork, Ireland
| | - Peter Proks
- Department of Physiology Anatomy & Genetics Parks Road, University of Oxford Oxford, OX1 3PT, UK
| | - Holger Kramer
- Department of Physiology Anatomy & Genetics Parks Road, University of Oxford Oxford, OX1 3PT, UK
| | - Katia K Mattis
- Department of Physiology Anatomy & Genetics Parks Road, University of Oxford Oxford, OX1 3PT, UK
| | - Gregor Sachse
- Department of Physiology Anatomy & Genetics Parks Road, University of Oxford Oxford, OX1 3PT, UK
| | - Caroline Joyce
- Department of Biochemistry, Cork University Hospital Cork, Ireland
| | - Jayne A L Houghton
- Institute of Biomedical and Clinical Science, University of Exeter Medical School Exeter, EX2 5AD, UK
| | - Sian Ellard
- Institute of Biomedical and Clinical Science, University of Exeter Medical School Exeter, EX2 5AD, UK
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School Exeter, EX2 5AD, UK
| | - Frances M Ashcroft
- Department of Physiology Anatomy & Genetics Parks Road, University of Oxford Oxford, OX1 3PT, UK
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Casey R, Garrahy A, Tuthill A, O'Halloran D, Joyce C, Casey MB, O'Shea P, Bell M. Universal genetic screening uncovers a novel presentation of an SDHAF2 mutation. J Clin Endocrinol Metab 2014; 99:E1392-6. [PMID: 24712571 DOI: 10.1210/jc.2013-4536] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
CONTEXT Hereditary pheochromocytoma/paraganglioma (PC/PGL) accounts for up to 60% of previously considered sporadic tumors. Guidelines suggest that phenotype should guide genetic testing. Next-generation sequencing technology can simultaneously sequence 9 of the 18 known susceptibility genes in a timely, cost-efficient manner. OBJECTIVE Our aim was to confirm that universal screening is superior to targeted testing in patients with histologically confirmed PC and PGL. METHODS In two tertiary referral hospitals in Ireland, NGS was carried out on all histologically confirmed cases of PC/PGL diagnosed between 2004 and 2013. The following susceptibility genes were sequenced: VHL, RET, SDHA, SDHB, SDHC, SDHD, SDHAF2, TMEM127, and MAX. A multiplex ligation-dependent probe amplification analysis was performed in VHL, SDHB, SDHC, SDHD, and SDHAF2 genes to detect deletions and duplications. RESULTS A total of 31 patients were tested, 31% (n = 10) of whom were found to have a genetic mutation. Of those patients with a positive genotype, phenotype predicted genotype in only 50% (n = 5). Significant genetic mutations that would have been missed in our cohort by phenotypic evaluation alone include a mutation in TMEM127, two mutations in SDHAF2, and two mutations in RET. Target testing would have identified three of the latter mutations based on age criteria. However, 20% of patients (n = 2) would not have satisfied any criteria for targeted testing including one patient with a novel presentation of an SDHAF2 mutation. CONCLUSION This study supports the value of universal genetic screening for all patients with PC/PGL.
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Affiliation(s)
- Ruth Casey
- Departments of Endocrinology (R.C., A.G., M.B.), Pathology (M.B.C.), and Clinical Biochemistry (P.O.), Galway University Hospital, Galway, Ireland; and Departments of Endocrinology (A.T., D.O.) and Clinical Biochemistry (C.J.), Cork University Hospital, Cork, Ireland
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Khalid AS, Marchocki Z, Hayes K, Lutomski JE, Joyce C, Stapleton M, O’Mullane J, O’Donoghue K. Establishing trimester-specific maternal thyroid function reference intervals. Ann Clin Biochem 2013; 51:277-83. [DOI: 10.1177/0004563213496394] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Thyroid disorders are common in women of childbearing age and are associated with adverse pregnancy outcomes. Physiological changes in pregnancy and the lack of pregnancy-specific reference ranges make managing thyroid disorders in pregnancy challenging. Our aim was to establish trimester-specific thyroid function reference intervals throughout pregnancy, and to examine the prevalence of thyroid autoimmunity in otherwise euthyroid women. Method This was a prospective, cross-sectional study of thyroid function tests (TFTs) in pregnant women attending a large, tertiary referral maternity hospital. Patients with known thyroid disorders, autoimmune disease, recurrent miscarriage, hyperemesis gravidarum and pre-eclampsia were excluded. TFTs were analysed in the CUH biochemistry laboratory using Roche Modular E170 electrochemiluminescent immunoassay. Trimester-specific reference ranges (2.5th, 50th and 97.5th centiles) were calculated. Results Three-hundred-and-fifty-one women were included into the analysis. Median maternal age was 30. Thyroid-stimulating hormone concentrations showed slightly increasing median centile throughout gestation. Free thyroxine (T4) and T3 decreased throughout gestation. Table 1 demonstrates the calculated percentiles according to gestational weeks. Conclusion We established pregnancy-specific thyroid function reference intervals for our pregnant population, for use in clinical practice.
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Affiliation(s)
- Azy S Khalid
- Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Republic of Ireland
| | - Zbigniew Marchocki
- Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Republic of Ireland
| | - Kevin Hayes
- Department of Mathematics and Statistics, University of Limerick, Limerick, Republic of Ireland
| | | | - Caroline Joyce
- Department of Biochemistry, Cork University Hospital, Cork, Republic of Ireland
| | - Mary Stapleton
- Department of Biochemistry, Cork University Hospital, Cork, Republic of Ireland
| | - John O’Mullane
- Department of Biochemistry, Cork University Hospital, Cork, Republic of Ireland
| | - Keelin O’Donoghue
- Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Republic of Ireland
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Bartels Ä, Egan N, Broadhurst DI, Khashan AS, Joyce C, Stapleton M, O'Mullane J, O'Donoghue K. Maternal serum cholesterol levels are elevated from the 1st trimester of pregnancy: a cross-sectional study. J OBSTET GYNAECOL 2013; 32:747-52. [PMID: 23075347 DOI: 10.3109/01443615.2012.714017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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]
Abstract
Cholesterol is monitored in the non-pregnant adult population, where normal values are established. Although reported to be elevated in pregnancy, cholesterol is neither routinely measured nor treated. We aimed to investigate cholesterol levels throughout pregnancy and to establish reference values for cholesterol in healthy pregnant women. This was a cross-sectional analysis of serum cholesterol in healthy women with an uncomplicated singleton pregnancy. Pregnant women attending for antenatal care were recruited and cholesterol levels assayed at 12, 20, 28 and 36 weeks' gestation and on day 1-3 postpartum. A total of 222 women were recruited. The majority (95%) were white Irish, with a median age of 31 years (range 16-46). Median BMI was 25.9 kg/m2 (range 18-40) and 16% were smokers. Cholesterol levels were elevated in all trimesters of pregnancy, with median values from 1st trimester raised outside the non-pregnant adult range. High-density lipoprotein (HDL) levels ranged from 0.9 to 3.7 mmol/l and low-density lipoprotein (LDL) levels ranged from 1.3 to 6.1 mmol/l. Fasting, smoking and obesity did not have any significant effects on results. Total and LDL-cholesterol levels were raised throughout pregnancy. Levels were above non-pregnant adult ranges as early as the 1st trimester. The implications of this on fetus and mother are undetermined and deserve further investigation.
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Affiliation(s)
- Ä Bartels
- Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
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Casey R, Prendeville S, Joyce C, O'Halloran D. First reported case in Ireland of MEN2A due to a rare mutation in exon 8 of the RET oncogene. Endocrinol Diabetes Metab Case Rep 2013; 2013:130044. [PMID: 24616773 PMCID: PMC3922143 DOI: 10.1530/edm-13-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Revised: 08/11/2013] [Accepted: 08/23/2013] [Indexed: 11/24/2022] Open
Abstract
We present the case of a 30-year-old female who was diagnosed with hereditary phaeochromocytoma secondary to a rare gene mutation in exon 8 of the RET oncogene. This genetic mutation was picked up as part of an extended genetic screen using a method known as next generation sequencing. Detection of this genetic mutation prompted further screening for the manifestation of multiple endocrine neoplasia type 2A (MEN2A). The patient subsequently underwent a thyroidectomy with histology confirming C-cell hyperplasia.
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Affiliation(s)
- R Casey
- Department of Endocrinology Cork University Hospital Cork Ireland
| | - S Prendeville
- Department of Pathology Cork University Hospital Cork Ireland
| | - C Joyce
- Department of Biochemistry Cork University Hospital Cork Ireland
| | - D O'Halloran
- Department of Endocrinology Cork University Hospital Cork Ireland
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Khalid AS, Joyce C, O'Donoghue K. Prevalence of subclinical and undiagnosed overt hypothyroidism in a pregnancy loss clinic. Ir Med J 2013; 106:107-110. [PMID: 23691843] [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: 06/02/2023]
Abstract
Recent studies have associated pregnancy loss with subclinical hypothyroidism, defined as elevated thyroid-stimulating-hormone level, with normal free thyroxine. In overt hypothyroidism, the free thyroxine is low. Subclinical and overt hypothyroidism occurs in 0.25-2.5% and 0.2-0.3% of pregnancies respectively. We examined the prevalence of subclinical and undiagnosed overt hypothyroidism in women with recurrent miscarriage, late miscarriage and stillbirth attending the Pregnancy Loss Clinic. Data was collected from the Pregnancy Loss Clinic records. Women with sporadic miscarriages, autoimmune disorders, thrombophilias and known hypothyroidism were excluded. Two-hundred-and-sixty-two women were included. Median maternal age was 35 years (range 18-47). Subclinical and undiagnosed overt hypothyroidism was found in 11.45% of women. Twenty-two women (8.39%) had subclinical hypothyroidism, eight (3.05%) had undiagnosed overt hypothyroidism. Results were compared to women with ongoing pregnancies. A proportion of women attending the clinic had subclinical or undiagnosed overt hypothyroidism, raising the suspicion of causation in unexplained pregnancy loss.
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Affiliation(s)
- A S Khalid
- Anu Research Centre, Department of Obstetrics and Gynaecology, UCC, Cork University Maternity Hospital, Wilton, Cork
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Aitken L, Macfarlane B, Chaboyer W, Schuetz M, Joyce C, Barnett AG. Predicting physical function and mental health in trauma intensive care patients 2 years after hospitalisation. Crit Care 2013. [PMCID: PMC3642935 DOI: 10.1186/cc12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Holt EW, Muntner P, Joyce C, Morisky DE, Webber LS, Krousel-Wood M. Life events, coping, and antihypertensive medication adherence among older adults: the cohort study of medication adherence among older adults. Am J Epidemiol 2012; 176 Suppl 7:S64-71. [PMID: 23035146 DOI: 10.1093/aje/kws233] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The authors examined the association between life events and antihypertensive medication adherence in older adults and the moderating role of coping. A cross-sectional analysis was conducted by using data (n = 1,817) from the Cohort Study of Medication Adherence among Older Adults (recruitment conducted from August 2006 through September 2007). Life events occurring in the 12 months preceding the study interview were assessed via the Holmes Rahe Social Readjustment Rating Scale (SRRS), and coping levels were assessed via an adapted version of the John Henry Active Coping Scale. Low adherence to antihypertensive medication was defined as scores less than 6 on the 8-item Morisky Medication Adherence Scale (known as "MMAS-8"). Of study participants, 13.2% had low adherence, and 27.2% and 5.0% had medium (150-299) and high (≥300) SRRS scores, respectively. After multivariable adjustment, the odds ratios for low adherence associated with medium and high, versus low, SRRS were 1.50 (95% confidence interval: 1.11, 2.02) and 2.11 (95% confidence interval: 1.24, 3.58), respectively. When multivariable models were stratified by coping level, the association between life events and adherence was evident only among participants with low coping levels.
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Affiliation(s)
- Elizabeth W Holt
- Center for Health Research, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA
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Bilotta GS, Burnside NG, Cheek L, Dunbar MJ, Grove MK, Harrison C, Joyce C, Peacock C, Davy-Bowker J. Developing environment-specific water quality guidelines for suspended particulate matter. Water Res 2012; 46:2324-32. [PMID: 22386884 DOI: 10.1016/j.watres.2012.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 01/23/2012] [Accepted: 01/30/2012] [Indexed: 05/26/2023]
Abstract
It is generally well recognised that suspended particulate matter (SPM), from nano-scale particles to sand-sized sediments, can cause serious degradation of aquatic ecosystems. However, at present there is a poor understanding of the SPM conditions that water quality managers should aim to achieve in contrasting environments in order to support good ecological status. In this article, we analyse long-term SPM data collected from a wide range of reference-condition temperate environments in the UK (638 stream/river sites comprising 42 different ecosystem-types). One-way analysis of variance reveals that there is a statistically significant difference (p < 0.001) between the background SPM concentrations observed in contrasting ecosystems that are in reference condition (minimal anthropogenic disturbance). One of the 42 ecosystems studied had mean background concentrations of SPM in excess of the current European Union (EU) water quality guideline, despite being in reference condition. The implications of this finding are that the EU's current blanket water quality guideline (25 mg L(-1) for all environments) is inappropriate for this specific ecosystem-type which will be non-compliant with the guideline regardless of the intensity of land-use. The other 41 ecosystems studied had mean concentrations below the current EU water quality guideline. However, this does not necessarily mean that the guideline is appropriate for these ecosystems, as previous research has demonstrated that detrimental impacts can be experienced by some freshwater organisms, of all trophic levels, when exposed to concentrations below 25 mg L(-1). Therefore, it is suggested here that it is likely that some ecosystems, particularly those with mean concentrations in the 0.00-5.99 mg L(-1) range, require much lower guideline values in order to be effectively protected. We propose a model for predicting environment-specific water quality guidelines for SPM. In order to develop this model, the 638 reference condition sites were first classified into one of five mean background SPM ranges (0.00-5.99, 6.00-11.99, 12.00-17.99, 18.00-23.99 and >24.00 mg L(-1)). Stepwise Multiple Discriminant Analysis (MDA) of these ranges showed that a site's SPM range can be predicted as a function of: mean annual air temperature, mean annual precipitation, mean altitude of upstream catchment, distance from source, slope to source, channel width and depth, the percentage of catchment area comprised of clay, chalk, and hard rock solid geology, and the percentage of the catchment area comprised of blown sand as the surface (drift) material. The MDA technique, with cross-validation (Wilks-Lambda 0.358, p 0.000), can predict the correct or the next closest SPM range of a site in 90% of cases. This technique can also predict SPM range membership in a probabilistic manner, allowing for an estimate of uncertainty to be made in the allocation of a site to an environment-specific SPM range.
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Affiliation(s)
- G S Bilotta
- School of Environment and Technology, University of Brighton, Cockcroft Building, Lewes Road, Brighton, East Sussex BN2 4GJ, UK.
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