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Wagener M, Dolan E, Arnous S, Galvin J, Murphy AW, Casserly I, Eustace J, O’Connor S, McCreery C, Shand J, Wall C, Matiullah S, Sharif F. Renal Denervation as a Complementary Treatment Option for Uncontrolled Arterial Hypertension: A Situation Assessment. J Clin Med 2023; 12:5634. [PMID: 37685701 PMCID: PMC10488551 DOI: 10.3390/jcm12175634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Uncontrolled arterial hypertension is a major global health issue. Catheter-based renal denervation has shown to lower blood pressure in sham-controlled trials and represents a device-based, complementary treatment option for hypertension. In this situation assessment, the authors, who are practicing experts in hypertension, nephrology, general practice and cardiology in the Republic of Ireland, discuss the current evidence base for the BP-lowering efficacy and safety of catheter-based renal denervation with different modalities. Although important questions remain regarding the identification of responders, and long-term efficacy and safety of the intervention, renal denervation has the potential to provide much-needed help to address hypertension and its adverse consequences. The therapeutic approach needs to be multidisciplinary and personalised to take into account the perspective of patients and healthcare professionals in a shared decision-making process.
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Affiliation(s)
- Max Wagener
- University Hospital Galway, University of Galway, H91 TK33 Galway, Ireland
| | - Eamon Dolan
- Stroke and Hypertension Unit, Connolly Hospital, D15 X40D Dublin, Ireland
| | - Samer Arnous
- University Hospital Limerick, V94 F858 Limerick, Ireland
| | - Joseph Galvin
- The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
| | - Andrew W. Murphy
- Turloughmore Medical Centre, University of Galway, H91 TK33 Galway, Ireland
| | - Ivan Casserly
- The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
| | | | | | | | - James Shand
- St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | | | | | - Faisal Sharif
- University Hospital Galway, University of Galway, H91 TK33 Galway, Ireland
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Singh A, Midha V, Mahajan R, Verma S, Kakkar C, Grover J, Singh D, Kaur R, Masih A, Bansal N, Wall C, Sood A. Evaluation of Nutritional Characteristics Reveals Similar Prevalence of Malnutrition in Patients with Ulcerative Colitis and Crohn's Disease. Dig Dis Sci 2023; 68:580-595. [PMID: 36064826 DOI: 10.1007/s10620-022-07652-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/29/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with an increased risk of malnutrition and sarcopenia. AIMS To evaluate the nutritional status of patients with IBD and determine the threshold values of different parameters of nutritional assessment to identify malnutrition. METHODS This was a single-centre cross-sectional analysis of adult patients with IBD [ulcerative colitis (UC) and Crohn's disease (CD)] who underwent anthropometry [body mass index (BMI), mid upper arm circumference (MUAC) and triceps-fold thickness (TSF)], body composition analysis and assessment for sarcopenia [hand-grip strength and skeletal muscle index (SMI) at L3 vertebral level)]. Age- and gender-matched healthy adults served as controls. Malnutrition was defined according to the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria. RESULTS A total of 406 patients [336 (82.76%) UC and 70 (17.24%) CD; mean age 40.56 ± 13.67 years; 215 (52.95%) males] with IBD and 100 healthy controls (mean age 38.69 ± 10.90 years; 56 (56%) males) were enrolled. The mean BMI, MUAC, TSF thickness, fat and lean mass, hand-grip strength, and SMI at L3 vertebral level were lower in patients with IBD compared to controls. The prevalence of malnutrition was similar in UC and CD [24.40% (n = 82) and 28.57% (n = 20), respectively (p = 0.46)]. Thresholds for fat mass in females (15.8 kg) and visceral fat index in males (0.26) were both sensitive and specific to detect malnutrition. The cutoff values of MUAC and TSF thickness to identify malnutrition were 23.25 cm and 25.25 cm, and 16.50 mm and 8.50 mm, in females and males, respectively. CONCLUSION Malnutrition and sarcopenia were common in patients with IBD, with the prevalence being similar in patients with both UC and CD.
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Affiliation(s)
- Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Shruti Verma
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Chandan Kakkar
- Department of Radiology and Radiodiagnosis, Dayanand Medical College, Ludhiana, Punjab, India
| | - Jasmine Grover
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Dharmatma Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ramandeep Kaur
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Abhishek Masih
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Namita Bansal
- Research and Development Centre, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Catherine Wall
- Department of Medicine and Department of Human Nutrition, University of Otago, Christchurch, New Zealand
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
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Tarkin J, Corovic A, Wall C, Nus M, Gopalan D, Huang Y, Imaz M, Zulcinski M, Reynolds G, Morgan AW, Jorgensen HF, Mallat Z, Peters JE, Rudd JHF, Mason JC. Somatostatin receptor PET/MR imaging of large vessel inflammation in active compared with inactive vasculitis and atherosclerosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Use of 18F-FDG PET in large vessel vasculitis (LVV) is limited by non-specific uptake due to arterial remodelling and/or atherosclerosis leading to diagnostic uncertainty.
Purpose
To investigate somatostatin receptor 2 (SST2) as a novel inflammation-specific PET imaging target in LVV.
Methods
In a prospective observational cohort study, we tested the ability of PET/MRI using two somatostatin receptor tracers (68Ga-DOTATATE and 18F-FET-βAG-TOCA) to differentiate active from inactive LVV, and aortic atherosclerosis in patients with recent myocardial infarction. Ex vivo mapping of the imaging target was performed using immunofluorescence microscopy, imaging mass cytometry, and bulk, single-cell and single-nuclei RNA sequencing of temporal artery biopsies from LVV patients.
Results
Sixty-one participants were included (LVV, n=27; myocardial infarction ≤2 weeks, n=25; control subjects with an oncological indication for imaging, n=9). LVV patients (mean age 58 [SD 16] years; 78% female; 63% active or grumbling disease) had giant cell arteritis (n=13), Takayasu arteritis (n=13), or unspecified LVV (n=1). Baseline index vessel SST2 PET maximum tissue-to-blood ratio (TBRmax) was 61.8% (95% CI 31.5–99.0%, p<0.0001) higher in patients with active/grumbling LVV than inactive LVV, and 34.6% (95% CI 15.1–57.6%, p=0.0002) higher than recent myocardial infarction (Fig. 1a–c; arrow: PET signal; arrowhead: aortic thickening; asterisk: aortic atherosclerosis), with good diagnostic accuracy (AUC ≥0.86, p<0.001 for both). None of the control subjects without LVV or MI had increased arterial SST2 PET signal (Fig. 1d).
Mean aortic TBRmax was strongly correlated with Indian Takayasu Clinical Activity Score (r=0.82 [95% CI 0.46–0.95], p=0.001) and maximum wall thickness on MRI (r=0.68 [95% CI 0.31–0.87], p=0.002). SST2 PET/MRI was generally consistent with 18F-FDG PET/CT in LVV patients with contemporaneous scans (Fig. 1a, b), but with very low background signal in the brain and heart allowing for unimpeded assessment of nearby coronary, myocardial, and intracranial artery involvement. On follow-up imaging after a mean 9.3 (SD 3.2) months, clinically effective treatment for LVV was associated with a 0.49 ±SEM 0.24 (p=0.04; 22.3%) reduction in SST2 PET TBRmax, with good scan-scan repeatability in inactive LVV patients with no change in treatment (ICC 0.86, 95% CI 0.04–0.99).
SST2 localised to macrophages, pericytes, and perivascular adipocytes in inflamed arterial specimens (Fig. 2; a: H&E; b: imaging mass cytometry; arrow: SST2/CD68 co-staining). SSTR2-expressing macrophages co-expressed pro-inflammatory markers (S100A8, S100A9). Specific SST2 radioligand binding was confirmed by autoradiography in LVV specimens.
Conclusion
This is the first study to examine SST2 PET/MRI in LVV and to provide histological and gene expression data for validation. Here we show this novel approach holds major promise for diagnosis and therapeutic monitoring in LVV.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Wellcome Trust; Imperial NIHR Biomedical Research Centre
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Affiliation(s)
- J Tarkin
- University of Cambridge , Cambridge , United Kingdom
| | - A Corovic
- University of Cambridge , Cambridge , United Kingdom
| | - C Wall
- University of Cambridge , Cambridge , United Kingdom
| | - M Nus
- University of Cambridge , Cambridge , United Kingdom
| | - D Gopalan
- Imperial College Healthcare NHS Trust , London , United Kingdom
| | - Y Huang
- University of Cambridge , Cambridge , United Kingdom
| | - M Imaz
- University of Cambridge , Cambridge , United Kingdom
| | - M Zulcinski
- University of Leeds , Leeds , United Kingdom
| | - G Reynolds
- Newcastle University , Newcastle-Upon-Tyne , United Kingdom
| | - A W Morgan
- University of Leeds , Leeds , United Kingdom
| | - H F Jorgensen
- University of Cambridge , Cambridge , United Kingdom
| | - Z Mallat
- University of Cambridge , Cambridge , United Kingdom
| | - J E Peters
- Imperial College London , London , United Kingdom
| | - J H F Rudd
- University of Cambridge , Cambridge , United Kingdom
| | - J C Mason
- Imperial College London , London , United Kingdom
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England G, Davin D, Lavin P, Wall C, Deasy E, Mellotte GJ. MO923: Electronic Medication Record Accuracy and Clinical Pharmacist Intervention in Haemodialysis Outpatient Settings. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac084.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Haemodialysis (HD) units in Ireland operate a national electronic Kidney Disease Clinical Patient Management System (KDCPMS). KDCMPS is not always used as the primary electronic patient record (EPR) but in conjunction with other electronic and paper record systems across the healthcare setting.
HD patients on average have 6 comorbidities and have the largest pill burden for any chronic disease; consuming 19 oral doses/day, comprising of 12 different medicines [1, 2]. Frequent medication changes, polypharmacy, comorbidities and non-adherence, increase the risk of drug-related problems (DRPs). In the HD population, DRPs are prevalent at a rate of 1 for every three medication exposures and can elicit negative outcomes, including worsening morbidity, mortality and increased healthcare expenditure [3].
In this study setting, KDCPMS information accuracy has not been examined to date. This study aims to describe medication discrepancies within KDCPMS records of HD outpatients.
METHOD
This prospective, observational study was conducted in the HD unit of Tallaght University Hospital, Dublin.
Medicine reconciliation was conducted to identify KDCPMS discrepancies, followed by medication review to document DRPs. Recommendations were issued by the clinical pharmacist to resolve DRPs.
RESULTS
All KDCPMS records examined contained intentional and unintentional discrepancies (n = 36). Unintentional discrepancies corresponding to 8.8 discrepancies per patient (5.13SD) were observed.
A total of 143 DRPs were identified in 34 patients (94.4%) (Table 1). Out of these, 65% of pharmacist recommendations were accepted (n = 93), 22.4% were rejected (n = 32), 8.4% (n = 12) were referred to the renal multidisciplinary team (MDT) and 4.2% were not actioned (n = 6).
Discrepancies and DRPs by therapeutic area are shown in Fig. 1. Parenteral anticoagulants and thrombolytics were the most common undocumented intentional discrepancies (48.6%, n = 50/103) followed by iron (32%, n = 33/103).
A total of 16 (44.4%) patients had at least one medicine de-prescribed. New prescriptions were issued for 26 patients (72.2%) for 81 medicines.
CONCLUSION
KDCPMS contains inaccuracies that could lead to systemic error. Robust clinical governance supported by the national policy is required to improve the accuracy of information contained in KDCPMS and support its use as the primary platform for renal patients. Specialist clinical pharmacists working collaboratively within the renal MDT reduce discrepancies, improve KDCPMS accuracy and resolve DRPs. Enhanced pharmaceutical care by specialist pharmacists should be supported within national models of care for chronic disease management to enhance patient outcomes.
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Affiliation(s)
- Gillian England
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - Dawn Davin
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - Peter Lavin
- Nephrology Department, Tallaght University Hospital, Dublin, Ireland
| | - Catherine Wall
- Nephrology Department, Tallaght University Hospital, Dublin, Ireland
| | - Evelyn Deasy
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - George J Mellotte
- Nephrology Department, Tallaght University Hospital, Dublin, Ireland
- National Renal Office, HSE, Dublin, Ireland
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5
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England G, Davin D, Lavin P, Wall C, Deasy E, Mellotte GJ. Electronic Medication Record Accuracy in Haemodialysis Outpatient Settings. Ir Med J 2022; 115:580. [PMID: 35695713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aims Irish haemodialysis (HD) units operate the electronic Kidney Disease Clinical Patient Management System (KDCPMS). KDCMPS is not always used as the primary electronic patient record. At this study setting, KDCPMS information accuracy has not been examined to date. This study aims to identify, characterise and quantify medication discrepancies within KDCPMS records of HD outpatients. Methods Prospective, observational study conducted on the HD unit of Tallaght University Hospital. Medicine reconciliation was conducted to identify KDCPMS discrepancies with medication review to document Drug Related Problems (DRPs). Clinical pharmacists issued recommendations to resolve DRPs. Results All KDCPMS records examined contained intentional and unintentional discrepancies (n=36). Unintentional discrepancies corresponding to 8.8 discrepancies per patient (5.13SD) was observed. One-hundred-and-forty-three DRPs were identified in 34 patients (94.4%). Sixty-five per cent (65%) of pharmacist recommendations were accepted (n=93), 22.4% rejected (n=32), 8.4% (n=12) referred to the renal multidisciplinary team (MDT) and 4.2% not actioned (n=6). Conclusion KDCPMS contains inaccuracies potentially leading to systemic error. Robust clinical governance supported by national policy is required to support KDCPMS as the primary platform for renal patients. Enhanced pharmaceutical care by specialist clinical pharmacists should be supported within national models of care for chronic disease management to improve patient outcomes.
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Affiliation(s)
- G England
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - D Davin
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - P Lavin
- Nephrology Department, Tallaght University Hospital, Dublin, Ireland
| | - C Wall
- Nephrology Department, Tallaght University Hospital, Dublin, Ireland
| | - E Deasy
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - G J Mellotte
- Nephrology Department, Tallaght University Hospital, Dublin, Ireland
- HSE National Clinical Lead for Renal Services, National Renal Office, HSE, Ireland
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6
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Singh A, Wall C, Levine A, Midha V, Mahajan R, Sood A. Nutritional screening and assessment in inflammatory bowel disease. Indian J Gastroenterol 2022; 41:5-22. [PMID: 35031977 DOI: 10.1007/s12664-021-01223-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/24/2021] [Indexed: 02/04/2023]
Abstract
Inflammatory bowel disease (IBD) is associated with increased risk of malnutrition and sarcopenia. Both malnutrition and sarcopenia negatively impact the clinical course, quality of life, response to therapy, and surgical outcomes in patients with IBD. This review article highlights the importance of nutritional assessment in patients with IBD and also discusses the different nutritional screening and assessment tools, and measures to detect sarcopenia in relation to IBD. Identification of malnutrition and sarcopenia will allow prioritization of the corrective actions, such as nutritional rehabilitation, to improve clinical outcomes. An approach to the evaluation of nutritional status in patients with IBD is also suggested.
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Affiliation(s)
- Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Catherine Wall
- Department of Medicine and Department of Human Nutrition, University of Otago, Christchurch, New Zealand
| | - Arie Levine
- Pediatric Gastroenterology and Nutrition Unit, Pediatric IBD Center, Wolfson Medical Center Holon, Tel Aviv University, Tel Aviv, Israel
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College, Ludhiana, 141 001, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India.
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Mucavele P, Wall C, Blake N. East Sussex Nursery Transformation Programme (2015-2020): embedding a best practice approach to healthy food in early years settings. Perspect Public Health 2022; 142:7-9. [PMID: 35018860 DOI: 10.1177/17579139211017930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- P Mucavele
- Visiting Lecturer, Department of Nutritional Sciences, King's College London, London, UK
| | - C Wall
- Lecturer in Nutrition, Food and Nutrition Group, Sheffield Hallam University, Room 7407 Stoddart Building, Sheffield S1 1WB, UK.,Consultant Nutritionist, Action for Children, Watford, UK
| | - N Blake
- Health Improvement Specialist, East Sussex County Council (ESCC) Public Health, Lewes, East Sussex
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8
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Alehosseini A, Wall C, Segat A, Tiwari BK, Sharma P, Kelly AL, Sheehan JJ. A preliminary evaluation of the impact of pulsed electric field and high‐pressure processing treatments on mobility of norbixin molecules through rennet‐induced casein matrices. J FOOD PROCESS ENG 2021. [DOI: 10.1111/jfpe.13935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ali Alehosseini
- Food Chemistry and Technology Department Teagasc Food Research Centre, Moorepark Fermoy Ireland
- Dairy Processing Technology Centre (DPTC) Limerick Ireland
| | - Catherine Wall
- Food Chemistry and Technology Department Teagasc Food Research Centre, Moorepark Fermoy Ireland
- Dairy Processing Technology Centre (DPTC) Limerick Ireland
| | - Annalisa Segat
- Food Chemistry and Technology Department Teagasc Food Research Centre, Moorepark Fermoy Ireland
- Dairy Processing Technology Centre (DPTC) Limerick Ireland
| | - Brijesh K. Tiwari
- Food Chemistry and Technology Department Teagasc Food Research Centre Ashtown Ireland
| | - Prateek Sharma
- Food Chemistry and Technology Department Teagasc Food Research Centre, Moorepark Fermoy Ireland
- Dairy Processing Technology Centre (DPTC) Limerick Ireland
| | - Alan L. Kelly
- Dairy Processing Technology Centre (DPTC) Limerick Ireland
- School of Food and Nutritional Sciences University College Cork Cork Ireland
| | - Jeremiah J. Sheehan
- Food Chemistry and Technology Department Teagasc Food Research Centre, Moorepark Fermoy Ireland
- Dairy Processing Technology Centre (DPTC) Limerick Ireland
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Gerasimidis K, Godny L, Sigall-Boneh R, Svolos V, Wall C, Halmos E. Current recommendations on the role of diet in the aetiology and management of IBD. Frontline Gastroenterol 2021; 13:160-167. [PMID: 35300465 PMCID: PMC8862489 DOI: 10.1136/flgastro-2020-101429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
Diet is a key modifier of risk of inflammatory bowel disease development and potentially a treatment option in patients with established disease. International organisations in gastroenterology and inflammatory bowel disease have published guidelines for the role of diet in disease onset and its management. Here, we discuss the major overarching themes arising from these guidelines and appraise recent literature on the role of diet for inflammatory bowel disease prevention, treatment of active disease and maintenance of remission, considering these themes. Except for exclusive enteral nutrition in active Crohn's disease, we currently possess very little evidence to make any further dietary recommendations for the management of inflammatory bowel disease. There is also currently uncertainty on the extrapolation of epidemiological dietary signals on risk of disease development and preclinical experiments in animal models to management, once disease is established. Until high-quality evidence from clinical research becomes available, the only specific recommendations for inflammatory bowel disease we might safely give are those of healthy eating which apply for the general population for overall health and well-being.
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Affiliation(s)
| | - Lihi Godny
- Division of Gastroenterology, Rabin Medical Center, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Rotem Sigall-Boneh
- Paediatric Gastroenterology and Nutrition Unit, Wolfson Medical Center, Holon and the Sackler Faculty of Medicine, Tel Aviv University, Israel, Holon, Israel
| | - Vaios Svolos
- Human Nutrition, School of Medicine, University of Glasgow, Glasgow, UK
| | - Catherine Wall
- Department of Medicine and Department of Human Nutrition, University of Otago Dunedin School of Medicine, Christchurch, New Zealand
| | - Emma Halmos
- Department of Gastroenterology, Central Clinical School, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia
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McDonald L, O' Doherty R, Ryan E, Enright H, Dunlea E, Kelliher S, Fortune A, Fay M, Maung SW, Desmond R, Wall C, Kumar S, O' Shea D, Fadalla K, Connaghan DG, Smyth L. Posttransplant Lymphoproliferative Disorder After Solid Organ Transplant: A Heterogeneous, Aggressive Disorder. Clin Lymphoma Myeloma Leuk 2021; 21:694-700. [PMID: 34148849 DOI: 10.1016/j.clml.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 11/17/2022]
Abstract
Posttransplant lymphoproliferative disorder (PTLD) is a rare complication of solid organ transplant. We identified 40 patients diagnosed with PTLD between 2009 and 2020 and analyzed their presentation, treatment strategies, and outcomes. Median age at diagnosis was 52.5 years (range 21.3 to 79). Median duration of immunosuppression was 95 months (range 4 to 292). Diffuse large B cell lymphoma (n = 16, 40%) and Burkitt lymphoma (n = 6, 15%) were the most common histological subtypes. First-line therapy varied. The median number of treatment lines was 1 (range 0 to 4). Sixteen patients (40%) achieved complete response after first-line therapy. Nineteen patients (47.5%) relapsed or progressed and received salvage therapy; 45% were alive at the end of the study period (median survival 52 months; range 1 to 266; 95% confidence interval 0 to 104). Causes of death included lymphoma-related (45.5%), therapy-related (27.3%), and other (27.3%). Five (22.7%) died within 3 months of diagnosis. Pearson's r test identified disease stage (P = .045) and proliferation index (P = .005) as negative predictors of response to frontline therapy. Bone marrow involvement (P = .033) and increased age (P = .018) were significant predictors of survival. Early mortality and poor response to frontline therapy are common, outlining the need for improved treatment strategies.
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Affiliation(s)
- Laura McDonald
- Department of Haematology, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
| | - Roseann O' Doherty
- Department of Haematology, Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
| | - Eileen Ryan
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Helen Enright
- Department of Haematology, Tallaght University Hospital, Dublin, Ireland
| | - Eoghan Dunlea
- Department of Haematology, Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
| | - Sarah Kelliher
- Department of Haematology, Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
| | - Anne Fortune
- Department of Haematology, Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
| | - Michael Fay
- Department of Haematology, Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
| | - S W Maung
- Department of Haematology, Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
| | - Ronan Desmond
- Department of Haematology, Tallaght University Hospital, Dublin, Ireland
| | - Catherine Wall
- Department of Haematology, Tallaght University Hospital, Dublin, Ireland
| | - Senthil Kumar
- Department of Haematology, University Hospital Waterford, Waterford, Ireland
| | - Derville O' Shea
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Kamal Fadalla
- Department of Haematology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - D G Connaghan
- Department of Haematology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Liam Smyth
- Department of Haematology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
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11
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Boyle S, Tyrrell O, Quigley A, Wall C. Improving ward level efficiency using a modified treatment room layout according to Lean methodologies. Ir J Med Sci 2021; 191:127-132. [PMID: 33712978 DOI: 10.1007/s11845-021-02590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Standardised ward treatment rooms have the potential to improve efficiency in performing routine tasks. Our aim was to produce a standardised layout for commonly used equipment using a Lean approach. METHODS A standardised layout was devised for equipment used for venepuncture, intravenous cannulation (IVC), arterial blood gas sampling, urinary catheter insertion and nasogastric tube insertion. Stakeholder engagement was sought from house officers (HO), nursing staff, store staff and care attendants. HO were timed gathering equipment pre- and post-intervention, and a questionnaire was distributed. Feedback from all potential stakeholders contributed to the final design using repeat Plan, Do, Study, Act (PDSA) cycles. RESULTS The intervention was implemented across 20 inpatient wards, in 3 tertiary university teaching hospitals. The mean time taken to gather equipment for IVC significantly reduced, from 94.9 to 33.9 s (n = 166; p < 0.0001). Self-reported frustration among HO with the treatment room significantly decreased from 54.9 to 4.5% (p < 0.0001). There was a 62.3% reduction in the need for HO to ask other ward staff for help to locate equipment. CONCLUSION This study demonstrates improved efficiency with a time saving of over 1 min for a very commonly performed ward-based task. Ward-based staff reported reduced frustration and less interruptions following the standardisation and optimisation of treatment room layouts.
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Affiliation(s)
- Seamus Boyle
- Tallaght University Hospital Sligo, Sligo, F91 H684, Ireland.
| | - Oisín Tyrrell
- Tallaght University Hospital Sligo, Sligo, F91 H684, Ireland
| | - Ailbhe Quigley
- Tallaght University Hospital Sligo, Sligo, F91 H684, Ireland
| | - Catherine Wall
- Tallaght University Hospital Sligo, Sligo, F91 H684, Ireland
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12
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Earle N, Poppe K, Cameron V, Aish S, Choi Y, Wall C, Stewart R, Kerr A, Harrison W, Devlin G, Pera V, Troughton R, Porter G, Gladding P, Rolleston A, Richards M, Legget M, Doughty R. Outcomes Among Patients With First-Time Acute Coronary Syndromes in New Zealand: The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.05.014] [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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13
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Parsons J, Waters DL, Binns E, Burholt V, Cheung G, Clare S, Duncan R, Fox C, Gibson R, Grant A, Guy G, Jackson T, Kerse N, Logan R, Peri K, Petagna C, Stephens F, Taylor D, Teh R, Wall C. Letter to the Editor: Healthy for Life: An Innovative and Collaborative Approach to COVID 19 Lockdown in New Zealand. J Frailty Aging 2020; 10:72. [PMID: 33331626 PMCID: PMC7782046 DOI: 10.14283/jfa.2020.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recently Boreskie and colleagues published an editorial in the Journal of Frailty and Aging on Preventing Frailty Progression During the COVID-19 Pandemic (1). In it they proposed the SAVE programme (Socialization, Adequate nutrition, Vitamin D, Exercise) to prevent frailty. They concluded that creative thinking and concerted efforts would be needed to disseminate health recommendations to maintain the health of pre-frail and frail older adults in unprecedented times, such as those posed by the COVID-19 pandemic.
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Affiliation(s)
- J Parsons
- A/Prof John Parsons Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand. Email
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14
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Affiliation(s)
- P. Mucavele
- Children’s Food Trust Sheffield UK
- Department of Nutrition and Dietetics King's College London UK
| | - C. Wall
- Children’s Food Trust Sheffield UK
- Food and Nutrition Group Sheffield Hallam University Sheffield UK
| | - L. Whiting
- Children’s Food Trust Sheffield UK
- Mellors Catering Services Sheffield UK
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15
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Le E, Evans N, Tarkin J, Chowdhury M, Zaccagna F, Pavey H, Ganeshan B, Wall C, Huang Y, Weir-Mccall J, Warburton E, Schonlieb C, Sala E, Rudd J. Radiomics applied to carotid CT angiograms can identify significant differences between culprit and non-culprit lesions in patients with stroke and transient ischaemic attack. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Carotid artery atherosclerosis is an important cause of ischaemic stroke. In oncology, textural analysis (“radiomics”) of computed tomography (CT) images can predict the metastatic potential and prognosis of several types of malignant tumours. We investigated whether this quantitative approach could be applied in carotid artery disease.
Purpose
(1) To evaluate the feasibility of computed tomography angiography (CTA) texture analysis in differentiating symptomatic from asymptomatic patients. (2) To investigate whether CTA carotid texture analysis can identify culprit lesions in patients with stroke and transient ischaemic attack (TIA).
Methods
Carotid CTAs of consented research subjects were included in the study. Symptomatic patients had confirmed carotid artery-related ischaemic stroke or TIA in the 7 days before CTA imaging. Asymptomatic (ASX) patients had no prior stroke/TIA. Both TexRAD, a research texture analysis software, and PyRadiomics, a Python package for radiomics studies, were used to extract 99 first-order and higher-order texture features from regions-of-interest (ROI) drawn around the outer wall of the carotid artery. Single-slice analysis compared the carotid bifurcations of symptomatic and asymptomatic patients, and of culprit (CC) and non-culprit (NC) arteries in symptomatic patients. Multi-slice analysis was conducted using a 3D volume defined by ROIs drawn on 14 consecutive CT slices of 3mm thickness, covering 3cm of carotid artery. The Mann-Whitney U test was used for inter-subject comparisons (ASX vs CC; ASX vs NC) and the Wilcoxon signed-rank test was used for intra-subject comparisons (CC vs NC). A p value <0.0005 was deemed statistically significant after Bonferroni correction for multiple comparisons. Non-normally distributed variables are reported as median (interquartile range).
Results
The dataset comprised 82 carotid arteries from 41 symptomatic patients (41 culprit; 41 non-culprit) and 50 carotid arteries from 25 asymptomatic patients. Single-slice analysis revealed greater homogeneity in asymptomatic carotids versus symptomatic culprit carotids (Uniformity: ASX 0.11 (0.05); CC 0.08 (0.05), p<0.0005) and non-culprit carotids (NC 0.08 (0.18), p<0.0005). In multi-slice analysis, culprit and non-culprit carotid arteries displayed greater heterogeneity than asymptomatic carotids (GLSZM zone entropy: CC 6.57 (0.59); NC 6.76 (0.65); ASX 6.21 (0.32), p<0.0005). Multi-slice analysis of symptomatic culprit versus non-culprit carotids revealed greater heterogeneity in culprit carotids than non-culprit carotids (GLRLM run entropy CC 6.57 (0.59); NC 5.05 (0.70), p<0.0001).
Conclusion
Textural analysis of carotid CTAs reveal significant differences between symptomatic and asymptomatic patients and between culprit and non-culprit carotid arteries within symptomatic patients. This approach could be used to identify patients at high risk of further stroke for aggressive medical therapy and surveillance.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): EPVL is undertaking a PhD funded by the Cambridge School of Clinical Medicine and the Medical Research Council's Doctoral Training Partnership
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Affiliation(s)
- E Le
- University of Cambridge, Cambridge, United Kingdom
| | - N.R Evans
- University of Cambridge, Cambridge, United Kingdom
| | - J.M Tarkin
- University of Cambridge, Cambridge, United Kingdom
| | | | - F Zaccagna
- University of Cambridge, Cambridge, United Kingdom
| | - H Pavey
- University of Cambridge, Cambridge, United Kingdom
| | - B Ganeshan
- University College London, London, United Kingdom
| | - C Wall
- University of Cambridge, Cambridge, United Kingdom
| | - Y Huang
- University of Cambridge, Cambridge, United Kingdom
| | | | | | | | - E Sala
- University of Cambridge, Cambridge, United Kingdom
| | - J.H.F Rudd
- University of Cambridge, Cambridge, United Kingdom
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16
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Wall C, Huang Y, Uy C, Le E, Tombetti E, Gopalan D, Manavaki R, Dweck M, Ariff B, Bennett M, Slomka P, Dey D, Mason J, Rudd J, Tarkin J. Pericoronary adipose tissue density is associated with clinical disease activity in Takayasu arteritis and coronary arterial inflammation measured by 68Ga-DOTATATE PET in atherosclerosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary artery disease (CAD) is an under-recognized complication of intense arterial inflammation in Takayasu arteritis (TAK). While pericoronary adipose tissue (PCAT) density is associated with arterial inflammation in CAD patients, this relationship has not previously been studied in TAK patients, nor directly compared with coronary arterial inflammation measured by 68Ga-DOTATATE positron emission tomography (PET).
Purpose
To compare PCAT density with clinical, biochemical and molecular imaging markers of inflammation in TAK and CAD patients.
Methods
PCAT density was quantified from computed tomography coronary angiography (CTCA) around each of the 17 coronary segments in patients with: (1) TAK and CAD, (2) atherosclerotic CAD, and (3) age and gender-matched healthy controls, using semi-automated software (Autoplaque). In TAK patients, PCAT density was compared to the Indian Takayasu Clinical Activity Score (ITAS) and high-sensitivity C-reactive protein (CRP). In CAD patients, PCAT density was compared to local arterial inflammation measured by coronary motion-frozen 68Ga-DOTATATE PET using image registration software (FusionQuant), and systemic (aortic) inflammation using 18F-fluorodeoxyglucose (FDG) PET. Data was acquired either during routine clinical care or prior research that established 68Ga-DOTATATE as an experimental marker of arterial inflammation that binds macrophage somatostatin receptor-2 in atherosclerotic plaques (NCT02021188).
Results
60 patients were included (TAK, n=20; CAD, n=20; healthy, n=20). Non-calcified plaque burden (TAK: 95.2%; CAD: 90.4%, p<0.0001) and CRP (TAK: 25.2 ±SD 16.1 mg/L; CAD: 2.5 ±SD 1.7 mg/L, p=0.04) were greater in TAK than CAD patients.
PCAT density varied significantly among the three groups (median [IQR] TAK: −72.9 [−81.2 to -66.1] Hounsfield unit [HU]; CAD: −79.9 [−88.0 to −72.2]; healthy: −83.8 [−90.1 to −75.8] HU, p<0.0001). Figure: box-plot showing the distribution of PCAT values by group, with corresponding representative multiplanar reconstructed and cross-sectional CTCA images with surrounding PCAT density displayed by color table in left anterior descending arteries.
PCAT density was significantly associated with ITAS (r=0.61, p=0.004) and CRP (r=0.43, p=0.03) in TAK patients, and coronary 68Ga-DOTATATE maximum tissue-to-blood ratio (r=0.31, p<0.001) in CAD patients. PCAT density was not associated with aortic 18F-FDG uptake in CAD patients, nor subcutaneous (pre-sternal) adipose tissue density in either disease group. No significant patient-level confounders were identified using linear mixed-effects regression modelling.
Conclusion
PCAT density measured by CTCA is greater in TAK than CAD patients, and is associated with clinical and biochemical markers of disease activity in TAK, and coronary arterial inflammation measured by 68Ga-DOTATATE PET in CAD. PCAT could be a useful, easy to measure marker of coronary inflammation and disease activity in both TAK and CAD.
PCAT density is greater in TAK than CAD
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Wellcome Trust
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Affiliation(s)
- C Wall
- University of Cambridge, Cambridge, United Kingdom
| | - Y Huang
- University of Cambridge, Cambridge, United Kingdom
| | - C Uy
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - E Le
- University of Cambridge, Cambridge, United Kingdom
| | - E Tombetti
- University Vita-Salute San Raffaele, Milan, Italy
| | - D Gopalan
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - R Manavaki
- University of Cambridge, Cambridge, United Kingdom
| | - M Dweck
- University of Edinburgh, Edinburgh, United Kingdom
| | - B Ariff
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M Bennett
- University of Cambridge, Cambridge, United Kingdom
| | - P Slomka
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - D Dey
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - J Mason
- Imperial College London, London, United Kingdom
| | - J Rudd
- University of Cambridge, Cambridge, United Kingdom
| | - J Tarkin
- University of Cambridge, Cambridge, United Kingdom
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17
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Le E, Evans N, Tarkin J, Chowdhury M, Zaccagna F, Wall C, Huang Y, Weir-Mccall J, Chen C, Warburton E, Schonlieb C, Sala E, Rudd J. Contrast CT classification of asymptomatic and symptomatic carotids in stroke and transient ischaemic attack with deep learning and interpretability. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Convolutional neural networks (CNNs), part of deep learning, are used widely for computer vision tasks and in some medical domains, such as mammography interpretation. The application of deep learning to carotid artery imaging is scarce. We investigated the ability of deep learning to correctly classify contrast CT images of the carotid arteries without the need for prior feature selection.
Purpose
(1) To assess the ability of deep learning to differentiate symptomatic patients (had prior stroke or transient ischaemic attack [TIA]) from asymptomatic patients (no prior stroke/TIA) using contrast CT scans alone. (2) To investigate whether deep learning can further discriminate between culprit and non-culprit carotid arteries in symptomatic patients. (3) To assess the interpretability of the deep learning models.
Methods
Carotid contrast CT scans of consented research subjects were included in the study. Symptomatic patients had confirmed carotid artery-related ischaemic stroke or TIA in the 7 days before CT imaging, and asymptomatic patients had no prior cerebrovascular events. The dataset comprised 1148 axial symptomatic slices (covering a 3cm area of each carotid artery in 41 patients; 41 culprit and 41 non-culprit carotids) and 700 asymptomatic slices (from the bilateral carotid arteries of 25 patients). The dataset was split such that 75% was used for training and 25% for testing. A 30x30 bounding box was used to create patches of the carotid arteries from these axial slices for use as input to the CNN, a modified VGG16 architecture initialised with ImageNet weights to leverage transfer learning (the application of a model trained in one domain to a different domain) implemented in Python. Data augmentation was applied to the training set and the model was trained for 100 epochs using a cyclic learning rate, the RMSProp optimizer and binary cross-entropy loss. Class activation heatmaps were generated using the GradCAM method to highlight the areas of the image that were most important to the model for making its classification decision.
Results
The deep learning model was 92% accurate in correctly identifying carotid arteries from symptomatic patients versus those from asymptomatic patients. Discriminating between culprit versus non-culprit carotid arteries in symptomatic patients alone was 71% accurate. The class activation heatmaps demonstrated how the model learnt to localise the carotid artery within the image patch, and to ignore the arterial lumen when making its classification decision.
Conclusions
Deep learning can be used to differentiate between symptomatic and asymptomatic carotid CT scans from stroke/TIA subjects without the need for prior feature engineering. The model learns to identify relevant features in the image that predict the patients' symptom state. If further validated, this approach could be used to identify high-risk patients for intensive medical therapy.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): EPVL is undertaking a PhD funded by the Cambridge School of Clinical Medicine and the Medical Research Council's Doctoral Training Partnership
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Affiliation(s)
- E.P.V Le
- University of Cambridge, Cambridge, United Kingdom
| | - N.R Evans
- University of Cambridge, Cambridge, United Kingdom
| | - J.M Tarkin
- University of Cambridge, Cambridge, United Kingdom
| | | | - F Zaccagna
- University of Cambridge, Cambridge, United Kingdom
| | - C Wall
- University of Cambridge, Cambridge, United Kingdom
| | - Y Huang
- University of Cambridge, Cambridge, United Kingdom
| | | | - C Chen
- Imperial College London, London, United Kingdom
| | | | | | - E Sala
- University of Cambridge, Cambridge, United Kingdom
| | - J.H.F Rudd
- University of Cambridge, Cambridge, United Kingdom
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Ho SS, Wall C, Gearry RB, Keenan J, Day AS. A Pilot Study Evaluating Novel Urinary Biomarkers for Crohn's Disease. Inflamm Intest Dis 2020; 5:212-220. [PMID: 33313074 DOI: 10.1159/000510682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Although collecting faeces and blood samples are considered non-invasive methods of monitoring Crohn's disease (CD), these methods are less preferred by some patients. This study utilized urine as an alternative to evaluate four disease biomarkers in young adults with active CD before and after exclusive enteral nutrition (EEN) therapy. Methods Urine samples collected at baseline (W0) and after 8 weeks (W8) of EEN therapy were assayed by ELISA for levels of intestinal fatty acid-binding protein (I-FABP), liver fatty acid-binding protein (L-FABP), claudin-3, and calprotectin. Levels of each biomarker were also compared with standard clinical parameters, including disease indexes, nutrient, and inflammatory markers. Results Of the paired urine samples from 14 patients, 10 were female and 12 were newly diagnosed with CD. Urinary I-FABP: Cr (standardized to urine Cr) levels were significantly reduced, while urinary L-FABP: Cr levels increased following EEN therapy. Urinary L-FABP: Cr correlated positively with serum insulin-like growth factor 1 (IGF-1) (r = 0.60, p = 0.02). Urinary CLND3: Cr and calprotectin: Cr levels were not significantly different after treatment. Conclusion I-FABP is a potential urinary biomarker of disease activity in adults with CD, while urinary L-FABP may be an indirect marker of nutritional status in adults with CD. CLND3 and calprotectin do not appear to have roles as urinary biomarkers in CD. These findings warrant further investigations using a larger sample size.
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Affiliation(s)
- Shaun S Ho
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Catherine Wall
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Richard B Gearry
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Jacqueline Keenan
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
| | - Andrew S Day
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
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Roy N, Heenan P, Wall C, Young W, Carco C, Keenan J, Cotter P, Maclean P, Mullaney J, Fraser K, James S, McNabb W, Gearry R. Association of Habitual Dietary Fiber Intake and Fecal Microbiome Gene Abundance with Gastrointestinal Symptoms in an Irritable Bowel Syndrome Cohort. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa062_038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Dietary fibre supplementation is recognised as important for functional gastrointestinal disorders (FGID). The exact role of the microbiome in this relationship remains unclear. We explored differences in dietary fibre intake, GI symptoms and the fecal microbiome in those with FGID.
Methods
The COMFORT cohort is an observational case control study examining FGID, particularly irritable bowel syndrome (IBS) aetiology (Ethics 16/NTA/21). Participants prospectively completed a food and GI symptoms diary over 3 days. Severity of GI symptoms and mood disorders were assessed using clinical questionnaires; SAGIS and PROMIS for GI symptoms and HADS for anxiety and depression. Fecal samples were analysed by shotgun sequencing; 95 healthy controls (HC), 22 constipation IBS (IBS-C) and 50 diarrhea IBS (IBS-D). Taxonomic classifications were assigned by aligning sequences against the NCBI non-redundant database using DIAMOND.
Results
Diet diaries were completed by 292 participants (176 cases, 71.2% female). Average daily fibre intake was higher in HC compared to FGID (23.99g, 95% CI = –2.06-0.55; 20.28g, 95% CI = -1.96-0.45; P < 0.05). Low fibre daily intake (< 15g) was associated with higher depression scores (P < 0.05) and increased anxiety in those with functional diarrhea (r2 = -0.554, P = 0.03). A negative association between fibre consumption and increased bloating in IBS (r2 = -0.19, P = 0.04) was also found. The GI microbiome in IBS was characterised by differences in Firmicutes belonging to the Lachnospiraceae family (e.g., Blautia and Ruminococcus, P < 0.05). Other differentiating taxa included Bilophila (higher in IBS-D) and Methanobrevibacter (lower in IBS-D) (P < 0.05). At the phylum level, bloating and constipation were correlated with Firmicutes relative abundance, and negatively correlated with Bacteroides (canonical r > |0.5|). At the genus level, Blautia were correlated with diarrhea and faecal incontinence (canonical r > 0.5).
Conclusions
Higher fibre consumption was associated with decreased bloating, anxiety and depression in different FGID subgroups. IBS was also associated with altered fecal microbiome composition including some taxa linked to carbohydrate and hydrogen metabolism.
Funding Sources
Funded by the Ministry of Business, Innovation and Employment through the High-Value Nutrition National Science Challenge.
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Adamina M, Gerasimidis K, Sigall-Boneh R, Zmora O, de Buck van Overstraeten A, Campmans-Kuijpers M, Ellul P, Katsanos K, Kotze PG, Noor N, Schäfli-Thurnherr J, Vavricka S, Wall C, Wierdsma N, Yassin N, Lomer M. Perioperative Dietary Therapy in Inflammatory Bowel Disease. J Crohns Colitis 2020; 14:431-444. [PMID: 31550347 DOI: 10.1093/ecco-jcc/jjz160] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The incidence of inflammatory bowel disease [IBD] is rising worldwide and no cure is available. Many patients require surgery and they often present with nutritional deficiencies. Although randomised controlled trials of dietary therapy are lacking, expert IBD centres have long-established interdisciplinary care, including tailored nutritional therapy, to optimise clinical outcomes and resource utilisation. This topical review aims to share expertise and offers current practice recommendations to optimise outcomes of IBD patients who undergo surgery. METHODS A consensus expert panel consisting of dietitians, surgeons, and gastroenterologists, convened by the European Crohn's and Colitis Organisation, performed a systematic literature review. Nutritional evaluation and dietary needs, perioperative optimis ation, surgical complications, long-term needs, and special situations were critically appraised. Statements were developed using a Delphi methodology incorporating three successive rounds. Current practice positions were set when ≥80% of participants agreed on a recommendation. RESULTS A total of 26 current practice positions were formulated which address the needs of IBD patients perioperatively and in the long term following surgery. Routine screening, perioperative optimisation by oral, enteral, or parenteral nutrition, dietary fibre, and supplements were reviewed. IBD-specific situations, including management of patients with a restorative proctocolectomy, an ostomy, strictures, or short-bowel syndrome, were addressed. CONCLUSIONS Perioperative dietary therapy improves the outcomes of IBD patients who undergo a surgical procedure. This topical review shares interdisciplinary expertise and provides guidance to optimise the outcomes of patients with Crohn's disease and ulcerative colitis. taking advantage of contemporary nutrition science.
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Affiliation(s)
- Michel Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.,University of Basel, Basel, Switzerland
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, Dentistry and Nursing, Glasgow Royal Infirmary, Glasgow, UK
| | - Rotem Sigall-Boneh
- PIBD Research Center, Pediatric Gastroenterology and Nutrition Unit, Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of Surgery, Assaf Harofeh Medical Center, Tel Aviv, Israel
| | | | - Marjo Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | | | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Catholic University of Paraná [PUCPR], Curitiba, Brazil
| | - Nurulamin Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Stephan Vavricka
- Department of Surgery, Kantonsspital Winterthur, Winerthur, Switzerland
| | - Catherine Wall
- Department of Nutritional Sciences, King's College London, London, UK
| | - Nicolette Wierdsma
- Department of Nutrition and Dietetics, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
| | - Nuha Yassin
- Department of Colorectal Surgery, Wolverhampton Hospital, Wolverhampton, UK
| | - Miranda Lomer
- Department of Nutritional Sciences, King's College London, London, UK.,Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Sienko KH, Whitney SL, Carender WJ, Wall C. The role of sensory augmentation for people with vestibular deficits: Real-time balance aid and/or rehabilitation device? J Vestib Res 2018; 27:63-76. [PMID: 28387692 DOI: 10.3233/ves-170606] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This narrative review highlights findings from the sensory augmentation field for people with vestibular deficits and addresses the outstanding questions that are critical to the translation of this technology into clinical and/or personal use. Prior research has demonstrated that the real-time use of visual, vibrotactile, auditory, and multimodal sensory augmentation technologies can improve balance during static and dynamic stance tasks within a laboratory setting. However, its application in improving gait requires additional investigation, as does its efficacy as a rehabilitation device for people with vestibular deficits. In some locomotor studies involving sensory augmentation, gait velocity decreased and secondary task performance worsened, and subjects negatively altered their segmental control strategies when cues were provided following short training sessions. A further question is whether the retention and/or carry-over effects of training with a sensory augmentation technology exceed the retention and/or carry-over effects of training alone, thereby supporting its use as a rehabilitation device. Preliminary results suggest that there are short-term improvements in balance performance following a small number of training sessions with a sensory augmentation device. Long-term clinical and home-based controlled training studies are needed. It is hypothesized that sensory augmentation provides people with vestibular deficits with additional sensory input to promote central compensation during a specific exercise/activity; however, research is needed to substantiate this theory. Major obstacles standing in the way of its use for these critical applications include determining exercise/activity specific feedback parameters and dosage strategies. This paper summarizes the reported findings that support sensory augmentation as a balance aid and rehabilitation device, but does not critically examine efficacy or the quality of the research methods used in the reviewed studies.
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Affiliation(s)
- K H Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - S L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.,Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - W J Carender
- Department of Otolaryngology, University of Michigan Health System, Ann Arbor, MI, USA
| | - C Wall
- Jenks Vestibular Diagnostic Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
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Dineen R, Bogdanet D, Thompson D, Thompson CJ, Behan LA, McKay AP, Boran G, Wall C, Gibney J, O'Keane V, Sherlock M. Endocrinopathies and renal outcomes in lithium therapy: impact of lithium toxicity. QJM 2017; 110:821-827. [PMID: 29590494 DOI: 10.1093/qjmed/hcx171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Received: 02/21/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lithium is the mainstay of treatment for bipolar disorder, mania and an augmentation therapy in patients with treatment resistant depression. It has a narrow therapeutic index, with recognized adverse multi-system and endocrine side effects. AIM To assess the impact of lithium therapy, in particular lithium toxicity, on the development of endocrine and renal disorders in a cohort of patients in a single tertiary referral centre in Ireland. STUDY DESIGN A retrospective analysis was performed of the prevalence of lithium toxicity and renal, thyroid and parathyroid dysfunction in our study population. METHODS We collected laboratory data from the Clinical Chemistry department of the Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), Dublin, Ireland. Our study population included all patients who had at least one serum lithium measurement from January 1st 2000 to December 31st 2014 inclusive. RESULTS A total of 580 patients were included in the study. Among our study group, 70 patients (12.1%) had 1 toxic lithium measurement (lithium level >1.2 mmol/l). 27.8% (n > 161) of patients developed stage 3 Chronic kidney Disease (CKD) or higher, which was commoner in those patients who developed toxic lithium levels (P < 0.0001) and in those who developed hypernatraemia (P > 0.0001). 16.2% of patients (n > 94) had one serum sodium >145 mmol/l during follow up. 60 patients(10.3%) had a TSH >10 mU/l, while complete suppression of TSH (<0.05 mU/l) was observed in 22 patients (3.8%) during follow-up. 4% (n > 37) of the study population had ≥1 serum corrected calcium level > 2.55 mmol/l, and 4 patients had biochemical confirmation of primary hyperparathyroidism but PTH levels were only performed in 2.8% (n > 16) of the studypopulation. CONCLUSION Stage 3 CKD is common in patients receiving lithium therapy. Lithium toxicity is associated with CKD and hypernatraemia. Thyroid dysfunction and hypercalcaemia are common in patients receiving lithium therapy. Patients receiving lithium therapy require surveillance of renal, thyroid and bone biochemistry.
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Affiliation(s)
- R Dineen
- From the Department of Endocrinology
| | | | | | - C J Thompson
- Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - L A Behan
- From the Department of Endocrinology
| | - A P McKay
- Department of Psychiatry/Psychological Medicine
| | - G Boran
- Department of Chemical Pathology
| | - C Wall
- Department of Nephrology, The Adelaide and Meath Hospital Incorporating the National Children's Hospital, Tallaght, Dublin/Trinity College, Dublin, Ireland
| | - J Gibney
- From the Department of Endocrinology
| | - V O'Keane
- Department of Psychiatry/Psychological Medicine
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Corrigan C, Peterson L, McVeigh C, Lavin PJ, Mellotte GJ, Wall C, Baker Kerrigan A, Barnes L, O'Neill D, Moss H. The Perception of Art among Patients and Staff on a Renal Dialysis Unit. Ir Med J 2017; 110:632. [PMID: 29372947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study investigated the purpose and effectiveness of giving outpatients an opportunity to engage in art activities while receiving dialysis treatment. A mixed method study was conducted. 21 semi-structured interviews were conducted with outpatients attending the dialysis unit and 13 surveys of clinicians were completed. The principle reasons to partake in the art activity programme included: to pass time, to relieve boredom, to be creative, to try something new, distraction from concerns, to stay positive and to achieve something new. Patients who did not participate in the programme pass their time primarily by watching TV or sleeping. All staff who partook in the survey were satisfied with the programme and wanted it to continue. Our findings indicate that the creative arts programme is viewed positively by staff and patients alike, and might be useful in other hospital departments. Further in depth qualitative research would be useful to interrogate the potential effect of engagement in art on positive mental health and quality of life for patients with chronic conditions.
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Affiliation(s)
- C Corrigan
- Trinity College Dublin School of Medicine
| | - L Peterson
- Trinity College Dublin School of Medicine
| | - C McVeigh
- Trinity College Dublin School of Medicine
| | - P J Lavin
- Trinity Health Kidney Centre, Tallaght Hospital, Dublin 24
| | - G J Mellotte
- Trinity Health Kidney Centre, Tallaght Hospital, Dublin 24
| | - C Wall
- Trinity Health Kidney Centre, Tallaght Hospital, Dublin 24
| | - A Baker Kerrigan
- National Centre for Arts and Health Tallaght Hospital, Dublin 24
| | - L Barnes
- National Centre for Arts and Health Tallaght Hospital, Dublin 24
| | - D O'Neill
- Trinity College Dublin School of Medical Gerontology
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25
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Affiliation(s)
- Bernadette Brady
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, Dublin, Ireland
- Department of Palliative Medicine, Tallaght Hospital, Dublin, Ireland
| | - Lynn Redahan
- Department of Renal Medicine, Tallaght Hospital, Dublin, Ireland
| | | | - George J. Mellotte
- Department of Renal Medicine, Tallaght Hospital, Dublin, Ireland
- Department of Renal Medicine, St. James’s Hospital, Dublin, Ireland
| | - Catherine Wall
- Department of Renal Medicine, Tallaght Hospital, Dublin, Ireland
| | - Stephen Higgins
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, Dublin, Ireland
- Department of Palliative Medicine, Tallaght Hospital, Dublin, Ireland
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Mitchell EA, Stewart AW, Braithwaite I, Hancox RJ, Murphy R, Wall C, Beasley R. Birth weight and subsequent body mass index in children: an international cross-sectional study. Pediatr Obes 2017; 12:280-285. [PMID: 27170099 DOI: 10.1111/ijpo.12138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The reported association between birth weight and subsequent body mass index (BMI) is conflicting. OBJECTIVES To examine the relationship between birth weight and BMI in children aged 6-7 years. METHODS Secondary analysis of data from a multi-centre, multi-country, cross-sectional study (International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three). Parents/guardians of children aged 6-7 years completed questionnaires about their children's birth weight, current height and weight and whether their mother smoked in the first year of the child's life. A general linear mixed model was used to determine the association between BMI and birth weight. RESULTS A total of 72 111 children (17 countries) were included in the analysis. There was a positive association of birth weight with BMI (for each kg increase in birth weight the BMI at 6-7 increased by 0.47 (SE 0.02) kg/m2 ; p < 0.0001) with a clear gradient by birth weight category. There was no statistically significant interaction between birth weight and Gross National Income (GNI). CONCLUSIONS There is a positive linear relationship between birth weight and BMI in 6-7 year old children, which is present in both high and low income countries.
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Affiliation(s)
- E A Mitchell
- Department of Paediatrics, Child and Youth Health, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - A W Stewart
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - I Braithwaite
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - R J Hancox
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - R Murphy
- Department of Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, New Zealand
| | - C Wall
- Department of Nutrition, The University of Auckland, New Zealand
| | - R Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
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Crowley J, Ball L, Wall C. Nutrition advice provided by general practice registrars: an investigation using patient scenarios. Public Health 2016; 140:17-22. [PMID: 27745893 DOI: 10.1016/j.puhe.2016.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 09/01/2016] [Accepted: 09/14/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nutrition is recognized as a strong factor influencing the health outcomes of patients with chronic disease. General practitioners (GPs) require nutrition knowledge and skills to support patients to have healthy dietary behaviours. OBJECTIVE To investigate New Zealand GP registrars' provision of nutrition advice using patient scenarios. STUDY DESIGN A cross-sectional study design targeted GP registrars to investigate the nutrition care they provided to patients. METHODS Fourty-seven GP registrars completed a survey at a training event. The survey included patient scenarios. Respondents were asked to provide nutrition advice for each scenario, in line with best practice guidelines. Responses to each scenario were scored based on a panel of nutrition experts. Regression analysis was used to compare the scores to participants' previously reported confidence to provide nutrition care. RESULTS Seventeen male (36.2%) and thirty female (63.8%) GP registrars completed the survey, giving a response rate of 92.2%. GP registrars scored a mean of 7.9 ± 0.2 out of 15 for recall of dietary strategies with the scenarios. There was no association between GP registrars' scenario scores and their confidence to provide nutrition care. CONCLUSIONS An evidence-practice gap exists for New Zealand GP registrars' confidence to provide nutrition care, and their knowledge of evidence-based nutritional guidelines to support patients to have healthy dietary behaviours. A better understanding of the determinants of this disparity is required in order to support optimal nutrition care by GPs.
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Affiliation(s)
- J Crowley
- Discipline of Nutrition and Dietetics, Faculty of Medical and Health Sciences, University of Auckland, 1142, New Zealand.
| | - L Ball
- Menzies Health Institute Queensland, Griffith University, 4222, Australia
| | - C Wall
- Discipline of Nutrition and Dietetics, Faculty of Medical and Health Sciences, University of Auckland, 1142, New Zealand
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Laur C, Ball L, Ahankari AS, Avdagovska M, Crowley J, Deen D, Douglas P, Hark L, Kohlmeier M, Luzi L, McCotter L, Martyn K, Nowson C, Wall C, Ray S. Proceedings of the inaugural International Summit for Medical Nutrition Education and Research. Public Health 2016; 140:59-67. [PMID: 27726865 DOI: 10.1016/j.puhe.2016.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/22/2016] [Accepted: 08/25/2016] [Indexed: 10/20/2022]
Abstract
Medical Nutrition Education (MNE) has been identified as an area with potential public health impact. Despite countries having distinctive education systems, barriers and facilitators to effective MNE are consistent across borders, demanding a common platform to initiate global programmes. A shared approach to supporting greater MNE is ideal to support countries to work together. In an effort to initiate this process, the Need for Nutrition Education/Innovation Programme group, in association with their strategic partners, hosted the inaugural International Summit on Medical Nutrition Education and Research on August 8, 2015 in Cambridge, UK. Speakers from the UK, the USA, Canada, Australia, New Zealand, Italy, and India provided insights into their respective countries including their education systems, inherent challenges, and potential solutions across two main themes: (1) Medical Nutrition Education, focused on best practice examples in competencies and assessment; and (2) Medical Nutrition Research, discussing how to translate nutrition research into education opportunities. The Summit identified shared needs across regions, showcased examples of transferrable strategies and identified opportunities for collaboration in nutrition education for healthcare (including medical) professionals. These proceedings highlight the key messages presented at the Summit and showcase opportunities for working together towards a common goal of improvement in MNE to improve public health at large.
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Affiliation(s)
- C Laur
- The Need for Nutrition Education/Innovation Programme (University of Cambridge), C/O MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK; Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada.
| | - L Ball
- The Need for Nutrition Education/Innovation Programme (University of Cambridge), C/O MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK; Menzies Health Institute Queensland, G02.05A, Griffith University, Gold Coast, Australia.
| | - A S Ahankari
- The Need for Nutrition Education/Innovation Programme (University of Cambridge), C/O MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK; University of Nottingham, UK; Halo Medical Foundation, India.
| | - M Avdagovska
- Faculty of Medicine and Dentistry, University of Alberta, 3-285 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB T6G 1C9, Canada.
| | - J Crowley
- The Need for Nutrition Education/Innovation Programme (University of Cambridge), C/O MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK; Discipline of Nutrition and Dietetics, Faculty of Medical Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - D Deen
- Office of Academic Affairs; Sophie Davis School of Biomedical Education, City College of New York, New York, NY, 10031, USA.
| | - P Douglas
- The Need for Nutrition Education/Innovation Programme (University of Cambridge), C/O MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK; Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, UK.
| | - L Hark
- Wills Eye Hospital, Professor of Medicine, Sidney Kimmel Medical College, 840 Walnut Street, Suite 800, Philadelphia, PA, 19107, USA.
| | - M Kohlmeier
- The Need for Nutrition Education/Innovation Programme (University of Cambridge), C/O MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK; University of North Carolina, School of Medicine and Gillings School of Global Public Health, and UNC Nutrition Research Institute, 500 Laureate Way, Kannapolis, NC, 28081, USA.
| | - L Luzi
- Endocrinology and Metabolism, Policlinico San Donato IRCCS, Università degli Studi di Milano, Italy.
| | - L McCotter
- The Need for Nutrition Education/Innovation Programme (University of Cambridge), C/O MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK; Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, UK.
| | - K Martyn
- Brighton and Sussex Medical School University of Brighton, Westlain House, Village Way, Falmer, BN21 9PH, UK.
| | - C Nowson
- School of Exercise and Nutrition Sciences, Deakin University, Locked Bag 20000, Geelong, Victoria, 3220, Australia; Institute for Physical Activity and Nutrition, Australia.
| | - C Wall
- Discipline of Nutrition and Dietetics, Faculty of Medical Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - S Ray
- The Need for Nutrition Education/Innovation Programme (University of Cambridge), C/O MRC Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK.
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Gunning H, Taylor G, Smyth A, Mellotte G, Fennell J, Murphy P, Lavin P, Wall C. An Approach to Optimise Therapeutic Vancomycin Dosage in a Haemodialysis Population. Ir Med J 2016; 109:465. [PMID: 28125179] [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: 06/06/2023]
Abstract
Haemodialysis patients are at risk of gram-positive bacteraemia and commonly require intravenous vancomycin. Intravenously administered vancomycin is primarily excreted by the kidney and exhibits complex pharmacokinetics in haemodialysis patients; achieving therapeutic levels can be challenging. An audit in our unit showed current practises of vancomycin administration resulted in a high proportion of sub-therapeutic levels. A new protocol was developed with fixed weight-based loading and subsequent dosing guided by pre-dialysis levels, target levels were 10-20mg/L. Its effectiveness was prospectively evaluated between 24th September 2012, and 8th February 2013. During this period 25 patients commenced vancomycin, 15 were included. In total, 112 vancomycin levels were taken, 94 (84%) were therapeutic, this was a significant improvement compared to previous practise (odds ratio 5.4, CI 3.1-9.4, p<0.0001). In conclusion, our study shows this protocol can consistently and reliably achieve therapeutic vancomycin levels.
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Affiliation(s)
- H Gunning
- Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24
| | - G Taylor
- Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24
| | - A Smyth
- Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24
| | - G Mellotte
- Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24
| | - J Fennell
- Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24
| | - P Murphy
- Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24
| | - P Lavin
- Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24
| | - C Wall
- Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24
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Grimes TC, Breslin N, Deasy E, Moloney E, O'Byrne J, Wall C, Delaney T. Comment on: pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. J Clin Pharm Ther 2016; 41:739-740. [PMID: 27709658 DOI: 10.1111/jcpt.12452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T C Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland. .,Pharmacy Department, Tallaght Hospital, Dublin 24, Ireland.
| | - N Breslin
- Medical Directorate, Tallaght Hospital, Dublin 24, Ireland
| | - E Deasy
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland.,Pharmacy Department, Tallaght Hospital, Dublin 24, Ireland
| | - E Moloney
- Medical Directorate, Tallaght Hospital, Dublin 24, Ireland
| | - J O'Byrne
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland.,Pharmacy Department, Tallaght Hospital, Dublin 24, Ireland
| | - C Wall
- Medical Directorate, Tallaght Hospital, Dublin 24, Ireland
| | - T Delaney
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland.,Pharmacy Department, Tallaght Hospital, Dublin 24, Ireland
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Affiliation(s)
- D Kelly
- From the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - M R Rodzlan
- From the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - X Jeunemaitre
- AP-HP, Département de Génétique, Hopital Europeen Georges Pompidou; Université Paris Descartes, Paris Sorbonne Cité; INSERM, UMR-S 970, Paris France
| | - C Wall
- From the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
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Chhabra R, Wall C. A rare case of Erdheim–Chester disease. Clin Med (Lond) 2016; 16 Suppl 3:s24. [DOI: 10.7861/clinmedicine.16-3-s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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33
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Tallon M, Barragry J, Allen A, Breslin N, Deasy E, Moloney E, Delaney T, Wall C, O'Byrne J, Grimes T. Impact of the Collaborative Pharmaceutical Care at Tallaght Hospital (PACT) model on medication appropriateness of older patients. Eur J Hosp Pharm 2015; 23:16-21. [PMID: 31156809 DOI: 10.1136/ejhpharm-2014-000511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/28/2015] [Accepted: 06/02/2015] [Indexed: 11/03/2022] Open
Abstract
Objectives A high prevalence of potentially inappropriate prescribing (PIP) has been identified in older patients in Ireland. The impact of the Collaborative Pharmaceutical Care at Tallaght Hospital (PACT) model on the medication appropriateness of acute hospitalised older patients during admission and at discharge is reported. Methods Uncontrolled before-after study. The study population for this study was medical patients aged ≥65 years, using ≥3 regular medicines at admission, taken from a previous before-after study. Standard care involved clinical pharmacists being ward-based, contributing to medication history taking and prescription review, but not involved at discharge. The innovative PACT model involved clinical pharmacists being physician team-based, leading admission and discharge medication reconciliation and undertaking prescription review, with authority to change the prescription during admission or at discharge. The primary outcome was the Medication Appropriateness Index (MAI) score applied pre-admission, during admission and at discharge. Results Some 108 patients were included (48 PACT, 60 standard). PACT significantly improved the MAI score from pre-admission to admission (mean difference 2.4, 95% CI 1.0 to 3.9, p<0.005), and from pre-admission to discharge (mean difference 4.0, 95 CI 1.7 to 6.4, p<0.005). PACT resulted in significantly fewer drugs with one or more inappropriate rating at discharge (PACT 15.0%, standard 30.5%, p<0.001). The MAI criteria responsible for most inappropriate ratings were 'correct directions' (4.8% PACT, 17.3% standard), expense (5.3% PACT, 5.7% standard) and dosage (0.6% PACT, 4.0% standard). PACT suggestions to optimise medication use were accepted more frequently, and earlier in the hospital episode, than standard care (96.7% PACT, 69.3% standard, p<0.05). Conclusions Collaborative pharmaceutical care between physicians and pharmacists from admission to discharge, with authority for pharmacists to amend the prescription, improves medication appropriateness in older hospitalised Irish patients.
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Affiliation(s)
- Maria Tallon
- Pharmacy Department, Tallaght Hospital Dublin, Ireland
| | - John Barragry
- Medical Directorate, Tallaght Hospital Dublin, Ireland
| | - Ann Allen
- Pharmacy Department, Tallaght Hospital Dublin, Ireland
| | - Niall Breslin
- Medical Directorate, Tallaght Hospital Dublin, Ireland
| | - Evelyn Deasy
- Pharmacy Department, Tallaght Hospital Dublin, Ireland
| | - Eddie Moloney
- Medical Directorate, Tallaght Hospital Dublin, Ireland
| | - Tim Delaney
- Pharmacy Department, Tallaght Hospital Dublin, Ireland
| | | | - John O'Byrne
- Pharmacy Department, Tallaght Hospital Dublin, Ireland
| | - Tamasine Grimes
- Pharmacy Department, Tallaght Hospital Dublin, Ireland.,School of Pharmacy, Trinity College Dublin, Ireland
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Wall C, Black FO, O'Leary DP. Dynamic evaluation of human vestibulo-ocular function using white noise rotation stimulus and linear system parameter estimation techniques. Adv Otorhinolaryngol 2015; 25:138-43. [PMID: 484347 DOI: 10.1159/000402931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
White noise acceleration inputs were used to determine the human VOR transfer function both for normal subjects and for patients falling into two pilot categories: unilateral labyrinthectomy and reduced bilateral responses. The systematic patterns shown in the transfer function of the pilot abnormal categories as compared to the normal data suggests one method of classifying test results (table I). Frequency domain linear systems parameter fits were also made using the same data. The changes in these fit parameters, when pilot abnormal data is compared to normal data, suggests the use of the parameter fits themselves as a second classification scheme (fig. 1). The second scheme is not appropriate in cases where the response is unrelated to the stimulus.
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35
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Healy NA, Kok HK, Wall C, Torreqgiani W. Erdheim-Chester disease. Ir Med J 2015; 108:61. [PMID: 25803962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Wall C, Zhao-Karger Z, Fichtner M. Corrosion Resistance of Current Collector Materials in Bisamide Based Electrolyte for Magnesium Batteries. ACTA ACUST UNITED AC 2014. [DOI: 10.1149/2.0111501eel] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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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37
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Narod SA, Sun P, Wall C, Baines C, Miller AB. Impact of screening mammography on mortality from breast cancer before age 60 in women 40 to 49 years of age. ACTA ACUST UNITED AC 2014; 21:217-21. [PMID: 25302030 DOI: 10.3747/co.21.2067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Whether screening mammography programs should include women in their 40s is controversial. In Canada, screening of women aged 40-49 years has not been shown to reduce mortality from breast cancer. Given that screening mammography reduces mean tumour size and that tumour size is inversely associated with survival, the lack of benefit seen with screening is puzzling and suggests a possible adverse effect on mortality of mammography or subsequent treatment (or both) that counterbalances the expected benefit derived from downstaging. METHODS We followed 50,436 women 40-49 years of age until age 60 for mortality from breast cancer. Of those women, one half had been randomly assigned to annual mammography and one half to no mammography. The impact of mammography on breast cancer mortality was estimated using a left-censored Cox proportional hazards model. RESULTS Of 256 deaths from breast cancer recorded in the study cohort, 134 occurred in women allocated to mammography, and 122 occurred in those receiving usual care and not allocated to mammography. The cumulative risk of death from breast cancer to age 60 was 0.53% for women assigned to mammography and 0.48% for women not so assigned. The hazard ratio for breast cancer-specific death associated with 1 or more screening mammograms before age 50 was 1.10 (95% confidence interval: 0.86 to 1.40). CONCLUSIONS Mammography in women 40-49 years of age is associated with a small but nonsignificant increase in the risk of dying of breast cancer before age 60. Caution should be exercised when recommending mammographic screening to women before age 50.
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Affiliation(s)
- S A Narod
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON. ; Women's College Research Institute, Women's College Hospital, Toronto, ON
| | - P Sun
- Women's College Research Institute, Women's College Hospital, Toronto, ON
| | - C Wall
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - C Baines
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - A B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Appleton L, Wyatt D, Perkins E, Parker C, Crane J, Jones A, Moorhead L, Brown V, Wall C, Pagett M. The impact of prostate cancer on men's everyday life. Eur J Cancer Care (Engl) 2014; 24:71-84. [DOI: 10.1111/ecc.12233] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 01/10/2023]
Affiliation(s)
- L. Appleton
- The Clatterbridge Cancer Centre NHS Foundation Trust; Wirral UK
| | - D. Wyatt
- University of Chester/Clatterbridge Cancer Centre; Faculty of Health and Social Care; University of Chester; Chester UK
| | - E. Perkins
- Health and Community Care Research Unit; Institute of Psychology, Health and Society; University of Liverpool; Liverpool UK
| | - C. Parker
- Urology; Aintree University Hospital; Liverpool UK
| | - J. Crane
- School of Health Sciences; University of Liverpool; Liverpool UK
| | | | | | - V. Brown
- Hospice of the Good Shepherd; Chester UK
| | - C. Wall
- Faculty of Education Health and Community; Liverpool John Moores University; Liverpool UK
| | - M. Pagett
- The Clatterbridge Cancer Centre NHS Foundation Trust; Wirral UK
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Medani S, Hussein W, Shantier M, Flynn R, Wall C, Mellotte G. Comparison of Percutaneous and Open Surgical Techniques for First-Time Peritoneal Dialysis Catheter Placement in the Unbreached Peritoneum. Perit Dial Int 2014; 35:576-85. [PMID: 25082842 DOI: 10.3747/pdi.2013.00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/02/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The percutaneous Seldinger method of peritoneal dialysis catheter (PDC) insertion has gained favor over recent years whereas traditionally it was reserved for patients considered not fit for general anesthesia. This blind technique is believed to be less safe, and is hence avoided in patients with previous laparotomy incisions. Reports on the success of this method may therefore be criticized for selection bias. In those with no prior abdominal surgery the optimal method of insertion has not been established. METHODS We retrospectively reviewed the outcomes of first-time PDC placements comparing the percutaneous (group P) and surgical (group S) insertion techniques in patients without a history of previous abdominal surgery in a single center between January 2003 and June 2010. We assessed catheter survival at 3 and 12 months post-insertion and compared complication rates between the two groups. RESULTS A total of 63 percutaneous and 64 surgical catheter insertions were analyzed. No significant difference was noted in catheter survival rates between group P and group S (86.2% vs 80% at 3 months, p = 0.37; and 78.3% vs 71.2% at 12 months, p = 0.42 respectively). Early and overall peritonitis rates were similar (5% vs 5.3%; p = 1, and 3.5 vs 4.9 episodes per 100 patient-months; p = 0.13 for group P and group S respectively). There were also no significant differences between the two groups in exit site leaks (15.9% in group P vs 6.3% in group S; p = 0.15), poor initial drainage (9.5% in group P vs 10.9% in group S, p = 0.34) or secondary drainage failure (7.9% in group P vs 18.8% in group S, p = 0.09). CONCLUSION This study illustrates the success and safety of percutaneous PDC insertion compared with the open surgical technique in PD naive patients without a history of prior abdominal surgery. Catheter survival was favorable with percutaneous insertion in this low-risk patient population but larger prospective studies may help to determine whether either method is superior. The percutaneous technique can be recommended as a minimally invasive, cost-effective procedure that facilitates implementing an integrated care model in nephrology practice.
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Affiliation(s)
- Samar Medani
- Nephrology, Adelaide & Meath Hospital, Dublin, Ireland
| | - Wael Hussein
- Nephrology, Adelaide & Meath Hospital, Dublin, Ireland
| | | | - Robert Flynn
- Urology, Adelaide & Meath Hospital, Dublin, Ireland
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Grimes TC, Deasy E, Allen A, O'Byrne J, Delaney T, Barragry J, Breslin N, Moloney E, Wall C. Collaborative pharmaceutical care in an Irish hospital: uncontrolled before-after study. BMJ Qual Saf 2014; 23:574-83. [PMID: 24505112 PMCID: PMC4078714 DOI: 10.1136/bmjqs-2013-002188] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND We investigated the benefits of the Collaborative Pharmaceutical Care in Tallaght Hospital (PACT) service versus standard ward-based clinical pharmacy in adult inpatients receiving acute medical care, particularly on prevalence of medication error and quality of prescribing. METHODS Uncontrolled before-after study, undertaken in consecutive adult medical inpatients admitted and discharged alive, using at least three medications. Standard care involved clinical pharmacists being ward-based, contributing to medication history taking and prescription review, but not involved at discharge. The innovative PACT intervention involved clinical pharmacists being team-based, leading admission and discharge medication reconciliation and undertaking prescription review. Primary outcome measures were prevalence per patient of medication error and potentially severe error. Secondary measures included quality of prescribing using the Medication Appropriateness Index (MAI) in patients aged ≥65 years. FINDINGS Some 233 patients (112 PACT, 121 standard) were included. PACT decreased the prevalence of any medication error at discharge (adjusted OR 0.07 (95% CI 0.03 to 0.15)); number needed to treat (NNT) 3 (95% CI 2 to 3) and no PACT patient experienced a potentially severe error (NNT 20, 95% CI 10 to 142). In patients aged ≥65 years (n=108), PACT improved the MAI score from preadmission to discharge (Mann-Whitney U p<0.05; PACT median -1, IQR -3.75 to 0; standard care median +1, IQR -1 to +6). CONCLUSIONS PACT, a collaborative model of pharmaceutical care involving medication reconciliation and review, delivered by clinical pharmacists and physicians, at admission, during inpatient care and at discharge was protective against potentially severe medication errors in acute medical patients and improved the quality of prescribing in older patients.
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Affiliation(s)
- Tamasine C Grimes
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Evelyn Deasy
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Ann Allen
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - John O'Byrne
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - Tim Delaney
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - John Barragry
- Medical Directorate, Tallaght Hospital, Dublin, Ireland
| | - Niall Breslin
- Medical Directorate, Tallaght Hospital, Dublin, Ireland
| | - Eddie Moloney
- Medical Directorate, Tallaght Hospital, Dublin, Ireland
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Aguirre M, Greenberg N, Sharpley J, Simpson R, Wall C. A pilot study of an enhanced mental health assessment during routine and discharge medicals in the British Armed Forces. J ROY ARMY MED CORPS 2013; 160:27-31. [PMID: 24109091 DOI: 10.1136/jramc-2013-000058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/03/2022]
Abstract
OBJECTIVES A pilot study to assess the practicality of introducing an enhanced mental health assessment (EMHA) into all routine and discharge medicals of the UK Armed Forces in order to facilitate treatment prior to and on return to civilian life. METHODS A pilot study was conducted using an EMHA questionnaire with questions about depression, anxiety, post-traumatic stress disorder, alcohol use, sleep and anger/irritability. At pilot sites, the EMHA was completed during all routine and discharge medicals between May 2011 and July 2011. At the end of the study period, qualitative data were collected from participating medical officers and practice managers regarding their opinions about the pilot study. RESULTS The quantitative data revealed an average pick-up rate for mental health (MH) problems. Out of the four military medical centres who participated and the 325 questionnaires collected, one referral to a Department of Community Mental Health was made. 26 (8%) patients were categorised as 'some concern and patient offered advice and/or reassurance'. The vast majority of patients were found to have no evidence of MH problems. However, using a validated alcohol screening tool, 64% of service personnel were found to have a score indicating 'higher risk drinking'. Analysis of the qualitative data suggests that the EMHA is an easy tool to implement with minimal additional time and resources needed. The interviewees pointed out a number of limitations and suggestions for possible further studies. CONCLUSIONS The pilot study successfully demonstrated that the EMHA questionnaire is easy to administer, does not take up a large amount of additional resources or manpower and provides a useful check of MH status. The study picked up an average number of MH cases and the questions on alcohol consumption highlighted that military personnel may be at a 'higher risk of drinking'.
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Affiliation(s)
- Marcela Aguirre
- Department of General Practice, Royal Centre for Defence Medicine, Birmingham, UK
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Redahan L, Brady B, Smyth A, Higgins S, Wall C. The use of palliative care services amongst end-stage kidney disease patients in an Irish tertiary referral centre. Clin Kidney J 2013; 6:604-8. [PMID: 26069830 PMCID: PMC4438365 DOI: 10.1093/ckj/sft117] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/29/2013] [Indexed: 11/17/2022] Open
Abstract
Background Although patients with end-stage kidney disease (ESKD) have a shortened life expectancy, their end-of-life (EOL) care is suboptimal. The aim of this study was to review the utilization of specialist palliative care (SPC) in patients with ESKD in Dublin, Ireland. Methods We conducted a retrospective chart review of prevalent patients with ESKD who died between January 2005 and December 2009 at a tertiary referral centre. We recorded SPC referrals, modality of renal replacement therapy, age and place of death. Results Of 131 included patients, 88 (67.2%) were male, mean age at death was 63.2 ± 15.1 years and 102 (77.9%) were treated with haemodialysis. Forty-eight patients (36.7%) were referred to SPC, who were involved in the patients' management for a median of 12 days (range 0–907) before death. A total 104 patients (79.4%) died in an acute hospital, 19 (14.5%) died at home, 3 (2.3%) died in an inpatient hospice and the place of death was unknown for 5 patients (3.8%). Dialysis was withdrawn prior to death in 50 patients (38.1%), with a median time to death after withdrawal of dialysis of 6 days (0–105 days). A discussion regarding the withdrawal of dialysis was more frequently held with family member(s) rather than the patient. Conclusions SPC was involved in the antemortem care of ∼1/3 of the patients with the majority of referrals placed at a late stage. Given the short timeframe until death once dialysis is withdrawn, it is imperative that appropriate EOL care is instituted. This study identifies an underutilization of SPC and improved integration of palliative care and nephrology services may optimize EOL care for patients with ESKD.
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Affiliation(s)
- Lynn Redahan
- Department of Nephrology , AMNCH, Tallaght , Dublin , Ireland
| | - Bernadette Brady
- Department of Palliative Care Medicine , AMNCH, Tallaght , Dublin , Ireland
| | - Andrew Smyth
- Department of Nephrology , AMNCH, Tallaght , Dublin , Ireland
| | - Stephen Higgins
- Department of Palliative Care Medicine , AMNCH, Tallaght , Dublin , Ireland
| | - Catherine Wall
- Department of Nephrology , AMNCH, Tallaght , Dublin , Ireland
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Aguirre M, Greenberg N, Sharpley J, Simpson R, Wall C. Alcohol consumption in the UK armed forces: are we drinking too much? J ROY ARMY MED CORPS 2013; 160:72-3. [DOI: 10.1136/jramc-2013-000059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ritson JE, Wall C. The role of a Royal Navy General Duties Medical Officer in helicopter assault force operations: a reflective article. J ROY ARMY MED CORPS 2013; 158:205-7. [PMID: 23472566 DOI: 10.1136/jramc-158-03-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Royal Navy General Duties Medical Officers (RN GDMOs) are employed in land operations in Afghanistan in much the same way as British Army GDMOs. In this article the author explores how time with a Royal Marine Commando unit and completion of Commando training in parallel to thorough medical training are beneficial for the roles a RN GDMO is expected to undertake in Helicopter Assault Force Operations.
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Affiliation(s)
- J E Ritson
- Department of General Practice, RCDM, ICT Centre, Vincent Drive, Birmingham B15 2SQ.
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Abstract
OBJECTIVES There are currently over 9000 British soldiers serving in Afghanistan. The Defence Medical Services provide primary health care to soldiers at forward locations using Regimental Medical Officers (RMOs) and General Duties Medical Officers (GDMOs). If required, GDMOs can refer patients to senior colleagues. Currently, little is known about the reasons for referrals by GDMOs. This study aims to identify the main factors affecting why GDMOs refer from forward locations. METHODS Nine GDMOs, who deployed on Operation HERRICK 13, were invited to join the study. They maintained a log of their referrals for two 14 day periods, one in each half of their tour. In addition, a semi-structured interview was performed with each GDMO in order to elicit the common themes surrounding referrals. RESULTS The mean referral rate was 0.9 referrals/GDMO/week. The main reasons for referral were dental problems, musculoskeletal injuries, abdominal pain of unknown cause, and ano-genital problems. Factors that influenced referrals included availability of forwardly projected services (dentist and physiotherapist), manpower availability at the locations, the availability of flights (affected by weather, enemy action, and schedule of routine flights), and the timing of the tour in relation to leave. CONCLUSIONS Referrals from GDMOs were due to doctor inexperience in the treatment of a particular condition, lack of access to investigations and the potential for deterioration in a location without adequate support. The referral decision process was affected by the patient's importance with regards to the mission, the weather and access to safe transportation. The introduction of clinical guidelines for common conditions in conjunction with minor alterations to GDMO training could help reduce referrals from Role 1, preserving manpower, reducing costs, and minimising risk to evacuation aircraft.
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Affiliation(s)
- J M Driver
- GDMO 5 Medical Regiment, Gaza Barracks, Catterick.
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Mears KP, Morgan-Jones DJ, Richardson JC, Simpson R, Wall C. General Practice in the Armed Forces: A Definition and Model. J ROY ARMY MED CORPS 2012; 158:156-61. [DOI: 10.1136/jramc-158-03-03] [Citation(s) in RCA: 3] [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: 11/03/2022]
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