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Alsadhan N, Alhurishi SA, Pujades-Rodriguez M, Shuweihdi F, Brennan C, West RM. Demographic and clinical characteristics associated with advanced stage colorectal cancer: a registry-based cohort study in Saudi Arabia. BMC Cancer 2024; 24:533. [PMID: 38671382 PMCID: PMC11055310 DOI: 10.1186/s12885-024-12270-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND In Saudi Arabia, approximately one-third of colorectal cancer (CRC) patients are diagnosed at an advanced stage. Late diagnosis is often associated with a worse prognosis. Understanding the risk factors for late-stage presentation of CRC is crucial for developing targeted interventions enabling earlier detection and improved patient outcomes. METHODS We conducted a retrospective cohort study on 17,541 CRC patients from the Saudi Cancer Registry (1997-2017). We defined distant CRCs as late-stage and localized and regional CRCs as early-stage. To assess risk factors for late-stage CRC, we first used multivariable logistic regression, then developed a decision tree to segment regions by late-stage CRC risk, and finally used stratified logistic regression models to examine geographical and sex variations in risk factors. RESULTS Of all cases, 29% had a late-stage diagnosis, and 71% had early-stage CRC. Young (< 50 years) and unmarried women had an increased risk of late-stage CRC, overall and in some regions. Regional risk variations by sex were observed. Sex-related differences in late-stage rectosigmoid cancer risk were observed in specific regions but not in the overall population. Patients diagnosed after 2001 had increased risks of late-stage presentation. CONCLUSION Our study identified risk factors for late-stage CRC that can guide targeted early detection efforts. Further research is warranted to fully understand these relationships and develop and evaluate effective prevention strategies.
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Affiliation(s)
- Norah Alsadhan
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK.
| | - Sultana A Alhurishi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mar Pujades-Rodriguez
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Farag Shuweihdi
- Dental Translational & Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Cathy Brennan
- Psychological & Social Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Robert M West
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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Brennan C, Al Bakry M, Fort-Schaale A, Jose J, Mizen K, Matteucci P, Kelemen N. Immediate lengthening temporalis myoplasty for facial palsy reconstruction following facial nerve inclusive total parotidectomy. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00024-9. [PMID: 38395687 DOI: 10.1016/j.ijom.2024.01.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
Immediate lengthening temporalis myoplasty (Labbé procedure) for immediate dynamic facial reanimation after nerve-inclusive parotidectomy in the elderly population is undocumented in the literature. The aim of this work was to determine whether the Labbé approach could achieve immediate, good functional and static results in elderly patients with acquired facial palsy. A retrospective analysis of five patients with parotid malignancies involving the facial nerve who underwent parotidectomy and an immediate Labbé procedure was performed. The House-Brackmann and Sunnybrook scores for facial palsy were used as objective measurements of the functional outcome. All patients underwent total parotidectomy, neck dissection, Labbé procedure, immediate temporary tarsorrhaphy, brow lift, and postoperative radiotherapy. Mean patient age was 83 (range 73-87) years. The average resected tumour size was 3.54 cm. The mean duration of surgery was 324 min and length of hospital stay 4 days. All patients experienced an improvement in House-Brackmann of one grade postoperative (grade V to IV in four, grade VI to V in one); the Sunnybrook score improved by 31 points on average (mean preoperative 3.8 vs postoperative 34.8). An immediate Labbé procedure following ablative parotid malignancy resection is a reliable and safe reconstructive procedure in a carefully selected elderly population, providing acceptable immediate static and dynamic hemifacial mimetic function and eliminating an additional facial palsy correction procedure.
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Affiliation(s)
- C Brennan
- Plastic and Reconstructive Surgery Department, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, UK.
| | - M Al Bakry
- Hull York Medical School, Heslington, York, UK
| | - A Fort-Schaale
- Plastic and Reconstructive Surgery Department, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, UK
| | - J Jose
- Plastic and Reconstructive Surgery Department, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
| | - K Mizen
- Plastic and Reconstructive Surgery Department, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
| | - P Matteucci
- Plastic and Reconstructive Surgery Department, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
| | - N Kelemen
- Plastic and Reconstructive Surgery Department, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
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Diggins E, Heuvelman H, Pujades-Rodriguez M, House A, Cottrell D, Brennan C. Exploring gender differences in risk factors for self-harm in adolescents using data from the Millennium Cohort Study. J Affect Disord 2024; 345:131-140. [PMID: 37863369 DOI: 10.1016/j.jad.2023.10.106] [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: 06/01/2023] [Revised: 09/24/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Self-harm is common in young people and girls have consistently higher rates of self-harm than boys. Differences in exposure and reactions to risk and protective factors, adverse events and problematic interpersonal relationships, and levels of wellbeing could contribute to the gender difference. This study aims to explore gender differences in risk factors associated with self-harm, to provide the foundation for developing more gender-sensitive approaches to self-harm management. METHODS Data were analysed from 11,196 young people recruited to the Millennium Cohort Study, surveyed around age 14. We examined gender differences in the prevalence of key psychological and social risk factors for self-harm, including family and peer relationships, emotional wellbeing, and bullying and victimisation. We utilised modified Poisson regression to estimate gender-specific risks. RESULTS At age 14 self-harm prevalence was 15.4 % with a ratio of 2.6 females to 1 male. Differential exposure to recorded psychosocial risk factors explained a third of the gender difference in risk of self-harm. Intense social media use and not confiding in family members were associated with a greater likelihood of self-harm in girls than boys. Bullying others and same-sex attraction were more strongly associated with self-harm in boys than girls. LIMITATIONS Self-harm data were obtained by self-report therefore subject to misclassification. The cross-sectional design does not enable us to establish causation. CONCLUSIONS Unhappiness and dissatisfaction are common in adolescence. Our findings suggest the need for further research into young people's experiences to explore why rates differ and inform the development of gender-specific approaches to self-harm management.
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Affiliation(s)
- Emma Diggins
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, LS2 9NL, UK..
| | - Hein Heuvelman
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, LS2 9NL, UK
| | | | - Allan House
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, LS2 9NL, UK
| | - David Cottrell
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, LS2 9NL, UK
| | - Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, LS2 9NL, UK
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4
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Hare D, Dembicka KM, Brennan C, Campbell C, Sutton-Fitzpatrick U, Stapleton PJ, De Gascun CF, Dunne CP. Whole-genome sequencing to investigate transmission of SARS-CoV-2 in the acute healthcare setting: a systematic review. J Hosp Infect 2023; 140:139-155. [PMID: 37562592 DOI: 10.1016/j.jhin.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/03/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Whole-genome sequencing (WGS) has been used widely to elucidate transmission of SARS-CoV-2 in acute healthcare settings, and to guide infection, prevention, and control (IPC) responses. AIM To systematically appraise available literature, published between January 1st, 2020 and June 30th, 2022, describing the implementation of WGS in acute healthcare settings to characterize nosocomial SARS-CoV-2 transmission. METHODS Searches of the PubMed, Embase, Ovid MEDLINE, EBSCO MEDLINE, and Cochrane Library databases identified studies in English reporting the use of WGS to investigate SARS-CoV-2 transmission in acute healthcare environments. Publications involved data collected up to December 31st, 2021, and findings were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. FINDINGS In all, 3088 non-duplicate records were retrieved; 97 met inclusion criteria, involving 62 outbreak analyses and 35 genomic surveillance studies. No publications from low-income countries were identified. In 87/97 (90%), WGS supported hypotheses for nosocomial transmission, while in 46 out of 97 (47%) suspected transmission events were excluded. An IPC intervention was attributed to the use of WGS in 18 out of 97 (18%); however, only three (3%) studies reported turnaround times ≤7 days facilitating near real-time IPC action, and none reported an impact on the incidence of nosocomial COVID-19 attributable to WGS. CONCLUSION WGS can elucidate transmission of SARS-CoV-2 in acute healthcare settings to enhance epidemiological investigations. However, evidence was not identified to support sequencing as an intervention to reduce the incidence of SARS-CoV-2 in hospital or to alter the trajectory of active outbreaks.
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Affiliation(s)
- D Hare
- UCD National Virus Reference Laboratory, University College Dublin, Ireland; School of Medicine, University of Limerick, Limerick, Ireland.
| | - K M Dembicka
- School of Medicine, University of Limerick, Limerick, Ireland
| | - C Brennan
- UCD National Virus Reference Laboratory, University College Dublin, Ireland
| | - C Campbell
- UCD National Virus Reference Laboratory, University College Dublin, Ireland
| | | | | | - C F De Gascun
- UCD National Virus Reference Laboratory, University College Dublin, Ireland
| | - C P Dunne
- School of Medicine, University of Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
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Gray Stephens C, Dias A, Skinner E, Brennan C, Middleton RG, Angel CK. Penthrox enables quicker management of fractures, dislocations and more: learning lessons from expedited care of trauma patients during the COVID-19 pandemic. Ann R Coll Surg Engl 2023; 105:S22-S27. [PMID: 35950512 PMCID: PMC10390238 DOI: 10.1308/rcsann.2021.0340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Methoxyflurane is an historical anaesthetic agent that has undergone a renaissance with the introduction of a smaller dose in a handheld 'Penthrox' device. The benefits of Penthrox include its ease of use, with disposable individual packets, and the need for less monitoring and staff, when compared with deeper sedation. The literature acknowledges its use for analgesia and in the management of anterior shoulder dislocation but in no other procedural orthopaedic circumstance. METHODS Following institutional approval, we undertook a retrospective review of all incidences of Penthrox use to facilitate minor procedures within a 2-month period starting 24 March 2020. Time to procedure and success were recorded using the surrogate markers of patient attendance and x-Ray occurrence times. RESULTS Some 101 Penthrox doses were given to 89 patients over 97 unique episodes between 24 March and 26 May 2020. No complications were recorded following the use of Penthrox during this period. Patient demographics were explored. Fracture manipulations and casting (n=54) had a 100% success rate in achieving adequate and safe reduction. Joint dislocations (n=34) were treated with varying success. Native elbow dislocations were reduced most successfully (4/4, 100%). Native shoulder dislocations were seen in 17 patients and successful relocation was seen in 11 cases, giving a success rate of 65%. CONCLUSIONS This is the first study, outside anterior shoulder dislocations, to report on the efficacy of Penthrox within emergent orthopaedic scenarios. We have demonstrated Penthrox to be a safe tool for helping to manage trauma procedures in the emergency department.
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Affiliation(s)
| | - A Dias
- Royal Cornwall Hospitals NHS Trust, UK
| | - E Skinner
- Royal Cornwall Hospitals NHS Trust, UK
| | - C Brennan
- Royal Cornwall Hospitals NHS Trust, UK
| | | | - C K Angel
- Royal Cornwall Hospitals NHS Trust, UK
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Abstract
The psychedelic research renaissance is gaining traction. Preliminary clinical studies of the hallucinogenic fungi, psilocybin, with psychological support, have indicated improvements in mood, anxiety and quality of life. A seminal, open-label study demonstrated marked reductions in depression symptoms in participants with treatment-resistant depression (TRD). The associated neurobiological processes involve alterations in brain connectivity, together with altered amygdala and default mode network activity. At the cellular level, psychedelics promote synaptogenesis and neural plasticity. Prompted by the promising preliminary studies, a randomized, double-blind trial has recently been launched across Europe and North America to investigate the efficacy of psilocybin in TRD. One of these centres is based in Ireland - CHO Area 7 and Tallaght University Hospital. The outcome of this trial will determine whether psilocybin with psychological support will successfully translate into the psychiatric clinic for the benefit of patients.
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Affiliation(s)
- J R Kelly
- Department of Psychiatry, Trinity College Dublin & Tallaght Hospital, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - A Baker
- Sheaf House, Exchange Hall, Tallaght, Dublin, Ireland
| | - M Babiker
- Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - L Burke
- Sheaf House, Exchange Hall, Tallaght, Dublin, Ireland
| | - C Brennan
- Sheaf House, Exchange Hall, Tallaght, Dublin, Ireland
| | - V O'Keane
- Department of Psychiatry, Trinity College Dublin & Tallaght Hospital, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin, Ireland
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Alsadhan N, Almaiman A, Pujades-Rodriguez M, Brennan C, Shuweihdi F, Alhurishi SA, West RM. Statistical methods for measuring trends in colorectal cancer incidence in registries: A systematic review. Front Oncol 2022; 12:1049486. [DOI: 10.3389/fonc.2022.1049486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
BackgroundMonitoring cancer trends in a population is essential for tracking the disease’s burden, allocating resources, and informing public health policies. This review describes variations in commonly employed methods to estimate colorectal cancer (CRC) incidence trends.MethodsWe performed a systematic literature search in four databases to identify population-based studies reporting CRC incidence trends, published between January 2010 and May 2020. We extracted and described data on methods to estimate trends and assess model validity, and the software used.ResultsThis review included 145 articles based on studies conducted in five continents. The majority (93%) presented visual summaries of trends combined with absolute, relative, or annual change estimates. Fourteen (10%) articles exclusively calculated the relative change in incidence over a given time interval, presented as the percentage of change in rates. Joinpoint regression analysis was the most commonly used method for assessing incidence trends (n= 65, 45%), providing estimates of the annual percentage change (APC) in rates. Nineteen (13%) studies performed Poisson regression and 18 (12%) linear regression analysis. Age-period-cohort modeling- a type of generalized linear models- was conducted in 18 (12%) studies. Thirty-nine (37%) of the studies modeling incidence trends (n=104, 72%) indicated the method used to evaluate model fitness. The joinpoint program (52%) was the statistical software most commonly used.ConclusionThis review identified variation in the calculation of CRC incidence trends and inadequate reporting of model fit statistics. Our findings highlight the need for increasing clarity and transparency in reporting methods to facilitate interpretation, reproduction, and comparison with findings from previous studies.
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Sass C, Farley K, Brennan C. "They have more than enough to do than patch up people like me." Experiences of seeking support for self-harm in lockdown during the COVID-19 pandemic. J Psychiatr Ment Health Nurs 2022; 29:544-554. [PMID: 35403770 PMCID: PMC9115186 DOI: 10.1111/jpm.12834] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 01/17/2022] [Accepted: 03/29/2022] [Indexed: 12/02/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: In the initial months of the pandemic, there was no significant increase in demand for mental health services During the pandemic, there was an increase in people reporting an increase in suicidal thoughts. Understanding of the experience of seeking help for self-harm during lockdown is lacking, in terms of availability and accessibility of support services WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: People who self-harm found that their support structures were significantly impacted by lockdown Lockdown presented relational difficulties for people who self-harm WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Learning about the experience of receiving support from mental health liaison services during lockdown from a first-hand perspective is essential to improving the provision of these services in the future. In times of national crisis, services should be prepared to support clients via alternative means including telephone and online. Public facing messages about service availability should be carefully expressed to minimize misunderstandings. ABSTRACT: Introduction National lockdown caused disruption to health services and third-sector organizations offering support to people who self-harm. Early reports suggested self-harm-related hospital attendances declined. Lack of knowledge related to the availability and accessibility of support provisions for people who self-harm warrants exploration into how they experienced help-seeking during lockdown. Aims This study aimed to explore the experiences of people who self-harm and perspectives on help-seeking. Method We conducted a qualitative study based on telephone and email interviews with 14 people who self-harm in England. Results Participants identified challenges to coping with life in lockdown, emphasizing the role of self-harm. Help-seeking was impeded by feeling like a burden and potential for spreading the virus. People who self-harm exercised self-reliance in response to "stay home" messaging, but some may have struggled without formal support. Online support served an important role in continuity of care during lockdown but could widen inequalities from limited resources and access. Implications for practice Helping mental health liaison nurses to understand the experiences of people who self-harm during lockdown is critical to providing continuing support to this population. Services should consider how and when they communicate changes to their provisions to the public, and the impact this will have on those in need of support.
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Affiliation(s)
- Cara Sass
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kate Farley
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Alsadhan N, Almaiman A, Pujades-Rodriguez M, Brennan C, Shuweihdi F, Alhurishi SA, West RM. A systematic review of methods to estimate colorectal cancer incidence using population-based cancer registries. BMC Med Res Methodol 2022; 22:144. [PMID: 35590277 PMCID: PMC9118801 DOI: 10.1186/s12874-022-01632-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/04/2022] [Indexed: 11/14/2022] Open
Abstract
Background Epidemiological studies of incidence play an essential role in quantifying disease burden, resource planning, and informing public health policies. A variety of measures for estimating cancer incidence have been used. Appropriate reporting of incidence calculations is essential to enable clear interpretation. This review uses colorectal cancer (CRC) as an exemplar to summarize and describe variation in commonly employed incidence measures and evaluate the quality of reporting incidence methods. Methods We searched four databases for CRC incidence studies published between January 2010 and May 2020. Two independent reviewers screened all titles and abstracts. Eligible studies were population-based cancer registry studies evaluating CRC incidence. We extracted data on study characteristics and author-defined criteria for assessing the quality of reporting incidence. We used descriptive statistics to summarize the information. Results This review retrieved 165 relevant articles. The age-standardized incidence rate (ASR) (80%) was the most commonly reported incidence measure, and the 2000 U.S. standard population the most commonly used reference population (39%). Slightly more than half (54%) of the studies reported CRC incidence stratified by anatomical site. The quality of reporting incidence methods was suboptimal. Of all included studies: 45 (27%) failed to report the classification system used to define CRC; 63 (38%) did not report CRC codes; and only 20 (12%) documented excluding certain CRC cases from the numerator. Concerning the denominator estimation: 61% of studies failed to state the source of population data; 24 (15%) indicated census years; 10 (6%) reported the method used to estimate yearly population counts; and only 5 (3%) explicitly explained the population size estimation procedure to calculate the overall average incidence rate. Thirty-three (20%) studies reported the confidence interval for incidence, and only 7 (4%) documented methods for dealing with missing data. Conclusion This review identified variations in incidence calculation and inadequate reporting of methods. We outlined recommendations to optimize incidence estimation and reporting practices. There is a need to establish clear guidelines for incidence reporting to facilitate assessment of the validity and interpretation of reported incidence. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01632-7.
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Affiliation(s)
- Norah Alsadhan
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia. .,School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Alaa Almaiman
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mar Pujades-Rodriguez
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Cathy Brennan
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Farag Shuweihdi
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sultana A Alhurishi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Robert M West
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Sass C, Brennan C, Farley K, Crosby H, Rodriguez Lopez R, Romeu D, Mitchell E, House A, Guthrie E. Valued attributes of professional support for people who repeatedly self-harm: A systematic review and meta-synthesis of first-hand accounts. Int J Ment Health Nurs 2022; 31:424-441. [PMID: 35034422 PMCID: PMC9306637 DOI: 10.1111/inm.12969] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 02/01/2023]
Abstract
Therapeutic interventions are an important adjunct to self-help strategies for people who self-harm. There is little guidance for those offering therapy on the effective components of interventions for people who self-harm. This was a systematic review aiming to identify the factors that contribute to positive experiences of therapy as described by people who have reduced or stopped self-harm. The review followed PRISMA guidelines to locate and synthesize peer-reviewed qualitative studies describing experiences of therapy among people who had reduced or stopped self-harm. Study selection, data extraction, and quality assessment were peer reviewed and conducted for at least two researchers independently. Relevant first-hand quotations were extracted from eligible studies and synthesized using a thematic analysis in collaboration with experts with personal and professional experience of self-harm. Twenty-three studies met eligibility criteria. Themes identified in the reported accounts were arranged under two meta-themes. 'Positive aspects of seeing a professional' identified aspects of professional care that were common to all encounters: the value of sharing, space to talk and reflect, and the boundaries inherent in contact with a professional. 'Positive attributes of individual professionals' depended upon individual characteristics: the ability to build reciprocal trust by being non-judgemental, showing genuine empathic concern, and being confident to talk about and respond directly to self-harm. Our review indicates that therapeutic alliance is perceived as key to effective professional help for self-harm, irrespective of underlying principles of therapy. All forms of therapy should be timely and reliable and centred around the needs of the individual and their experience of self-harm.
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Affiliation(s)
- Cara Sass
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Cathy Brennan
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Kate Farley
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Helen Crosby
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK.,Leeds Trinity University, Leeds, UK
| | - Rocio Rodriguez Lopez
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Daniel Romeu
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK.,Leeds and York Partnership Foundation Trust, Leeds, UK
| | | | - Allan House
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Else Guthrie
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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11
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Brennan C, Stone M, Pinder R, Gowda A. 306 In the COVID Aftermath, Using an Innovative Collaborative Approach to Improve Wait Times for Skin Cancer Patients. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.202] [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: 11/12/2022]
Abstract
Abstract
COVID-19 led to drastic reductions in non-urgent medical visits and cancer care. Surgical patient backlogs mean new strategies are required to decrease wait times and administrative costs whilst improving patient outcomes. We review the impact of combined speciality Plastic Surgery and Dermatology 2 week-wait (2ww) clinics on wait times and hospital attendances and associated cost implications when compared to the single speciality clinics.
Retrospective analysis comparing Plastic surgery (PS) and Dermatology (DM) 2ww clinics against combined Dermatology and Plastic surgery (DP) clinics across the same 3-month period in 2018 and 2019 at a single UK tertiary centre.
283 patients reviewed across the same 3-month period in 2018 and 2019 (PS n = 53, DM n = 158, PD n = 72). PD reviewed most patients per clinic (Averages: PD n = 18.0, PS n = 8.8, DM n = 12.1). Hospital attendance decreased from 1.84 to 1.51 visits. 42.9% of excisional biopsies were performed on the same day as initial assessment compared to 18.0% in PS/DM clinics. Referral to surgery time decreased from 67.7days to 50.4 days, and tertiary assessment to surgery from 49.5days to 36.9days. PD attracted tariffs of up to £29.78 more per patient.
Combined clinics see more patients and attract higher tariffs per patient, whilst reducing outpatient attendances and wait times to surgery. This has significant cost-saving implications whilst optimising cancer care.
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Affiliation(s)
- C. Brennan
- Hull University Teaching Hospitals, Hull, United Kingdom
| | - M. Stone
- Hull University Teaching Hospitals, Hull, United Kingdom
| | - R. Pinder
- Hull University Teaching Hospitals, Hull, United Kingdom
| | - A. Gowda
- Hull University Teaching Hospitals, Hull, United Kingdom
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Brennan C, Saraiva S, Mitchell E, Melia R, Campbell L, King N, House A. Self-harm and suicidal content online, harmful or helpful? A systematic review of the recent evidence. JPMH 2022. [DOI: 10.1108/jpmh-09-2021-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
There are calls for greater regulation of online content related to self-harm and suicide, particularly that which is user-generated. However, the online space is a source of support and advice, including an important sharing of experiences. This study aims to explore what it is about such online content, and how people interact with it, that may confer harm or offer benefit.
Design/methodology/approach
The authors undertook a systematic review of the published evidence, using customised searches up to February 2021 in seven databases. The authors included empirical research on the internet or online use and self-harm or suicide content that had been indexed since 2015. The authors undertook a theoretically driven narrative synthesis.
Findings
From 4,493 unique records, 87 met our inclusion criteria. The literature is rapidly expanding and not all the evidence is high quality, with very few longitudinal or intervention studies so little evidence to understand possible causal links. Very little content online is classifiable as explicitly harmful or definitively helpful, with responses varying by the individual and immediate context. The authors present a framework that seeks to represent the interplay in online use between the person, the medium, the content and the outcome.
Originality/value
This review highlights that content should not be considered separately to the person accessing it, so online safety means thinking about all users. Blanket removal or unthinking regulation may be more harmful than helpful. A focus on safe browsing is important and tools that limit time and diversify content would support this.
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13
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Horner CR, Hugh-Jones S, Sutherland E, Brennan C, Sadler-Smith C. “This doesn’t feel like living”: How the COVID-19 Pandemic Affected the Mental Health of Vulnerable University Students in the United Kingdom. EJMH 2022. [DOI: 10.5708/ejmh.17.2022.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Concerns about student mental health have been rising globally. The COVID-19 pandemic triggered unprecedented disruption in higher education as universities were forced to close and adapt their education delivery. Understanding the impact of this on vulnerable students can inform higher education’s response to future similar events. Aims: To understand the lived experience of first year university students studying in the United Kingdom, who had a history of poor mental health and lived on a low income, we examined the inter-relatedness between mental health, financial strain, remote learning and engagement, and well-being. Methods: At the start of their first year of study, whilst the UK was in periods of lockdown, we conducted in-depth semi-structured interviews with 20 diverse first-year university students. We analyzed data using interpretative phenomenological analysis. Results: The pandemic’s impact on student mental health, engagement and learning remained pervasive and serious. Key themes conveyed how isolation triggered past mental health difficulties and a perception that the universities – and government – had forgotten about them. Students also experienced greater difficulty in navigating the liminal threshold between being a child and an adult, and having the additional worry of financial instability left students with fewer coping resources. Conclusions: To mitigate the impact of future pandemic responses, constant and effective communication is needed between faculty and students to safeguard against isolation and low motivation. Vulnerable students need guidance in coping skills to manage mental health risks when they are away from family and familiar support networks.
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14
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Brennan C, O' Donoghue G, Hall A, Keogh A, Matthews J. A systematic review of mother-daughter interventions targeting physical activity. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.535] [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
Growing gender disparities in levels of physical inactivity put women and female youths at a greater risk of associated health problems. Mother-daughter interventions have been proposed as means to promote physical activity in this at-risk cohort. However, there is a lack of clarity as to if and why these types of interventions might be effective.
Methods
This systematic review examined the intervention characteristics, and behaviour change theory and techniques used in these interventions to promote physical activity for daughters and their mothers. PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Library (Wiley) databases were searched for English language studies from inception to 13th May 2020. Interventions of any design that targeted daughters and mothers' physical activity were included in the review. Data was extracted using the Template for Intervention Description and Replication checklist, and the Behaviour Change Technique Taxonomy v1.
Results
4962 articles were screened and 11 unique studies met the inclusion criteria. Risk of bias was generally high. Narrative summary highlighted that many studies used social cognitive theory as a theoretical foundation, were based in the community and less than three months in duration with multiple sessions per week. Thirty-seven behaviour change techniques were identified across studies. Some techniques were deemed potentially effective including credible source, information on the health consequences of the behaviour and the self-regulatory related techniques of goal-setting, self-monitoring and problem-solving.
Conclusions
Future research should consider using checklists, frameworks and formative work with mothers and daughters to ensure interventions are rigorously designed, implemented, and evaluated, which can inform public policy to combat physical inactivity in this at-risk cohort.
Key messages
This is the first review to assess the intervention characteristics, and behaviour change theory and techniques of mother-daughter interventions targeting physical activity. This review advances the evidence base for future intervention development and more broadly can inform public policy to tackle physical inactivity in this at-risk cohort.
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Affiliation(s)
- C Brennan
- University College Dublin, Dublin, Ireland
| | | | - A Hall
- University College Dublin, Dublin, Ireland
| | - A Keogh
- University College Dublin, Dublin, Ireland
| | - J Matthews
- University College Dublin, Dublin, Ireland
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15
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Brennan C, Kelemen N, Matteucci P. Continuing to establish the relationship between anatomical location of cutaneous head and neck melanoma primaries and locoregional sites of metastasis: A consideration of a new anatomical site, drainage to multiple and non-adjacent neck levels, and the impact on the selectivity of neck dissection. J Plast Reconstr Aesthet Surg 2021; 74:3443-3476. [PMID: 34756553 DOI: 10.1016/j.bjps.2021.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Affiliation(s)
- C Brennan
- Department of Plastic Surgery, Hull University Teaching Hospitals, Hull, United Kingdom.
| | - N Kelemen
- Department of Plastic Surgery, Hull University Teaching Hospitals, Hull, United Kingdom
| | - P Matteucci
- Department of Plastic Surgery, Hull University Teaching Hospitals, Hull, United Kingdom
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16
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Powell-Bowns M, Olley R, McCann C, Balfour J, Brennan C, Scott C. 441 Intravenous Tranexamic Acid Given at Femoral Fragility Fracture Surgery Reduces Blood Transfusion Requirements Four-Fold. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Tranexamic acid (TXA) is proven to reduce blood loss in several surgical fields, but its use in femoral fragility fracture (FFF) management is ill defined. This study examined the effect of intraoperative TXA on the rate of postoperative blood transfusion following FFF.
Method
A prospective non-randomized case-control study of 361 consecutive patients admitted to the study centre with FFFs over a 4-month period was performed. Intravenous TXA 1g was administered intraoperatively at the discretion of the operating team: 178 patients received TXA and 183 did not.
Results
Patients given TXA required fewer blood transfusions: 15/178 (8.4%) vs controls 58/183 (31.7%), (p < 0.001). Calculated blood loss (mean difference -222ml (-337 to -106, 95%CI), p < 0.001) and percentage drop in Hb (mean difference -4.3% (-6.3 to -2.3, 95%CI), p < 0.001) were significantly lower in the TXA group. The difference in CBL was greatest following intramedullary nail (n = 49: mean difference -394ml, p = 0.030) and DHS (n = 101, mean difference -216ml, p = 0.032). There was no significant difference in complication rates: venous thromboembolism TXA 2/178 vs control 1/182 (p = 0.620); MI/stroke/TIA 2/178 vs 0/182 (p = 0.244)
Conclusions
Intraoperative intravenous TXA significantly reduced calculated blood loss and blood transfusion requirements following femoral fragility fracture surgery without increasing the rate of complications.
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Affiliation(s)
- M Powell-Bowns
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - R Olley
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - C McCann
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - J Balfour
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - C Brennan
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - C Scott
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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17
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Williamson C, Brennan C. 717 The Introduction of a Discharge Letter Proforma For Hip Fracture Patients Improves Compliance with VTE Prophylaxis Prescription on Discharge: A Closed Loop Audit. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in inpatients; with those undergoing lower limb surgery at particularly high risk. NICE recommends that Low Molecular Weight Heparin (LMWH) or Fondaparinux should be used for VTE prophylaxis for one month following hip fracture. Our local policy is to prescribe Dalteparin for 30 days following surgery.
Method
A closed loop audit of VTE prophylaxis on discharge for 193 patients with hip fractures was performed. The first audit cycle established whether VTE prophylaxis was being prescribed in line with departmental policy. Following this, a template discharge letter was introduced which included a prompt for appropriate prescription of VTE prophylaxis.
Results
Initially, data for 93 consecutive patients was collected. It was found that 13% had not received VTE prophylaxis in line with guidelines. Of these, six patients had no documented contraindication or alternative prophylaxis prescribed. Results were disseminated locally.
After introduction of the template discharge letter, data for 100 consecutive patients was collected. Re-audit showed a marked improvement in adherence to local policy with 95% of patients now receiving appropriate VTE prophylaxis on discharge.
Conclusions
Introduction of a template discharge letter prompts the documentation of contraindications to prophylaxis and improves compliance with local policy.
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Affiliation(s)
- C Williamson
- Royal Infirmary Edinburgh, Edinburgh, United Kingdom
| | - C Brennan
- Royal Infirmary Edinburgh, Edinburgh, United Kingdom
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18
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Bryant LD, O'Shea R, Farley K, Brennan C, Crosby HF, Guthrie E, House A. Understanding the functions of repeated self-harm: A Q methodology approach. Soc Sci Med 2020; 268:113527. [PMID: 33293170 DOI: 10.1016/j.socscimed.2020.113527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Multiple repetition of self-harm is common and is associated with poor quality of life and with an increased risk of suicide. Treatment outside specialist clinics rarely takes account of what is known about the varied and conflicting reasons for multiple repetition. We aimed to identify ways in which individuals who self-harm make sense of their motivations for repetition. METHODS In 2018/2019 we recruited 59 participants from NHS services, support organizations in England and via social media into a Q-methodology study. Participants sorted, ranked and commented on 46 separate functions of self-harm according to whether they agreed or disagreed with them as reasons for their own self-harm. The functions were identified from a range of academic sources and first-person accounts. RESULTS Principal Component Analysis was used to identify four distinct accounts for repeated self-harm: 1) Managing my mental state, 2) Communicating Distress, 3) Distract from suicidal thoughts or feelings and 4) Producing positive feelings. There were no clear links between account and gender or other respondent characteristic, although those who self-harmed most regularly and frequently ('so many times I've lost count') were mostly in Accounts 1 and 4. CONCLUSIONS This is the first study to use Q methodology to explore reasons for repeated self-harm. The accounts identified can help in personalizing therapy by going beyond models that focus on a single function such as affect regulation or experiential avoidance, while reducing the field to a manageable number of points of view that can be explored in therapy.
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Affiliation(s)
- Louise D Bryant
- Leeds Institute of Health Sciences, University of Leeds, UK.
| | | | - Kate Farley
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Helen F Crosby
- Leeds Institute of Health Sciences, University of Leeds, UK
| | | | - Allan House
- Leeds Institute of Health Sciences, University of Leeds, UK
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19
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Traore-Toure F, Etheredge G, Shah G, Brennan C. Retention and predictors of attrition among children living with HIV on antiretroviral therapy (ART) in Côte d’Ivoire between 2012 and 2016. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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20
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Brennan C, Gunasekaran T, Williams K, Sanders RA. Infective aortic valve endocarditis in a cat with patent ductus arteriosus and perimembranous ventricular septal defect. J Vet Cardiol 2020; 31:30-35. [PMID: 32956937 DOI: 10.1016/j.jvc.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Abstract
A 3-year-old, male neutered, domestic short-haired cat presented for evaluation of respiratory distress. Transthoracic echocardiography revealed a left-to-right shunting ventricular septal defect, a left-to-right shunting patent ductus arteriosus, and a vegetative growth on the aortic valve leaflet consistent with aortic valve endocarditis. Because of poor response to therapy, the owner elected euthanasia, and a necropsy was performed. Gross necropsy examination confirmed the congenital cardiac defects, and aortic valve endocarditis was noted on the echocardiogram. Histopathological examination revealed diffuse interstitial pneumonia and evidence for systemic septic embolism including renal infarcts and brain microabscesses. To the authors' knowledge, this is the first case report of aortic valve endocarditis in a cat in association with congenital cardiac malformations.
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Affiliation(s)
- C Brennan
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, 736 Wilson Rd, East Lansing, MI, 48824, United States
| | - T Gunasekaran
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, 736 Wilson Rd, East Lansing, MI, 48824, United States
| | - K Williams
- College of Veterinary Medicine, Veterinary Diagnostic Laboratory, Michigan State University, 4125 Beaumont Rd, Lansing, MI, USA 48910
| | - R A Sanders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, 736 Wilson Rd, East Lansing, MI, 48824, United States.
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21
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Brennan C, Morrissey B, Dubois-Marshall S, McAteer D, Qadir A, Ramsay G. COVID-19: No benefit of chest inclusion in acute abdomen CT. Br J Surg 2020; 107:e474-e475. [PMID: 32790173 PMCID: PMC7436728 DOI: 10.1002/bjs.11934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 01/13/2023]
Affiliation(s)
| | | | | | | | | | - G Ramsay
- Correspondence to: George Ramsay, Senior Lecturer and Consultant Colorectal Surgeon, Rowett Institute for Health, , University of Aberdeen, Foresterhill, Aberdeen, AB252 ZD, (44) 345 456 6000
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22
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Golovchak R, Brennan C, Fletcher J, Ignatova T, Jain H. Dynamics of structural relaxation in bioactive 45S5 glass. J Phys Condens Matter 2020; 32:295401. [PMID: 32187590 DOI: 10.1088/1361-648x/ab80f3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Kinetics of physical aging in archetypic 45S5 bioactive silicate glass composition with different types of phase separation are studied in situ below the glass transition temperature (T g). The qualitative nature of aging is found to be almost independent of the structural differences on the micrometer scale. A well-expressed step-like behavior in the enthalpy recovery kinetics is observed for aging temperatures T a ∼ 0.90T g and T a ∼ 0.85T g, which, however, disappears when the aging occurs at T a ∼ 0.95T g. The overall kinetics are described by a stretched-exponential function with stretching exponent close to 3/7 at T a ∼ 0.95T g, and 1/3 when the aging temperature drops to ∼0.90T g and below. The values correlate well with the predictions of Phillips' diffusion-to-traps and percolating fractals models. Appearance of step-like behavior at larger departure from T g is attributed to the hierarchical scheme of approaching equilibrium based on an alignment-shrinkage mechanism of physical aging proposed earlier for chalcogenide glasses.
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Affiliation(s)
- R Golovchak
- Department of Physics, Engineering and Astronomy, Austin Peay State University, Clarksville, TN 37044, United States of America
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23
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Abstract
The objective of this study was to explore, using first-hand accounts, adolescents' understandings of why they self-harmed, what their responses to self-harm were, and how they resisted or ceased self-harm. Secondary analysis was conducted of video-recorded family therapy sessions from the Self-harm Intervention: Family Therapy (SHIFT Trial). Recordings of 22 participants, approximately 170 hours of footage, formed the dataset. The study developed 5 core themes: (1) Distress can be difficult to convey; (2) Self-harm and suicidal ideation: a complex relationship; (3) Self-harm as a form of communication; (4) Self-harm to manage emotions; and (5) Moving forward. Self-harm was a means of communicating distress as well as managing emotions. Accounts highlighted the complex interplay between self-harm and suicidal intent. Encouragingly, many participants described being able to resist self-harm.
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Affiliation(s)
- Robert Holliday
- School of Medicine, University of Leeds, Leeds Institute of Health Sciences, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Cathy Brennan
- School of Medicine, University of Leeds, Leeds Institute of Health Sciences, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - David Cottrell
- School of Medicine, University of Leeds, Leeds Institute of Health Sciences, Leeds, United Kingdom of Great Britain and Northern Ireland
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24
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Murray J, Wickramasekera N, Elings M, Bragg R, Brennan C, Richardson Z, Wright J, Llorente MG, Cade J, Shickle D, Tubeuf S, Elsey H. The impact of care farms on quality of life, depression and anxiety among different population groups: A systematic review. Campbell Syst Rev 2019; 15:e1061. [PMID: 37131853 PMCID: PMC8534033 DOI: 10.1002/cl2.1061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Care farming (also called social farming) is the therapeutic use of agricultural and farming practices. Service users and communities supported through care farming include people with learning disabilities, mental and physical health problems, substance misuse, adult offenders, disaffected youth, socially isolated older people and the long term unemployed. Care farming is growing in popularity, especially around Europe. This review aimed to understand the impact of care farming on quality of life, depression and anxiety, on a range of service user groups. It also aimed to explore and explain the way in which care farming might work for different groups. By reviewing interview studies we found that people valued, among other things, being in contact with each other, and feeling a sense of achievement, fulfilment and belonging. Some groups seemed to appreciate different things indicating that different groups may benefit in different ways but, it is unclear if this is due to a difference in the types of activities or the way in which people take different things from the same activity. We found no evidence that care farms improved people's quality of life and some evidence that they might improve depression and anxiety. Larger studies involving single service user groups and fully validated outcome measures are needed to prove more conclusive evidence about the benefits of care farming.
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Affiliation(s)
- Jenni Murray
- Academic Unit of Public Health, Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Nyantara Wickramasekera
- Academic Unit of Public Health, Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Marjolein Elings
- Plant Research InternationalWageningen UniversityWageningenThe Netherlands
| | | | - Cathy Brennan
- Academic Unit of Public Health, Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Zoe Richardson
- York Trials Unit, Department of Health Sciences, Faculty of ScienceUniversity of YorkYorkUK
| | - Judy Wright
- Leeds Institute of Health SciencesThe University of LeedsLeedsUK
| | - Marina G. Llorente
- Madrid Institute for Rural, Agricultural and Food Research and Development (IMIDRA), Social‐Ecological Systems Lab, Ecology DepartmentUniversidad Autónoma de Madrid (Spain)MadridSpain
| | | | - Darren Shickle
- Academic Unit of Public Health, Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Sandy Tubeuf
- Academic Unit of Public Health, Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Helen Elsey
- Academic Unit of Public Health, Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
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25
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Brennan C, Haas D, Landsberger S, Artnak E, Bátor G, Bednár A, Kovács T. A feasibility study on the determination of 90Sr food-chain transfer using stable strontium as a surrogate and neutron activation analysis. J Environ Radioact 2019; 208-209:105988. [PMID: 31176957 DOI: 10.1016/j.jenvrad.2019.105988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 06/09/2023]
Abstract
We evaluated the applicability of neutron activation analysis for investigating the potential mobility of 90Sr in a pasture area in Hungary. To measure strontium concentrations, we made use of the 84Sr(n,γ)85Sr radiative capture reaction using neutron activation analysis and performed gamma spectroscopy using Compton-suppression techniques on the resulting 514.0 keV gamma ray. Our values for soil-to-plant transfer factors value of 1.6 (2.2) kg kg-1 were in agreement with recommended values from the ICRP and IAEA, as well as similar studies performed by independent researchers. Our values for plant-to-animal transfer coefficients and concentration ratios varied from suggested values by several orders of magnitude to agreement with other values. Based on our results the utilized transfer of stable strontium could not be regarded as a convenient substitute to help clarify the long-term transfer of radioactive strontium in the environment, because short term dosing was applied. Neutron activation analysis provides a unique niche as a technique with very little chemical processing and short sample analysis times.
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Affiliation(s)
- C Brennan
- University of Texas at Austin, Nuclear Engineering Teaching Laboratory, Pickle Research Campus, R-9000, Austin, TX, 78712, USA
| | - D Haas
- University of Texas at Austin, Nuclear Engineering Teaching Laboratory, Pickle Research Campus, R-9000, Austin, TX, 78712, USA
| | - S Landsberger
- University of Texas at Austin, Nuclear Engineering Teaching Laboratory, Pickle Research Campus, R-9000, Austin, TX, 78712, USA.
| | - E Artnak
- University of Texas at Austin, Nuclear Engineering Teaching Laboratory, Pickle Research Campus, R-9000, Austin, TX, 78712, USA
| | - G Bátor
- Institute of Radiochemistry and Radioecology, University of Pannonia, PO Box 158, 8201, Veszprém, Hungary
| | - A Bednár
- Institute of Radiochemistry and Radioecology, University of Pannonia, PO Box 158, 8201, Veszprém, Hungary
| | - T Kovács
- Institute of Radiochemistry and Radioecology, University of Pannonia, PO Box 158, 8201, Veszprém, Hungary
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26
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Gerber A, da Silva Lopes A, Szüts N, Ribordy-Baudat V, Ebneter A, Perrinjaquet C, Betticher D, Cote M, Duchosal M, Brennan C, Decosterd S, Peters S, Koelliker R, Ninane F, Jeitziner MM, Colomer-Lahiguera S, Dietrich PY, Simon M, Gaignard ME, Eicher M. Adverse events in oncology and haemato-oncology inpatients of Swiss hospitals: A descriptive study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz274] [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: 11/13/2022] Open
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27
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Shortal BP, Hickman LB, Mak-McCully RA, Wang W, Brennan C, Ung H, Litt B, Tarnal V, Janke E, Picton P, Blain-Moraes S, Maybrier HR, Muench MR, Lin N, Avidan MS, Mashour GA, McKinstry-Wu AR, Kelz MB, Palanca BJ, Proekt A. Duration of EEG suppression does not predict recovery time or degree of cognitive impairment after general anaesthesia in human volunteers. Br J Anaesth 2019; 123:206-218. [PMID: 31202561 DOI: 10.1016/j.bja.2019.03.046] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/14/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Burst suppression occurs in the EEG during coma and under general anaesthesia. It has been assumed that burst suppression represents a deeper state of anaesthesia from which it is more difficult to recover. This has not been directly demonstrated, however. Here, we test this hypothesis directly by assessing relationships between EEG suppression in human volunteers and recovery of consciousness. METHODS We recorded the EEG of 27 healthy humans (nine women/18 men) anaesthetised with isoflurane 1.3 minimum alveolar concentration (MAC) for 3 h. Periods of EEG suppression and non-suppression were separated using principal component analysis of the spectrogram. After emergence, participants completed the digit symbol substitution test and the psychomotor vigilance test. RESULTS Volunteers demonstrated marked variability in multiple features of the suppressed EEG. In order to test the hypothesis that, for an individual subject, inclusion of features of suppression would improve accuracy of a model built to predict time of emergence, two types of models were constructed: one with a suppression-related feature included and one without. Contrary to our hypothesis, Akaike information criterion demonstrated that the addition of a suppression-related feature did not improve the ability of the model to predict time to emergence. Furthermore, the amounts of EEG suppression and decrements in cognitive task performance relative to pre-anaesthesia baseline were not significantly correlated. CONCLUSIONS These findings suggest that, in contrast to current assumptions, EEG suppression in and of itself is not an important determinant of recovery time or the degree of cognitive impairment upon emergence from anaesthesia in healthy adults.
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Affiliation(s)
- B P Shortal
- Neuroscience Graduate Group, University of Pennsylvania, Philadelphia, PA, USA
| | - L B Hickman
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - R A Mak-McCully
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - W Wang
- Department of Mathematics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - C Brennan
- Neuroscience Graduate Group, University of Pennsylvania, Philadelphia, PA, USA
| | - H Ung
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - B Litt
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - V Tarnal
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - E Janke
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - P Picton
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - S Blain-Moraes
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - H R Maybrier
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - M R Muench
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - N Lin
- Department of Mathematics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - M S Avidan
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - G A Mashour
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - A R McKinstry-Wu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M B Kelz
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - B J Palanca
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - A Proekt
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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- Department of Anesthesiology and Critical Care, University of Pennsylvania, USA; Department of Anesthesiology, Washington University, St. Louis, MO, USA; Center for Consciousness Science, Department of Anesthesiology, Ann Arbor, MI, USA
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Shanahan N, Brennan C, House A. Self-harm and social media: thematic analysis of images posted on three social media sites. BMJ Open 2019; 9:e027006. [PMID: 30782950 PMCID: PMC6367987 DOI: 10.1136/bmjopen-2018-027006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the nature of images tagged as self-harm on popular social media sites and what this might tell us about how these sites are used. DESIGN A visual content and thematic analysis of a sample of 602 images captured from Twitter, Instagram and Tumblr. RESULTS Over half the images tagged as self-harm had no explicit representation of self-harm. Where there was explicit representation, self-injury was the most common; none of these portrayed images of graphic or shocking self-injury. None of the images we captured specifically encouraged self-harm or suicide and there was no image that could be construed as sensationalising self-harm.Four themes were found across the images: communicating distress, addiction and recovery, gender and the female body, identity and belonging. CONCLUSIONS Findings suggest that clinicians should not be overly anxious about what is being posted on social media. Although we found a very few posts suggesting self-injury was attractive, there were no posts that could be viewed as actively encouraging others to self-harm. Rather, the sites were being used to express difficult emotions in a variety of creative ways, offering inspiration to others through the form of texts or shared messages about recovery.
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Affiliation(s)
- Nicola Shanahan
- Division of Psychological and Social Medicine, University of Leeds, Leeds, UK
| | - Cathy Brennan
- Division of Psychological and Social Medicine, University of Leeds, Leeds, UK
| | - Allan House
- Division of Psychological and Social Medicine, University of Leeds, Leeds, 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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House A, Guthrie E, Walker A, Hewsion J, Trigwell P, Brennan C, Crawford M, Murray CC, Fossey M, Hulme C, Martin A, Quirk A, Tubeuf S. A programme theory for liaison mental health services in England. BMC Health Serv Res 2018; 18:742. [PMID: 30261875 PMCID: PMC6161457 DOI: 10.1186/s12913-018-3539-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/13/2018] [Indexed: 11/11/2022] Open
Abstract
Background Mechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice. Method We synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems. Results We identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred. Conclusions Our findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control.
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Affiliation(s)
- Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Elspeth Guthrie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Andrew Walker
- Clinical Research Network National Coordinating Centre, National Institute of Health Research Clinical Research Network, Leeds, UK
| | - Jenny Hewsion
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Peter Trigwell
- National Inpatient Centre for Psychological Medicine, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mike Crawford
- Faculty of Medicine, Department of Medicine, Imperial College, London, UK
| | | | - Matt Fossey
- Veterans and Families Institute for Military Research, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alan Quirk
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Sandy Tubeuf
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Lin AL, Jonsson P, Ogilvie S, Chavan S, Nolan C, Gavrilovic I, Kaley T, Grommes C, Pentsova E, Diamond E, Daras M, Stone J, DeAngelis L, Tabar V, Brennan C, Young RJ, Rosenblum M, Taylor BS, Mellinghoff IK. OS1.7 Genomic attributes of tumor evolution and treatment response in diffuse glioma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.013] [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: 11/14/2022] Open
Affiliation(s)
- A L Lin
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - P Jonsson
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - S Ogilvie
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - S Chavan
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - C Nolan
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - I Gavrilovic
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - T Kaley
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - C Grommes
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - E Pentsova
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - E Diamond
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - M Daras
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - J Stone
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - L DeAngelis
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - V Tabar
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - C Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - R J Young
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - M Rosenblum
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - B S Taylor
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - I K Mellinghoff
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
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P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Brennan C, Gormley GJ, Corry R. The importance of human factors in right-left errors. Anaesthesia 2018; 73:790. [DOI: 10.1111/anae.14311] [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: 11/29/2022]
Affiliation(s)
- C. Brennan
- Centre of Medical Education; Queen's University Belfast; Belfast UK
| | - G. J. Gormley
- Centre of Medical Education; Queen's University Belfast; Belfast UK
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Abstract
BACKGROUND Reasons for self-harm are not well understood. One of the reasons for this is that first-hand accounts are usually elicited using traditional interview and questionnaire methods. This study aims to explore the acceptability of using an approach (photo-elicitation) that does not rely on solely verbal or written techniques, and to make a preliminary assessment of whether people can usefully employ images to support a discussion about the reasons why they self-harm. METHOD Interviews with eight participants using photo elicitation, a method in which photographs produced by the participant are used as a stimulus and guide within the interview. RESULTS Participants responded positively to using images to support a discussion about their self-harm and readily incorporated images in the interview. Four main themes were identified representing negative and positive or adaptive purposes of self-harm: self-harm as a response to distress, self-harm to achieve mastery, self-harm as protective and self-harm as a language or form of communication. CONCLUSIONS Employing this novel approach was useful in broadening our understanding of self-harm.
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Affiliation(s)
- Amanda J. Edmondson
- 0000 0001 0719 6059grid.15751.37Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH UK
| | - Cathy Brennan
- 0000 0004 1936 8403grid.9909.9Institute of Health Sciences, School of Medicine, University of Leeds, 101 Clarendon Rd, Leeds, LS2 9LJ UK
| | - Allan O. House
- 0000 0004 1936 8403grid.9909.9Institute of Health Sciences, School of Medicine, University of Leeds, 101 Clarendon Rd, Leeds, LS2 9LJ UK
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Otter S, Coates A, Franklin A, Brennan C, Cunningham M, Stewart A. EP-2216: The dosimetric impact of interstitial needles in HDR brachytherapy for cervical cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32525-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Elsey H, Farragher T, Tubeuf S, Bragg R, Elings M, Brennan C, Gold R, Shickle D, Wickramasekera N, Richardson Z, Cade J, Murray J. Assessing the impact of care farms on quality of life and offending: a pilot study among probation service users in England. BMJ Open 2018; 8:e019296. [PMID: 29550778 PMCID: PMC5875661 DOI: 10.1136/bmjopen-2017-019296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To assess the feasibility of conducting a cost-effectiveness study of using care farms (CFs) to improve quality of life and reduce reoffending among offenders undertaking community orders (COs). To pilot questionnaires to assess quality of life, connection to nature, lifestyle behaviours, health and social-care use. To assess recruitment and retention at 6 months and feasibility of data linkage to Police National Computer (PNC) reconvictions data and data held by probation services. DESIGN Pilot study using questionnaires to assess quality of life, individually linked to police and probation data. SETTING The pilot study was conducted in three probation service regions in England. Each site included a CF and at least one comparator CO project. CFs are working farms used with a range of clients, including offenders, for therapeutic purposes. The three CFs included one aquaponics and horticulture social enterprise, a religious charity focusing on horticulture and a family-run cattle farm. Comparator projects included sorting secondhand clothes and activities to address alcohol misuse and anger management. PARTICIPANTS We recruited 134 adults (over 18) serving COs in England, 29% female. RESULTS 52% of participants completed follow-up questionnaires. Privatisation of UK probation trusts in 2014 negatively impacted on recruitment and retention. Linkage to PNC data was a more successful means of follow-up, with 90% consenting to access their probation and PNC data. Collection of health and social-care costs and quality-adjusted life year derivation were feasible. Propensity score adjustment provided a viable comparison method despite differences between comparators. We found worse health and higher reoffending risk among CF participants due to allocation of challenging offenders to CFs, making risk of reoffending a confounder. CONCLUSIONS Recruitment would be feasible in a more stable probation environment. Follow-up was challenging; however, assessing reconvictions from PNC data is feasible and a potential primary outcome for future studies.
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Affiliation(s)
- Helen Elsey
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Tracey Farragher
- Division of Primary Care, Public Health and Palliative Care, University of Leeds, Leeds, UK
| | - Sandy Tubeuf
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Rachel Bragg
- Green Exercise Research Team, University of Essex and Care Farming, Colchester, UK
| | - Marjolein Elings
- Plant Research International, Wageningen University, Wageningen, The Netherlands
| | - Cathy Brennan
- Division of Psychiatry and Behavioural Sciences, University of Leeds, Leeds, UK
| | | | - Darren Shickle
- Division of Primary Care, Public Health and Palliative Care, University of Leeds, Leeds, UK
| | | | - Zoe Richardson
- MCP and Care Home Vanguard Programme, NHS Wakefield Clinical Commissioning Group, Wakefield, UK
| | - Janet Cade
- Nutritional Epidemiology Group, University of Leeds, Leeds, UK
| | - Jenni Murray
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Elsey H, Bragg R, Elings M, Brennan C, Farragher T, Tubeuf S, Gold R, Shickle D, Wickramasekera N, Richardson Z, Cade J, Murray J. Impact and cost-effectiveness of care farms on health and well-being of offenders on probation: a pilot study. Public Health Res 2018. [DOI: 10.3310/phr06030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Care farms (CFs), in which all or part of the farm is used for therapeutic purposes, show potential for improving well-being for disadvantaged groups. We assessed the feasibility of determining the cost-effectiveness of CFs in improving quality of life compared with comparator sites among probationers undertaking community orders (COs).
Objectives
(1) To conduct a systematic review of CF impacts and mechanisms in improving health and logic
model development; (2) to inform future studies by estimating differences
in quality of life and other outcomes, identifying factors driving CO
allocation and ways to maximise recruitment and follow-up; and (3) to assess
feasibility of cost-effectiveness analysis.
Review methods
A mixed-methods synthesis following Campbell Collaboration guidelines. Pilot study: three probation service regions in England, each with a CF and a comparator CO site. Participants were adult offenders (aged ≥ 18 years) serving COs. The primary outcome was quality of life [as measured via the Clinical Outcome in Routine Evaluation–Outcome Measure (CORE-OM)]. Other outcomes were health behaviours, mental well-being, connectedness to nature and reconvictions.
Data sources
In November 2014, we searched 22 health, education, environmental, criminal justice and social science electronic databases, databases of grey literature and care farming websites across Europe. There were no language restrictions. A full list of databases searched is given in
Appendix 1; some examples include Web of Science, Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost), The Campbell Library, Criminal Justice Abstracts (via EBSCOhost), MEDLINE (via Ovid) and Scopus (Elsevier B.V., Amsterdam, the Netherlands).
Results
Our systematic review identified 1659 articles: 14 qualitative, 12 quantitative and one mixed-methods study. Small sample sizes and poor design meant that all were rated as being at a high risk of bias. Components of CFs that potentially improve health are being in a group, the role of the farmer and meaningful work, and interaction with animals. There was a lack of quantitative evidence indicating that CFs improve quality of life and there was weak evidence of improved mental health, self-efficacy, self-esteem, affect and mood. In the pilot study we recruited 134 respondents, and only 21 declined; 37% were allocated to three CFs and the remainder to comparators. This was below our recruitment target of 300. Recruitment proved challenging as a result of the changes in probation (probation trusts were disbanded in 2014) and closure of one CF. We found significant differences between CFs and comparator users: those at CFs were more likely to be male, smokers, substance users, at higher risk of reoffending (a confounder) and have more missing CORE-OM questions. Despite these differences, the use of propensity analysis facilitated comparison. Participants consented to our team accessing, and we were able to link, probation and police reconviction data for 90% of respondents. We gained follow-up questionnaire data from 52% of respondents, including health and social care use cost data. We transformed CORE-OM into CORE-6D, allowing derivation of quality-adjusted life-years. As a pilot, our study was not powered to identify significant differences in outcomes. Qualitatively, we observed that within COs, CFs can be formally recognised as rehabilitative but in practice can be seen as punitive.
Limitations
Changes in probation presented many challenges that limited recruitment and collection of cost data.
Conclusions
Recruitment is likely to be feasible in a more stable probation environment. Retention among probationers is challenging but assessing reconvictions from existing data is feasible. We found worse health and risk of reoffending among offenders at CFs, reflecting the use of CFs by probation to manage challenging offenders.
Future work
A sufficiently powered natural experiment is feasible and of value. Using reconvictions (from police data) as a primary outcome is one solution to challenges with retention. Propensity analysis provides a viable method for comparison despite differences in participants at CFs and comparator sites. However, future work is dependent on stability and support for CFs within probation services.
Study registration
This study is registered as PROSPERO CRD42014013892 and SW2013–04 (the Campbell Collaboration).
Funding details
The National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Helen Elsey
- Academic Unit of Public Health, University of Leeds, Leeds, UK
| | - Rachel Bragg
- Essex Sustainability Institute, University of Essex, Colchester, UK
| | - Marjolein Elings
- Plant Research International, Wageningen University, Wageningen, the Netherlands
| | - Cathy Brennan
- Academic Unit of Public Health, University of Leeds, Leeds, UK
| | | | - Sandy Tubeuf
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Rochelle Gold
- NHS e-Referral Service, Health Digital Services, NHS Digital, Leeds, UK
| | - Darren Shickle
- Academic Unit of Public Health, University of Leeds, Leeds, UK
| | | | - Zoe Richardson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Janet Cade
- Nutritional Epidemiology Group, University of Leeds, Leeds, UK
| | - Jenni Murray
- Academic Unit of Public Health, University of Leeds, Leeds, UK
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Brennan C, Greenhalgh J, Pawson R. Guidance on guidelines: Understanding the evidence on the uptake of health care guidelines. J Eval Clin Pract 2018; 24:105-116. [PMID: 28370699 DOI: 10.1111/jep.12734] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 12/25/2022]
Abstract
RATIONALE Regardless of health issue, health sector, patient condition, or treatment modality, the chances are that provision is supported by "a guideline" making professionally endorsed recommendations on best practice. Against this background, research has proliferated seeking to evaluate how effectively such guidance is followed. These investigations paint a gloomy picture with many a guideline prompting lip service, inattention, and even opposition. This predicament has prompted a further literature on how to improve the uptake of guidelines, and this paper considers how to draw together lessons from these inquiries. METHODS This huge body of material presents a considerable challenge for research synthesis, and this paper produces a critical, methodological comparison of 2 types of review attempting to meet that task. Firstly, it provides an overview of the current orthodoxy, namely, "thematic reviews," which aggregate and enumerate the "barriers and facilitators" to guideline implementation. It then outlines a "realist synthesis," focussing on testing the "programme theories" that practitioners have devised to improve guideline uptake. RESULTS Thematic reviews aim to provide a definitive, comprehensive catalogue of the facilitators and barriers to guideline implementation. As such, they present a restatement of the underlying problems rather than an improvement strategy. The realist approach assumes that the incorporation of any guideline into current practice will produce unintended system strains as different stakeholders wrestle over responsibilities. These distortions will prompt supplementary revisions to guidelines, which in turn beget further strains. Realist reviews follow this dynamic understanding of organisational change. CONCLUSIONS Health care decision makers operate in systems that are awash with guidelines. But guidelines only have paper authority. Managers do not need a checklist of their pros and cons, because the fate of guidelines depends on their reception rather than their production. They do need decision support on how to engineer and reengineer guidelines so they dovetail with evolving systems of health care delivery.
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Affiliation(s)
- Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Schofield LM, Duff A, Brennan C. Airway Clearance Techniques for Primary Ciliary Dyskinesia; is the Cystic Fibrosis literature portable? Paediatr Respir Rev 2018; 25:73-77. [PMID: 28408202 DOI: 10.1016/j.prrv.2017.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/27/2017] [Accepted: 03/01/2017] [Indexed: 12/28/2022]
Abstract
Primary Ciliary Dyskinesia (PCD) is a rare inherited disease with impaired mucociliary clearance. Airway clearance techniques (ACTs) are commonly recommended for patients with PCD to facilitate mucus clearance, despite a lack of evidence in this group. Current physiotherapy practice in PCD is based on evidence extrapolated from the field of Cystic Fibrosis (CF). This paper focuses on the available evidence and outlines challenges in extrapolating evidence between the conditions for best clinical practice.
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Affiliation(s)
- Lynne Marie Schofield
- Leeds Teaching Hospitals, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
| | - Alistair Duff
- Leeds Teaching Hospitals, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
| | - Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, UK.
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Herting CJ, Chen Z, Pitter KL, Szulzewsky F, Kaffes I, Kaluzova M, Park JC, Cimino PJ, Brennan C, Wang B, Hambardzumyan D. Genetic driver mutations define the expression signature and microenvironmental composition of high-grade gliomas. Glia 2017; 65:1914-1926. [PMID: 28836293 DOI: 10.1002/glia.23203] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 11/11/2022]
Abstract
High-grade gliomas (HGG), including glioblastomas, are characterized by invasive growth, resistance to therapy, and high inter- and intra-tumoral heterogeneity. The key histological hallmarks of glioblastoma are pseudopalisading necrosis and microvascular proliferation, which allow pathologists to distinguish glioblastoma from lower-grade gliomas. In addition to being genetically and molecularly heterogeneous, HGG are also heterogeneous with respect to the composition of their microenvironment. The question of whether this microenvironmental heterogeneity is driven by the molecular identity of the tumor remains controversial. However, this question is of utmost importance since microenvironmental, non-neoplastic cells are key components of the most radiotherapy- and chemotherapy-resistant niches of the tumor. Our work demonstrates a versatile, reliable, and reproducible adult HGG mouse model with NF1-silencing as a driver mutation. This model shows significant differences in tumor microenvironment, expression of subtype-specific markers, and response to standard therapy when compared to our established PDGFB-overexpressing HGG mouse model. PDGFB-overexpressing and NF1-silenced murine tumors closely cluster with human proneural and mesenchymal subtypes, as well as PDGFRA-amplified and NF1-deleted/mutant human tumors, respectively, at both the RNA and protein expression levels. These models can be generated in fully immunocompetent mixed or C57BL/6 genetic background mice, and therefore can easily be incorporated into preclinical studies for cancer cell-specific or immune cell-targeting drug discovery studies.
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Affiliation(s)
- C J Herting
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.,Graduate Division of Molecular and Systems Pharmacology, Emory University, Atlanta, Georgia
| | - Z Chen
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - K L Pitter
- Department of Cancer Biology and Genetics, Memorial Sloan Cancer Kettering Center, New York
| | - F Szulzewsky
- Department of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - I Kaffes
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - M Kaluzova
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - J C Park
- CSI Core, Emory University School of Medicine, Atlanta, Georgia
| | - P J Cimino
- Department of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Pathology, Division of Neuropathology, University of Washington, Seattle, Washington
| | - C Brennan
- Neurosurgery Department, Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, New York
| | - B Wang
- Rammelkamp Center for Research, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Department of Pharmacology and Oncology, Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - D Hambardzumyan
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
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Otter S, Coates A, Brennan C, Franklin A, Cunningham M, Stewart A. The use of MRI and interstitial needles to achieve dose targets in image guided brachytherapy for cervical cancer at the Royal Surrey County Hospital. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rodgers MA, Vallari AS, Harris B, Yamaguchi J, Holzmayer V, Forberg K, Berg MG, Kenmenge J, Ngansop C, Awazi B, Mbanya D, Kaptue L, Brennan C, Cloherty G, Ndembi N. Identification of rare HIV-1 Group N, HBV AE, and HTLV-3 strains in rural South Cameroon. Virology 2017; 504:141-151. [PMID: 28193549 DOI: 10.1016/j.virol.2017.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 02/07/2023]
Abstract
Surveillance of emerging viral variants is critical to ensuring that blood screening and diagnostic tests detect all infections regardless of strain or geographic location. In this study, we conducted serological and molecular surveillance to monitor the prevalence and diversity of HIV, HBV, and HTLV in South Cameroon. The prevalence of HIV was 8.53%, HBV was 10.45%, and HTLV was 1.04% amongst study participants. Molecular characterization of 555 HIV-1 specimens identified incredible diversity, including 7 subtypes, 12 CRFs, 6 unclassified, 24 Group O and 2 Group N infections. Amongst 401 HBV sequences were found a rare HBV AE recombinant and two emerging sub-genotype A strains. In addition to HTLV-1 and HTLV-2 strains, sequencing confirmed the fifth known HTLV-3 infection to date. Continued HIV/HBV/HTLV surveillance and vigilance for newly emerging strains in South Cameroon will be essential to ensure diagnostic tests and research stay a step ahead of these rapidly evolving viruses.
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Affiliation(s)
| | | | - B Harris
- Abbott Laboratories, Abbott Park, IL, USA
| | | | | | - K Forberg
- Abbott Laboratories, Abbott Park, IL, USA
| | - M G Berg
- Abbott Laboratories, Abbott Park, IL, USA
| | - J Kenmenge
- Université de Yaoundé I, Yaoundé, Cameroon
| | - C Ngansop
- Université de Yaoundé I, Yaoundé, Cameroon
| | - B Awazi
- Université de Yaoundé I, Yaoundé, Cameroon
| | - D Mbanya
- Université de Yaoundé I, Yaoundé, Cameroon
| | - L Kaptue
- Université des Montagnes, Montagnes, Bangangté, Cameroon
| | - C Brennan
- Abbott Laboratories, Abbott Park, IL, USA
| | - G Cloherty
- Abbott Laboratories, Abbott Park, IL, USA
| | - N Ndembi
- Institute of Human Virology Nigeria, Abuja, Nigeria
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Brennan C, Gray M, Shields D, Gray A, DeGheldere A. Paediatric diaphyseal forearm fractures: A retrospective analysis of treatment modalities and outcome. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Brennan C, Delahunt E. Determination of proof of principle of the Star Excursion Test as a rehabilitation tool post ankle fracture. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Riordan F, McHugh SM, Harkins V, Marsden P, Brennan C, Kearney PM. P104 Trends in the Quality of Structure Diabetes Care in Primary Care in Ireland. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.201] [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: 11/04/2022]
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Smyth B, Marsden P, Corcoran R, Walsh R, Brennan C, McSharry K, Clarke J, Kelly P, Harbison J. Opportunistic screening for atrial fibrillation in a rural area. QJM 2016; 109:539-543. [PMID: 26819299 PMCID: PMC4986429 DOI: 10.1093/qjmed/hcw011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 10/07/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Opportunistic screening is an effective means of identifying subjects with Atrial Fibrillation (AF). Previous studies of opportunistic screening have been performed areas with high population density and before the development of novel oral anticoagulant drugs. We performed a study to determine feasibility of AF screening in a predominantly rural, low population density area. METHODS Over 6 months, subjects 65 years and older were screened by local General Practitioners using radial pulse palpation confirmed by 12 lead Electrocardiogram. Data were recorded electronically and those with newly identified AF were followed up to examine management post diagnosis. RESULTS In total, 7262 subjects were screened and an irregular pulse was found in 916 (12.6%) of whom 735 (10.1%) had known AF and 55 (0.76%) had newly detected AF. Of these 55 patients with newly documented AF, 28 (50.9%) were women, 38 (69.1%) had hypertension and eight (14.5%) had a smoking history. Mean body mass index in subjects with newly documented AF was 28.9 kg/m(2)(SD 5.6) There was no significant difference in gender mix (P = 0.4), smoking history (P = 0.8) or alcohol history (P = 0.8) with the overall population. Fifty-one (92.7%) subjects had a CHA2DS2VaSC score ≥ 2 of whom 33 (64.7%) were eventually anticoagulated and nine (17.6%) commenced on Aspirin. The rate of newly identified patients in AF was lower than in previous reported key studies because of a higher rate of subjects with known AF. CONCLUSION Opportunistic AF screening in a rural environment identified a substantial number of new cases, although less than in previous screening studies.
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Affiliation(s)
- B. Smyth
- From the Department of Public Health, National Clinical Programme for Stroke, Galway, Ireland
| | - P. Marsden
- Department of Public Health, National Clinical Programme for Stroke, Tullamore, Ireland
| | - R. Corcoran
- From the Department of Public Health, National Clinical Programme for Stroke, Galway, Ireland
| | - R. Walsh
- National Clinical Programme for Stroke, Department of Cardiology University College Hospital, Galway, Ireland
| | - C. Brennan
- Department of Public Health, National Clinical Programme for Stroke, Tullamore, Ireland
| | - K. McSharry
- Health Service Executive, Practice Nursing, National Clinical Programme for Stroke, Mayo, Ireland
| | - J. Clarke
- Health Service Executive, National Clinical Programme for Primary Care, Summerhill Meath, Ireland
| | - P.J. Kelly
- Department of Neurology UCD, National Clinical Programme for Stroke, Dublin, Ireland
| | - J. Harbison
- Department of Medical Gerontology Trinity College Dublin, National Clinical Programme for Stroke, Dublin, Ireland
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Koteff J, Lake J, Currier J, Brennan C, Gartland M, Shaefer M, Wynne B, Granier C, Aboud M. VIH-16 - Biomarqueurs cardiovasculaires après switch vers DTG/ABC/3TC dans l’essai striiving. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30561-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Koteff J, Trottier B, Lake J, Logue K, Brinson C, Santiago L, Brennan C, Wynne B, Granier C, Aboud M. VIH-17 - Le switch d’une trithérapie de 2 inti associés à un IP, un INNTI ou un INI par DTG/ABC/3TC maintient la suppression virologique à 24 semaines. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30562-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
BackgroundThe task of matching fluctuating demand with available capacity is one of the basic challenges in all large-scale service industries. It is a particularly pressing concern in modern health-care systems, as increasing demand (ageing populations, availability of new treatments, increased patient knowledge, etc.) meets stagnating supply (capacity and funding restrictions on staff and services, etc.). As a consequence, a very large portfolio of demand management strategies has developed based on quite different assumptions about the source of the problem and about the means of its resolution.MethodsThis report presents a substantial review of the effectiveness of main strategies designed to alleviate demand pressures in the area of planned care. The study commences with an overview of the key ideas about the genesis of demand and capacity problems for health services. Many different diagnoses were uncovered: fluctuating demand meeting stationary capacity; turf protection between different providers; social rather than clinical pressures on referral decisions; self-propelling diagnostic cascades; supplier-induced demand; demographic pressures on treatment; and the informed patient and demand inflation. We then conducted a review of the key ideas (programme theories) underlying interventions designed to address demand imbalance. We discovered that there was no close alignment between purported problems and advocated solutions. Demand management interventions take their starting point in seeking reforms at the levels of strategic decision-making, organisational re-engineering, procedural modifications and behavioural change. In mapping the ideas for reform, we also noted a tendency for programme theories to become ‘whole-system’ models; over time policy-makers have advocated the need for concerted action on all of these fronts.FindingsThe remainder and core of the report contains a realist synthesis of the empirical evidence on the effectiveness on a spanning subset of four major demand management interventions: referral management centres (RMCs); using general practitioners with special interests (GPwSIs) at the interface between primary and secondary care; general practitioner (GP) direct access to clinical tests; and referral guidelines. In all cases we encountered a chequered pattern of success and failure. The primary literature is replete with accounts of unanticipated problems and unintended effects. These programmes ‘work’ only in highly circumscribed conditions. To give brief examples, we found that the success of RMCs depends crucially on the balance of control in their governance structures; GPwSIs influence demand only after close negotiations on an agreed and intermediate case mix; significant efficiencies are created by direct GP access to tests mainly when there is low diagnostic yield and high ‘rule-out’ rates; and referral guidelines are more likely to work when implemented by staff with responsibility for their creation.ConclusionsThe report concludes that there is no ‘preferred intervention’ that has the capacity to outperform all others. Instead, the review found many, diverse, hard-won, local and adaptive solutions. Whatever the starting point, success in demand management depends on synchronising a complex array of strategic, organisational, procedural and motivational changes. The final chapter offers practitioners some guidance on how they might ‘think through’ all of the interdependencies, which bring demand and capacity into equilibrium. A close analysis of the implementation of different configurations of demand management interventions in different local contexts using mixed methods would be valuable to understand the processes through which such interventions are tailored to local circumstances. There is also scope for further evidence synthesis. The substitution theory is ubiquitous in health and social care and a realist synthesis to compare the fortunes of different practitioners placed at different professional boundaries (e.g. nurses/doctors, dentists/dental care practitioners, radiologists/radiographers and so on) would be valuable to identify the contexts and mechanisms through which substitution, support or short-circuit occurs.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Cunningham S, Hall A, Jackson A, Jarrett-Smith L, Rees P, Brennan C, Saeed Y, Ng F, Kirkwood G, Orini M, Lambiase P, Srinivasan N, Walker N, Wright G, Goodwin J, Reilly J, Connelly D, Mudd P, Wilson C, Rice A, Iglesias A, Taggart S, James S, Thornley A, Turley A, Linker N, Rashid-Fadel T, Bond R, Rosengarten J, Thomas G, Butcher C, Lysitsas D, Wong T, Markides V, Jones D, Hussain W, Gilmore M, Barry J, Srinivasan N, Patel K, Lowe M, Segal O, Temple I, Borbas Z, Atkinson A, Yanni J, Yanni J, Boyett M, Garratt C, Dobrzynski H, Roney C, Debney M, Eichhorn C, Nachiappan A, Qureshi N, Chowdhury R, Kanagaratnam P, Lyon A, Peters N, Lawless M, Pearman C, Radcliffe E, Caldwell J, Trafford A, Taggart P, Hanson B, Hayward M, Lambiase PD, Yanni J, Orini M, Hanson B, Hayward M, Smith A, Zhang H, Dobrzynski H, Boyett M, Taggart P, Orini M, Simon R, Providencia R, Babu G, Vyas S, Khan F, Chow T, Segal O, Lowe M, Lambiase P. Allied Professionals. Europace 2015; 17:v3-v5. [PMCID: PMC4892104 DOI: 10.1093/europace/euv325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
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