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Jenkins GB, Beckerman AP, Moore AJ, Nazareno AG, Cunningham C. Genetics Notes: A new category for descriptive genetics work. Ecol Evol 2024; 14:e10992. [PMID: 38390003 PMCID: PMC10883339 DOI: 10.1002/ece3.10992] [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: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Affiliation(s)
| | - Andrew P Beckerman
- School of Biosciences, Ecology and Evolutionary Biology University of Sheffield Sheffield UK
| | - Allen J Moore
- Department of Entomology University of Georgia Athens Georgia USA
| | - Alison G Nazareno
- Department of Genetics, Ecology and Evolution Federal University of Minas Gerais Belo Horizonte Brazil
| | - Chris Cunningham
- Department of Entomology University of Georgia Athens Georgia USA
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Mwaka CR, Best KL, Cunningham C, Gagnon M, Routhier F. Barriers and facilitators of public transport use among people with disabilities: a scoping review. Front Rehabil Sci 2024; 4:1336514. [PMID: 38283669 PMCID: PMC10812606 DOI: 10.3389/fresc.2023.1336514] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024]
Abstract
Barriers to public transport use may be experienced differently by people with various types of disabilities (e.g., physical, intellectual, cognitive, sensory). Thus, it is important to identify the variable needs within each element of the travel chain. For example, the unavailability or low volume of auditory announcements in a stop or station or on the public transport vehicle may be a barrier to people with visual disability who rely on hearing the information. Consequently, this could provoke negative emotions and unpleasant experiences, which may not be the case for people with physical disabilities. The primary objective was to describe the barriers and facilitators to using public transport experienced by people with disabilities (PWD). The secondary aim was to explore experiences in terms of self-efficacy and satisfaction, when using public transport among people with disabilities. A scoping review was conducted. The search was performed in MEDLINE, TRANSPORT DATABASE, PsycINFO, EMBASE, and WEB OF SCIENCE from 1995 to 2023. Of 6,820 citations identified, 34 articles were included in the review for extraction. The main physical and social barriers included lack of ramp, long walking distance, long waiting time, unavailability of information at bus stop or station, and drivers' negative attitudes towards PWD. Personal factors that prevented the use of public transport included lack of confidence, and decreased satisfaction with public transport use. Strategies such as providing ramps on public transport vehicles, availability of kneeling buses and courtesy of bus drivers, and travel training were considered as enablers to the use of public transport that can lead the improved self-efficacy and satisfaction. In conclusion, this review identified the physical and social barriers and facilitators in travel chain, and highlighted issues related to lack of confidence or self-efficacy and decreased satisfaction when PWD and older adults are using public transport. Identifying and understanding the barriers and facilitators to the use of public transport by PWD is a milestone that may help policy makers and transport operators around the world to develop and implement interventions enabling access, use and inclusion of this mode of transport, as the experiences of PWD when using this mode of transport have an impact on their well-being.
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Affiliation(s)
- C. R. Mwaka
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec, QC, Canada
- Faculty of Medicine, School of Rehabilitation Sciences, Université Laval, Québec, QC, Canada
| | - K. L. Best
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec, QC, Canada
- Faculty of Medicine, School of Rehabilitation Sciences, Université Laval, Québec, QC, Canada
| | - C. Cunningham
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - M. Gagnon
- Library, Université Laval, Québec, QC, Canada
| | - F. Routhier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec, QC, Canada
- Faculty of Medicine, School of Rehabilitation Sciences, Université Laval, Québec, QC, Canada
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Cooper EA, Cunningham C, Lindsey I. Role of Sacral Nerve Stimulation in Rectoanal Intussusception. Dis Colon Rectum 2023; 66:e1138. [PMID: 37535145 DOI: 10.1097/dcr.0000000000003023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Affiliation(s)
- Edward A Cooper
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Cunningham C, Mercury M. Coproducing health research with Indigenous peoples. Nat Med 2023; 29:2722-2730. [PMID: 37946057 DOI: 10.1038/s41591-023-02588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/13/2023] [Indexed: 11/12/2023]
Abstract
The coproduction of health research represents an important advance in the realm of participatory methodologies, which have evolved over the past five decades. This transition to a collaborative approach emphasizes shared control between academic researchers and their partners, fostering a more balanced influence on the research process. This shift not only enhances the quality of the research and the evidence generated, but also increases the likelihood of successful implementation. For Indigenous peoples, coproduced research represents a critical development, enabling a shift from being mere 'subjects' of research to being active controllers of the process-including addressing the extractive and oppressive practices of the past. In this Review, we explore how research coproduction with Indigenous peoples is evolving. An 'Indigenous turn' embraces the concept of shared control while also considering the principles of reciprocity, the incommensurability of Western and Indigenous knowledge systems, divergent ethical standards, strategic and political differences, and the broader impact of processes and outcomes. To illustrate these ideas, we present examples involving New Zealand's Māori communities and offer recommendations for further progress.
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Affiliation(s)
- Chris Cunningham
- Research Centre for Hauora & Health (RCHH), Massey University, Wellington, New Zealand.
| | - Monica Mercury
- The Family Centre Social Policy Research Unit, Lower Hutt, New Zealand
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Talboom K, Greijdanus NG, Brinkman N, Blok RD, Roodbeen SX, Ponsioen CY, Tanis PJ, Bemelman WA, Cunningham C, de Lacy FB, Hompes R. Comparison of proactive and conventional treatment of anastomotic leakage in rectal cancer surgery: a multicentre retrospective cohort series. Tech Coloproctol 2023; 27:1099-1108. [PMID: 37212927 PMCID: PMC10562258 DOI: 10.1007/s10151-023-02808-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/15/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Comparative studies on efficacy of treatment strategies for anastomotic leakage (AL) after low anterior resection (LAR) are almost non-existent. This study aimed to compare different proactive and conservative treatment approaches for AL after LAR. METHODS This retrospective cohort study included all patients with AL after LAR in three university hospitals. Different treatment approaches were compared, including a pairwise comparison of conventional treatment and endoscopic vacuum-assisted surgical closure (EVASC). Primary outcomes were healed and functional anastomosis rates at end of follow-up. RESULTS Overall, 103 patients were included, of which 59 underwent conventional treatment and 23 EVASC. Median number of reinterventions was 1 after conventional treatment, compared to 7 after EVASC (p < 0.01). Median follow-up was 39 and 25 months, respectively. Healed anastomosis rate was 61% after conventional treatment, compared to 78% after EVASC (p = 0.139). Functional anastomosis rate was higher after EVASC, compared to conventional treatment (78% vs. 54%, p = 0.045). Early initiation of EVASC in the first week after primary surgery resulted in better functional anastomosis rate compared to later initiation (100% vs. 55%, p = 0.008). CONCLUSION Proactive treatment of AL consisting of EVASC resulted in improved healed and functional anastomosis rates for AL after LAR for rectal cancer, compared to conventional treatment. If EVASC was initiated within the first week after index surgery, a 100% functional anastomosis rate was achievable.
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Affiliation(s)
- K Talboom
- Department of Surgery, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - N G Greijdanus
- Department of Surgery, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - N Brinkman
- Department of Surgery, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - R D Blok
- Department of Surgery, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - S X Roodbeen
- Department of Surgery, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - C Y Ponsioen
- Department of Gastro-Enterology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - C Cunningham
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - F B de Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Roel Hompes
- Department of Surgery, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Cooper EA, Cunningham C, Lindsey I. Pelvic floor retraining in patients with high-grade internal rectal prolapse. ANZ J Surg 2023; 93:2774. [PMID: 38011593 DOI: 10.1111/ans.18636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Edward A Cooper
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris Cunningham
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ian Lindsey
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Razavi-Shearer D, Gamkrelidze I, Pan C, Jia J, Berg T, Gray R, Lim YS, Chen CJ, Ocama P, Desalegn H, Abbas Z, Abdallah A, Aghemo A, Ahmadbekova S, Ahn SH, Aho I, Akarca U, Al Masri N, Alalwan A, Alavian S, Al-Busafi S, Aleman S, Alfaleh F, Alghamdi A, Al-Hamoudi W, Aljumah A, Al-Naamani K, Al-Rifai A, Alserkal Y, Altraif I, Amarsanaa J, Anderson M, Andersson M, Armstrong P, Asselah T, Athanasakis K, Baatarkhuu O, Ben-Ari Z, Bensalem A, Bessone F, Biondi M, Bizri AR, Blach S, Braga W, Brandão-Mello C, Brosgart C, Brown K, Brown, Jr R, Bruggmann P, Brunetto M, Buti M, Cabezas J, Casanovas T, Chae C, Chan HLY, Cheinquer H, Chen PJ, Cheng KJ, Cheon ME, Chien CH, Choudhuri G, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Coffin C, Contreras F, Coppola N, Cornberg M, Cowie B, Cramp M, Craxi A, Crespo J, Cui F, Cunningham C, Dalgard O, De Knegt R, De Ledinghen V, Dore G, Drazilova S, Duberg AS, Egeonu S, Elbadri M, El-Kassas M, El-Sayed M, Estes C, Etzion O, Farag E, Ferradini L, Ferreira P, Flisiak R, Forns X, Frankova S, Fung J, Gane E, Garcia V, García-Samaniego J, Gemilyan M, Genov J, Gheorghe L, Gholam P, Gish R, Goleij P, Gottfredsson M, Grebely J, Gschwantler M, Guingane NA, Hajarizadeh B, Hamid S, Hamoudi W, Harris A, Hasan I, Hatzakis A, Hellard M, Hercun J, Hernandez J, Hockicková I, Hsu YC, Hu CC, Husa P, Janicko M, Janjua N, Jarcuska P, Jaroszewicz J, Jelev D, Jeruma A, Johannessen A, Kåberg M, Kaita K, Kaliaskarova K, Kao JH, Kelly-Hanku A, Khamis F, Khan A, Kheir O, Khoudri I, Kondili L, Konysbekova A, Kristian P, Kwon J, Lagging M, Laleman W, Lampertico P, Lavanchy D, Lázaro P, Lazarus JV, Lee A, Lee MH, Liakina V, Lukšić B, Malekzadeh R, Malu A, Marinho R, Mendes-Correa MC, Merat S, Meshesha BR, Midgard H, Mohamed R, Mokhbat J, Mooneyhan E, Moreno C, Mortgat L, Müllhaupt B, Musabaev E, Muyldermans G, Naveira M, Negro F, Nersesov A, Nguyen VTT, Ning Q, Njouom R, Ntagirabiri R, Nurmatov Z, Oguche S, Omuemu C, Ong J, Opare-Sem O, Örmeci N, Orrego M, Osiowy C, Papatheodoridis G, Peck-Radosavljevic M, Pessoa M, Pham T, Phillips R, Pimenov N, Pincay-Rodríguez L, Plaseska-Karanfilska D, Pop C, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Rautiainen H, Razavi-Shearer K, Remak W, Ribeiro S, Ridruejo E, Ríos-Hincapié C, Robalino M, Roberts L, Roberts S, Rodríguez M, Roulot D, Rwegasha J, Ryder S, Sadirova S, Saeed U, Safadi R, Sagalova O, Said S, Salupere R, Sanai F, Sanchez-Avila JF, Saraswat V, Sargsyants N, Sarrazin C, Sarybayeva G, Schréter I, Seguin-Devaux C, Seto WK, Shah S, Sharara A, Sheikh M, Shouval D, Sievert W, Simojoki K, Simonova M, Sinn DH, Sonderup M, Sonneveld M, Spearman CW, Sperl J, Stauber R, Stedman C, Sypsa V, Tacke F, Tan SS, Tanaka J, Tergast T, Terrault N, Thompson A, Thompson P, Tolmane I, Tomasiewicz K, Tsang TY, Uzochukwu B, Van Welzen B, Vanwolleghem T, Vince A, Voeller A, Waheed Y, Waked I, Wallace J, Wang C, Weis N, Wong G, Wong V, Wu JC, Yaghi C, Yesmembetov K, Yip T, Yosry A, Yu ML, Yuen MF, Yurdaydin C, Zeuzem S, Zuckerman E, Razavi H. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol 2023; 8:879-907. [PMID: 37517414 DOI: 10.1016/s2468-1253(23)00197-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The 2016 World Health Assembly endorsed the elimination of hepatitis B virus (HBV) infection as a public health threat by 2030; existing therapies and prophylaxis measures make such elimination feasible, even in the absence of a virological cure. We aimed to estimate the national, regional, and global prevalence of HBV in the general population and among children aged 5 years and younger, as well as the rates of diagnosis, treatment, prophylaxis, and the future burden globally. METHODS In this modelling study, we used a Delphi process with data from literature reviews and interviews with country experts to quantify the prevalence, diagnosis, treatment, and prevention measures for HBV infection. The PRoGReSs Model, a dynamic Markov model, was used to estimate the country, regional, and global prevalence of HBV infection in 2022, and the effects of treatment and prevention on disease burden. The future incidence of morbidity and mortality in the absence of additional interventions was also estimated at the global level. FINDINGS We developed models for 170 countries which resulted in an estimated global prevalence of HBV infection in 2022 of 3·2% (95% uncertainty interval 2·7-4·0), corresponding to 257·5 million (216·6-316·4) individuals positive for HBsAg. Of these individuals, 36·0 million were diagnosed, and only 6·8 million of the estimated 83·3 million eligible for treatment were on treatment. The prevalence among children aged 5 years or younger was estimated to be 0·7% (0·6-1·0), corresponding to 5·6 million (4·5-7·8) children with HBV infection. Based on the most recent data, 85% of infants received three-dose HBV vaccination before 1 year of age, 46% had received a timely birth dose of vaccine, and 14% received hepatitis B immunoglobulin along with the full vaccination regimen. 3% of mothers with a high HBV viral load received antiviral treatment to reduce mother-to-child transmission. INTERPRETATION As 2030 approaches, the elimination targets remain out of reach for many countries under the current frameworks. Although prevention measures have had the most success, there is a need to increase these efforts and to increase diagnosis and treatment to work towards the elimination goals. FUNDING John C Martin Foundation, Gilead Sciences, and EndHep2030.
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Rowe S, Cunningham C, Ingenhoff L, Norris JM, Zadoks RN. Low prevalence of antimicrobial resistant organisms (methicillin resistant Staphylococcus aureus, extended beta-lactamase producing Enterobacteriaceae, and vancomycin resistant enterococci) in bulk tank milk in New South Wales, Australia. Aust Vet J 2023; 101:339-344. [PMID: 37403520 DOI: 10.1111/avj.13266] [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: 05/15/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Estimate the presence of methicillin resistant Staphylococcus aureus (MRSA), extended beta-lactamase (ESBL) producing Enterobacteriaceae, and vancomycin resistant enterococci (VRE) in bulk tank milk in dairy herds in New South Wales (NSW), Australia. METHODS Bulk tank milk samples (n = 80) were collected from dairy farms (n = 40, i.e. 2 per farm) in NSW during 2021. Bacteria were cultured using selective chromogenic indicator media with isolate identity confirmed using biochemical testing, Gram stain, and MALDI-TOF mass spectroscopy. Antimicrobial resistance (AMR) was confirmed using antibiotic disk diffusion. RESULTS No samples tested positive to the targeted AMR organisms. CONCLUSION The prevalence of MRSA, ESBL-producing Enterobacteriaceae, and VRE is low in NSW dairy herds.
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Affiliation(s)
- S Rowe
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, New South Wales, Australia
| | - C Cunningham
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, New South Wales, Australia
| | - L Ingenhoff
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, New South Wales, Australia
| | - J M Norris
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, New South Wales, Australia
| | - R N Zadoks
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, New South Wales, Australia
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Potter JD, Brooks C, Donovan G, Cunningham C, Douwes J. A perspective on green, blue, and grey spaces, biodiversity, microbiota, and human health. Sci Total Environ 2023:164772. [PMID: 37308017 DOI: 10.1016/j.scitotenv.2023.164772] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
Humans have lived from equator to poles for millennia but are now increasingly intruding into the wild spaces of other species and steadily extruding ourselves from our own wild spaces, with a profound impact on: our relationship with the natural world; survival of other species; pollution; climate change; etc. We have yet to grasp how these changes directly impact our own health. The primary focus of this paper is on the beneficial influence of proximity to the natural environment. We summarize the evidence for associations between exposure to green space and blue space and improvements in health. In contrast, grey space - the urban landscape - largely presents hazards as well as reducing exposure to green and blue space and isolating us from the natural environment. We discuss various hypotheses that might explain why green, blue, and grey space affect health and focus particularly on the importance of the biodiversity hypothesis and the role of microbiota. We discuss possible mechanisms and exposure routes - air, soil, and water. We highlight the problem of exposure assessment, noting that many of our current tools are not fit for the purpose of understanding exposure to green and blue space, aerosols, soils, and water. We briefly discuss possible differences between indigenous perspectives on the nature of our relationship with the environment and the more dominant international-science view. Finally, we present research gaps and discuss future directions, particularly focusing on the ways in which we might - even in the absence of a full understanding of the mechanisms by which blue, green, and grey space affect our health - begin to implement policies to restore some balance to our environment of with the aim of reducing the large global burden of ill health.
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Affiliation(s)
- John D Potter
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand; Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Collin Brooks
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | - Geoffrey Donovan
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand; PNW Research Station, USDA Forest Service, Portland, OR, USA
| | - Chris Cunningham
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
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Singh S, Smyth E, Jones O, Cunningham C, Lindsey I. Outcomes of rectal prolapse surgery in patients with benign joint hypermobility syndrome. Tech Coloproctol 2023; 27:491-494. [PMID: 36869924 DOI: 10.1007/s10151-023-02770-w] [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: 11/16/2022] [Accepted: 02/04/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Rectal prolapse is a debilitating disorder of the pelvic floor, and treatment outcomes are variable. Previous studies have identified underlying benign joint hypermobility syndrome (BJHS) in some patients. We sought to determine the outcomes of these patients after undergoing ventral rectopexy surgery (VMR). METHODS All consecutive patients who were referred to the pelvic floor unit at our institution between February 2010 and December 2011 were considered for recruitment into the study. Following recruitment, they were assessed using the Beighton criteria to determine the presence or absence of benign joint hypermobility syndrome. Both groups underwent similar surgical interventions and were then followed up. The need for revisional surgery was recorded in both groups. RESULTS Fifty-two patients [34 normal; M:F, 1:6; median age 61 (range 22-84) years; 18 BJHS; M:F, 0:1; median age 52 (range 25-79) years] were recruited. A total of 42 patients completed the full 1-year follow-up (26 normal, 16 benign joint hypermobility syndrome). Patients with benign joint hypermobility syndrome were significantly younger (median age 52 versus 61 years, p < 0.001) with male to female ratio of 0:1 versus 1:6, respectively. In addition, they were significantly more likely to require revisional surgery than those without the condition (31% versus 8% p < 0.001). In most cases, this was in the form of a posterior stapled transanal resection of the rectum procedure. CONCLUSIONS Patients with BJHS presenting for rectal prolapse surgery were younger and are more likely to require further surgery for rectal prolapse recurrence than those without the condition.
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Affiliation(s)
- Sandeep Singh
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK.
| | - Edward Smyth
- Department of Colorectal Surgery, Musgrove Park Hospital, Taunton, UK
| | - Oliver Jones
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Chris Cunningham
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Ian Lindsey
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
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Nandi D, Wright L, Sublett-Smith J, Brax A, Almond C, Bansal N, Azeka E, Butts R, Conway J, Chen C, Cunningham C, Fisher L, Hall E, Hunter T, Kobayashi R, Patterson D, Peng D, Simpson K, Ryan T, Spinner J, Wisotzkey B, Zangwill S, Gajarski R, O'Connor M. Suboptimal Titration of Heart Failure Medications in Pediatric Patients: Baseline Data from the ACTION Network. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1627] [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: 04/05/2023] Open
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Conway J, Barrett O, Pidborochynski T, Schroeder K, Cunningham C, Jeewa A, Padma K. Administrative Databases: Friend or Foe in Pediatric Cardiomyopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1329] [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: 04/05/2023] Open
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Howden-Chapman P, Crane J, Keall M, Pierse N, Baker MG, Cunningham C, Amore K, Aspinall C, Bennett J, Bierre S, Boulic M, Chapman R, Chisholm E, Davies C, Fougere G, Fraser B, Fyfe C, Grant L, Grimes A, Halley C, Logan-Riley A, Nathan K, Olin C, Ombler J, O’Sullivan K, Pehi T, Penny G, Phipps R, Plagman M, Randal E, Riggs L, Robson B, Ruru J, Shaw C, Schrader B, Teariki MA, Telfar Barnard L, Tiatia R, Toy-Cronin B, Tupara H, Viggers H, Wall T, Wilkie M, Woodward A, Zhang W. He Kāinga Oranga: reflections on 25 years of measuring the improved health, wellbeing and sustainability of healthier housing. J R Soc N Z 2023. [DOI: 10.1080/03036758.2023.2170427] [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: 02/09/2023]
Affiliation(s)
- Philippa Howden-Chapman
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Julian Crane
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Michael Keall
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Nevil Pierse
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Michael G. Baker
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Chris Cunningham
- Research Centre for Hauora & Health, Massey University, Wellington, New Zealand
| | - Kate Amore
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Clare Aspinall
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Julie Bennett
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Sarah Bierre
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Mikael Boulic
- School of the Built Environment, Massey University, Auckland, New Zealand
| | - Ralph Chapman
- School of Geography, Environment and Earth Sciences, Te Herenga Waka, Victoria University of Wellington, New Zealand
| | - Elinor Chisholm
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Cheryl Davies
- Tu Kotahi Māori Asthma Trust, Wainuiomata, Lower Hutt, New Zealand
| | - Geoff Fougere
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Brodie Fraser
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Caro Fyfe
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Libby Grant
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Arthur Grimes
- Motu Economic and Public Policy Research, Wellington, New Zealand
| | - Caroline Halley
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Amber Logan-Riley
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Kim Nathan
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Crystal Olin
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Jenny Ombler
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Kimberley O’Sullivan
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Tiria Pehi
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Guy Penny
- EMPlan Services Ltd, Wellington, New Zealand
| | - Robyn Phipps
- Faculty of Architecture and Design Innovation, Te Herenga Waka, Victoria University of Wellington, Wellington, New Zealand
| | - Manfred Plagman
- Building Research Association of New Zealand, Porirua, New Zealand
| | - Edward Randal
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Lynn Riggs
- Motu Economic and Public Policy Research, Wellington, New Zealand
| | - Bridget Robson
- Eru Pomare Māori Health Research Centre, University of Otago, Wellington, New Zealand
| | - Jacinta Ruru
- Faculty of Law, University of Otago, Dunedin, New Zealand
| | - Caroline Shaw
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ben Schrader
- Stout Research Centre, Te Herenga Waka, Victoria University of Wellington, Wellington, New Zealand
| | - Mary Anne Teariki
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Lucy Telfar Barnard
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | - Ramona Tiatia
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | | | - Hope Tupara
- Research Centre for Hauora & Health, Massey University, Wellington, New Zealand
| | - Helen Viggers
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
| | | | - Marg Wilkie
- Research Centre for Hauora & Health, Massey University, Wellington, New Zealand
| | - Alistair Woodward
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Wei Zhang
- He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington, New Zealand
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Cunningham C. Local Excision for Early Rectal Cancer. Clin Oncol (R Coll Radiol) 2023; 35:82-86. [PMID: 36137914 DOI: 10.1016/j.clon.2022.08.030] [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: 06/13/2022] [Revised: 06/26/2022] [Accepted: 08/18/2022] [Indexed: 01/18/2023]
Abstract
Local excision is an established treatment for significant benign rectal tumours and early-stage cancers. It provides cure for most patients with pT1 disease, with minimum impact on quality of life. It is particularly suitable for elderly or comorbid patients. Local excision is associated with a risk of local recurrence, and this may vary from 5 to 30%, as determined by pathological risk factors. Recurrent cancer may be challenging to manage, but this may be mitigated by early detection with intensive surveillance and the use of adjuvant radiotherapy. This approach offers a realistic option for organ preservation in carefully selected early-stage disease compared with primary treatment with radiotherapy or total neoadjuvant treatment.
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Affiliation(s)
- C Cunningham
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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15
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Bordes J, Cunningham C, Engel LS, Amoss J. A case of cardiac tamponade secondary to CMV pericardial effusion. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00116-7] [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: 01/28/2023]
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16
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Singh S, Bolckmans R, Ratnatunga K, Gorissen K, Jones O, Lindsey I, Cunningham C. Pelvic pain is a common prolapse symptom and improvement after ventral mesh rectopexy is more frequent than deterioration or de novo pain. Colorectal Dis 2023; 25:118-127. [PMID: 36050626 DOI: 10.1111/codi.16321] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/29/2022] [Accepted: 08/14/2022] [Indexed: 02/02/2023]
Abstract
AIM The aim of this work was to assess the relationship between pelvic pain and rectal prolapse both before prolapse surgery and in the long term after ventral mesh rectopexy (VMR). METHOD Patients undergoing VMR between 2004 and 2017 were contacted. Outcomes including the severity of pelvic pain were recorded using a numeric rating scale. RESULTS Four hundred and seventy eight of the 749 patients (64%) were successfully contacted. Of these, 39% reported pre-existing pelvic pain prior to VMR (group A) and 61% were pain free (group B). The median follow-up time was 8.0 years (interquartile range 5.0-10.0 years). Symptoms of obstructed defaecation were significantly more common (p = 0.002) in group A (91/187, 49%) than in group B (101/291, 35%). In contrast, faecal incontinence was more common (p = 0.007) in group B (75/291, 26%) than in group A (29/187, 15%). In group A, 76% showed improvement in pelvic pain after VMR: 61% were pain free and 39% had partial improvement in their pre-existing pelvic pain. Patients with persistent pelvic pain were younger (p = 0.01) and more likely to have revisional surgery after VMR (p = 0.0003), but there was no relation to the indication for surgery (p = 0.59). In group B, 15% reported de novo pelvic pain after VMR, and this was more common in women under 50 years old (p = 0.001), when obstructed defaecation was the indication (p = 0.03), in mesh erosion (p = <0.05) and when associated with revisional surgery (p = 0.005). CONCLUSION Pelvic pain is common (39%) in patients undergoing prolapse surgery, and VMR improves this pain in most patients (76%). However, a significant number of patients fail to improve (12%), experience worsening of pain (12%) or develop de novo pelvic pain (15%).
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Affiliation(s)
- Sandeep Singh
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Roel Bolckmans
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Keshara Ratnatunga
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kim Gorissen
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Oliver Jones
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ian Lindsey
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris Cunningham
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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17
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Waldegrave C, Cunningham C, Love C, Nguyen G. THE EFFECTS OF HOUSING AND LIVING STANDARDS ON LONELINESS AND SOCIAL EXCLUSION AMONG OLDER PEOPLE. Innov Aging 2022. [PMCID: PMC9765648 DOI: 10.1093/geroni/igac059.1050] [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: 12/24/2022] Open
Abstract
Introduction Housing security is a likely indicator of loneliness (Gierveld et. al. 2015, Gonyea et. al. 2018) but there are few studies that focus specifically on the relationship between the two. This paper presents findings from a New Zealand Ageing Well National Science Challenge research programme that presents findings on the impacts of housing and living standards on loneliness and social exclusion. Method: This presentation will provide results from a study of 200+ Māori (indigenous New Zealanders) aged 50 years and over. Key questions around loneliness and social isolation were co-created with the participants and responses compared with standard international scales to help identify both universal aspects of loneliness and culturally specific aspects. Questions relating to housing security, affordability, living standards and neighbourhood safety were also asked. Regression analysis was used to test the statistical significance of the various relationships between differing aspects of housing and loneliness. Results The results demonstrate statistically significant relationships between housing quality, affordability, living standards and neighbourhood suitability with both the universal and culturally specific scales of loneliness. Overall greater housing security and quality was shown to be negatively associated with loneliness, which suggests it contributes to the reduction of loneliness. Conclusion Addressing the quality of social connections has often been seen as the key way to address loneliness. The results of this study suggest housing security and living standards play an important role in people’s perception of loneliness and their experience of it, as well.
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Affiliation(s)
- Charles Waldegrave
- Family Centre Social Policy Research Unit, Lower Hutt, Wellington, New Zealand
| | - Chris Cunningham
- Research Centre for Maori Health and Development, Wellington, Wellington, New Zealand
| | - Catherine Love
- Family Centre Social Policy Research Unit, Wellington, Wellington, New Zealand
| | - Giang Nguyen
- Family Centre Social Policy Research Unit, Wellington, Wellington, New Zealand
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18
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Wexner S, Abu-Gazala M, Boni L, Buxey K, Cahill R, Carus T, Chadi S, Chand M, Cunningham C, Emile SH, Fingerhut A, Foo CC, Hompes R, Ioannidis A, Keller DS, Knol J, Lacy A, de Lacy FB, Liberale G, Martz J, Mizrahi I, Montroni I, Mortensen N, Rafferty JF, Rickles AS, Ris F, Safar B, Sherwinter D, Sileri P, Stamos M, Starker P, Van den Bos J, Watanabe J, Wolf JH, Yellinek S, Zmora O, White KP, Dip F, Rosenthal RJ. Use of fluorescence imaging and indocyanine green during colorectal surgery: Results of an intercontinental Delphi survey. Surgery 2022; 172:S38-S45. [PMID: 36427929 DOI: 10.1016/j.surg.2022.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fluorescence imaging with indocyanine green is increasingly being used in colorectal surgery to assess anastomotic perfusion, and to detect sentinel lymph nodes. METHODS In this 2-round, online, Delphi survey, 35 international experts were asked to vote on 69 statements pertaining to patient preparation and contraindications to fluorescence imaging during colorectal surgery, indications, technical aspects, potential advantages/disadvantages, and effectiveness versus limitations, and training and research. Methodological steps were adopted during survey design to minimize risk of bias. RESULTS More than 70% consensus was reached on 60 of 69 statements, including moderate-strong consensus regarding fluorescence imaging's value assessing anastomotic perfusion and leak risk, but not on its value mapping sentinel nodes. Similarly, although consensus was reached regarding most technical aspects of its use assessing anastomoses, little consensus was achieved for lymph-node assessments. Evaluating anastomoses, experts agreed that the optimum total indocyanine green dose and timing are 5 to 10 mg and 30 to 60 seconds pre-evaluation, indocyanine green should be dosed milligram/kilogram, lines should be flushed with saline, and indocyanine green can be readministered if bright perfusion is not achieved, although how long surgeons should wait remains unknown. The only consensus achieved for lymph-node assessments was that 2 to 4 injection points are needed. Ninety-six percent and 100% consensus were reached that fluorescence imaging will increase in practice and research over the next decade, respectively. CONCLUSION Although further research remains necessary, fluorescence imaging appears to have value assessing anastomotic perfusion, but its value for lymph-node mapping remains questionable.
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Affiliation(s)
- Steven Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL.
| | | | - Luigi Boni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Italy
| | - Kenneth Buxey
- Sandringham Hospital, Alfred Health, Melbourne, Australia
| | - Ronan Cahill
- UCD Centre of Precision Surgery, University College Dublin, Dublin, Ireland
| | - Thomas Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - Sami Chadi
- University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Roel Hompes
- Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | | | - Deborah S Keller
- University of California at Davis Medical Center, Sacramento, CA
| | - Joep Knol
- Department of Abdominal Surgery, ZOL Hospital, Genk, Belgium
| | - Antonio Lacy
- Department of Abdominal Surgery, ZOL Hospital, Genk, Belgium
| | | | - Gabriel Liberale
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Ido Mizrahi
- Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | | | | | - Frederic Ris
- Geneva University Hospitals and Medical School, Geneva, Switzerland
| | | | | | | | | | | | | | - Jun Watanabe
- Yokohama City University Medical Center, Yokohama, Japan
| | - Joshua H Wolf
- Sinai Hospital of Baltimore, LifeBridge Health, Baltimore, MD
| | | | | | - Kevin P White
- ScienceRight Research Consulting, London, Ontario, Canada
| | - Fernando Dip
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Raul J Rosenthal
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
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19
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Cunningham C, Mc Laughlin H, O Donoghue G. Physiotherapy post Vertebral Fragility Fracture: A Scoping Review. Physiotherapy 2022; 119:100-116. [PMID: 36996586 DOI: 10.1016/j.physio.2022.11.001] [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: 06/03/2022] [Revised: 09/30/2022] [Accepted: 11/04/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The incidence of vertebral fragility fractures (VFF) is rising, placing a major burden on individuals and health systems. No comprehensive picture of the research regarding physiotherapy exists for this patient cohort. OBJECTIVES This scoping review aims to summarise the research regarding Physiotherapy post VFF, the type of physiotherapy interventions employed and outcome measures utilised. DESIGN Scoping review, adhering to the Joanna Briggs Institute guidelines. Databases searched were PubMed, PEDro, CINAHL, Cochrane, Embase from 2005 to November 2021. Grey literature searching was conducted using ProQuest and Open Grey. A narrative summary of data was compiled to describe the current evidence regarding physiotherapy post VFF. STUDY SELECTION Articles were included if they related to Physiotherapy interventions delivered to patients with VFF in any setting. DATA SYNTHESIS A narrative synthesis was conducted. RESULTS Thirteen studies were included with five randomised control trials, three pilot RCTs, two qualitative studies, one cross-sectional survey of clinicians, one cohort study and one prospective comparative study. Interventions most commonly reported were exercise, education or manual therapy. A large diversity of outcome measures was utilised most commonly in the spinal deformity, physical performance and balance, pain and quality of life domains. CONCLUSION Findings of this scoping review indicate the limited evidence to guide physiotherapists in the management of patients with VFF. The most commonly explored physiotherapy interventions were exercise, manual therapy and education. A diversity of outcome measures is utilised. Research is urgently needed, including high quality clinical trials with representative populations and studies exploring physiotherapy practice and the experience of patients with VFF. CONTRIBUTION OF THE PAPER.
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20
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Kalim R, Ryder S, Cunningham C, McMahon N. 115 BARRIERS AND FACILITATORS TO DOCTORS DEPRESCRIBING FALL-RISK INCREASING DRUGS IN OLDER ADULTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.095] [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] Open
Abstract
Abstract
Background
Some medicines are associated with falls in older adults and have been classified as Fall-Risk Increasing Drugs (FRIDs). Deprescribing FRIDs is one of several possible preventive measures to reduce falls risk [1]. The aim of this qualitative study was to explore the barriers and facilitators to doctors deprescribing FRIDs in hospitals.
Methods
Doctors, who were experienced in caring for older patients, were interviewed individually, directed by an interview guide, at a large teaching hospital. Thematic analysis of transcribed audio recordings was undertaken in NVivo 12.
Results
A total of eighteen doctors participated in the study. Barriers and facilitators were classified into three categories: factors related to the care setting, to doctors and to patients. Incomplete patient medical records, limited time during inpatient stay, poor communication between care providers, and difficulties following up patients after discharge were major barriers to deprescribing in hospital. Doctors’ barriers included concerns about consequences and reluctance changing medications initiated by other prescribers. Acute illness or resistance to change were patient-related barriers to deprescribing. Facilitators included doctors’ awareness of the importance of deprescribing FRIDs, the ability to monitor patients during their inpatient stay, the use of electronic medical records, and support from other healthcare professionals e.g. clinical pharmacists.
Conclusion
Deprescribing FRIDs in older adults is challenging. Interventions based on identified facilitators, such as improved communication between prescribers, enhanced documentation using electronic medical records, and the support of team members with expertise in medication review, might enhance the feasibility of deprescribing.
Reference
1. Seppala LJ et al. EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research. Drugs Aging. 2019; 36(4): 299–307.
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Affiliation(s)
- R Kalim
- Trinity College , Dublin, Ireland
| | - S Ryder
- Trinity College , Dublin, Ireland
| | - C Cunningham
- Trinity College , Dublin, Ireland
- St. James's Hospital , Dublin, Ireland
| | - N McMahon
- Trinity College , Dublin, Ireland
- St. James's Hospital , Dublin, Ireland
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21
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Fitzpatrick D, Laird E, Hoey L, Hughes C, McNulty H, Ward M, Strain JJ, Tracey F, Molloy A, Cunningham C, McCarroll K. 72 SEASONAL VARIATION IN HYPERPARATHYROIDISM IN OLDER IRISH ADULTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.058] [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] Open
Abstract
Abstract
Background
Vitamin D deficiency is common in Ireland, varies by season and can result in secondary hyperparathyroidism. High Parathyroid Hormone (PTH) levels due to low vitamin D status are associated with increased bone turnover and lower bone mineral density, especially at cortical sites such as the hip. Given the variation in vitamin D status by time of year, our study aimed to examine for seasonal differences in hyperparthyroidism in older adults.
Methods
Study participants were from a large cross-sectional study of older Irish adults recruited from hospital outpatient services and GP practices. Exclusion criteria were: eGFR< 30ml/min and elevated serum calcium (>2.5 mmol/l) in order to avoid primary hyperparathyroidism or elevated serum PTH due to advanced renal impairment. Hyperparathyroidism was defined as a PTH level > 65 ng/ml. The relationship between hyperparathyroidism and season was examined in regression models adjusting for potential factors affecting PTH.
Results
There were 4324 participants, mean age 73.8 +/- 7.9 years, 65.4% were female. Hyperparathyroidism was more prevalent in Spring versus Autumn (17.4 vs 11.4 %, P = 0.0002). The increased prevalence remained after adjusting for age, gender, body mass index, timed up and go, dairy intake, eGFR, and smoking (OR 1.6, 1.2- 2.0, P=0.0003). This also corresponded to the seasonal variation in vitamin D status with deficiency (25(OH)D < 30 nmol/l) highest in Spring (23.3%) and lowest in Autumn (16.8%).
Conclusion
We found that hyperparathyroidism fluctuates with season in an inverse relationship with vitamin D. Overall, high PTH levels were 60% more likely in Spring versus Autumn. This emphasises the importance of maintaining adequate vitamin D status all year round. While we adjusted for dairy intake, we did not have accurate measures of total dietary calcium intake which could also vary seasonally and be a contributory factor.
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Affiliation(s)
- D Fitzpatrick
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - F Tracey
- Causeway Hospital, Northern Health and Social Care Trust , Coleraine, Northern Ireland, United Kingdom
| | - A Molloy
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - C Cunningham
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - K McCarroll
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
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22
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Kavanagh M, Bradley E, Hoey L, Hughes C, McNulty H, Ward M, Strain JJ, Tracey F, Molloy A, Laird E, Cunningham C, McCarroll K. 51 VITAMIN D DEFICIENCY IS ASSOCIATED WITH INCREASED RISK OF ATRIAL FIBRILLATION: A CROSS-SECTIONAL ANALYSIS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.041] [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] Open
Abstract
Abstract
Background
Atrial Fibrillation (AF) is prevalent (up to 10.9%) in Irish adults aged over 65 and significantly increases stroke risk, as well as being associated with greater stroke severity. Identifying potential contributing factors to development of AF offers opportunity for AF prevention and reduction in associated morbidity. Low vitamin D status has been associated with AF but studies are inconsistent. We aimed to assess the potential relationship between vitamin D deficiency and self-reported AF in older Irish adults.
Methods
Participants were from a large cross-sectional study of Irish adults aged >60 years, recruited from hospital outpatient services and GP practises. The diagnosis of AF was based on self-report so those with a Mini Mental State Examination (MMSE) <25 were excluded. Vitamin D deficiency was defined as a 25(OH)D <30 nmol/l. The relationship between deficiency and AF was explored in regression models.
Results
4264 participants, mean age 73.1± 8.0 years, female (67.4%) and 11.9% had AF. There was a higher prevalence of AF in those who were deficient vs non-deficient (17.2% vs 10.9%, P<0.0001). In a subsample (n = 4043), increased risk remained after adjusting for age, gender, season, vitamin D supplement use, body mass index, timed up and go, alcohol intake, smoking status, hypertension, diabetes, and heart disease (coronary artery disease and/or heart failure) (OR: 1.3, 1.1- 1.7 , P =0.023).
Conclusion
We identified that vitamin D deficiency was independently associated with a 30% increased likelihood of self-reported AF in older adults. Vitamin D is known to inhibit the renin angiotensin, aldosterone system which may play a role in both structural and electrical remodelling of the atrium. It may also have anti-inflammatory properties which could protect against AF. We were not able to distinguish between valvular and non-valvular AF though findings offer an interesting insight for potential further investigation.
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Affiliation(s)
- M Kavanagh
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
| | - E Bradley
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - F Tracey
- Causeway Hospital, Northern Health and Social Care Trust , Coleraine, United Kingdom
| | - A Molloy
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - C Cunningham
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - K McCarroll
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
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23
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Bademosi O, Murphy N, Byrne L, Rice C, Briggs R, Lavan A, O’Callaghan S, Kenny RA, Cunningham C, Romero-Ortuno R. 105 EVALUATION OF A NEW PHYSIOTHERAPY-LED VESTIBULAR SERVICE EMBEDDED IN THE FALLS AND SYNCOPE UNIT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Clinical presentations in the falls and syncope unit (FASU) are diverse and require a range of skillsets. Vestibular disorders amount to a significant proportion of presentations. In our FASU, we embedded a 0.5 FTE specialist physiotherapist with expertise in vestibular disorders to work alongside medical and nursing staff. We conducted a service evaluation of the activity of this new service.
Methods
Retrospective Service Evaluation Approval was granted by our Research & Innovation Office. Pseudonymised data was collected corresponding to all new FASU physiotherapy service attendances between August 2021 and May 2022. Descriptive statistics were complemented by a binary logistic regression model to establish independent predictors of more than one physiotherapy session being required over the period.
Results
There were 104 episodes recorded by the new service, corresponding to 101 unique patients. Mean age was 67.7 (SD 19.0, range 17-93), and 73.1% were women. 67% were treated and discharged in 1 session. On average, patients had had a mean of 2 falls prior to the consultation (range 0-25). 28.8% were using a walking aid, and 54.8% self-reported fear of falling. 25% of the referrals to the service were due to suspected vestibular disorders, 62% of which were directly treated by the physiotherapy service. The logistic regression model adjusting by age, sex, use of walking aid, number of falls, and fear of falling showed that only referral for vestibular disorder was an independent predictor of patients needing more than 1 physiotherapy treatment (OR 3.91, 95% CI 1.32-11.58, P=0.014).
Conclusion
Vestibular disorders are common in FASU, and a majority can be treated by a specialist physiotherapy service. Repeated vestibular maneuvers are often needed in such patients. A responsive, embedded physiotherapy service in FASU can directly address this need and further evaluation will focus on the impact of this service on avoidance of ED attendances.
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Affiliation(s)
| | - N Murphy
- St. James's Hospital , Dublin, Ireland
| | - L Byrne
- St. James's Hospital , Dublin, Ireland
| | - C Rice
- St. James's Hospital , Dublin, Ireland
| | - R Briggs
- St. James's Hospital , Dublin, Ireland
| | - A Lavan
- St. James's Hospital , Dublin, Ireland
| | | | - RA Kenny
- St. James's Hospital , Dublin, Ireland
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24
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Fitzpatrick D, Laird E, Hoey L, Hughes C, McNulty H, Ward M, Strain JJ, Tracey F, Molloy A, Cunningham C, Carroll KM. 73 PREVALENCE OF SECONDARY HYPERPARATHYROIDISM BY VITAMIN D STATUS IN OLDER IRISH ADULTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.059] [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
Secondary hyperparathyroidism commonly results from vitamin D deficiency and can lead to accelerated bone turnover and bone loss, especially at cortical sites like the hip. It can also attenuate the response to antiresorptive treatments used for osteoporosis. However, several factors may influence PTH response. We aimed to identify the prevalence of secondary hyperparathyroidism by categories of vitamin D status in older Irish adults attending a bone health clinic.
Methods
The study population consisted of older adults (aged over 60 years) attending a bone health clinic at a large hospital. Participants with a serum calcium >2.5 mmol/l and eGFR <30 ml/min were excluded to avoid cases of primary hyperparathyroidism or elevated serum PTH due to advanced renal disease. Hyperparathyroidism was defined as a serum PTH > 65 pg/ml. 25 hydroxyvitamin D (25(OH)D) was measured with liquid chromatography mass spectroscopy.
Results
There were 800 cases identified, mean age 72.9 +/- 7.9 years, and 85.3% were female. The prevalence of secondary hyperparathyroidism by 25(OH)D categories were 28.1% (<30nmol/l), 17.4% (30-49.9 nmol/l) and 8.0% (50-74 nmol/l). Older age (P < 0.03) and lower eGFR (P = 0.01) were associated with hyperparathyroidism independent of vitamin D status.
Conclusion
Nearly one-third of patients who were vitamin D deficient (<30 nmol/L) and one-sixth who were insufficient (30-49.9 nmol/l) had hyperparathyroidism, similar to the results of other studies. However, hyperparathyroidism was also observed in 8% of those with 25(OH)D levels between 50 -74 nmol/l, suggesting that higher levels i.e. ≥ 75 nmol/l may be preferable in older adults. Lower eGFR and older age were also independently associated with higher PTH, consistent with previous research. Higher dietary and supplemental calcium intake is also known to suppress PTH response, though we were not able to account for this in our study.
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Affiliation(s)
- D Fitzpatrick
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - F Tracey
- Causeway Hospital, Northern Health and Social Care Trust , Coleraine, Northern Ireland, United Kingdom
| | - A Molloy
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - C Cunningham
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - KM Carroll
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
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25
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Moloney K, Byrne T, Mathews S, Foran M, Conroy B, Molamphy A, Murphy N, Dillon A, Doyle K, Cunningham C, Romero-Ortuno R. 82 THE IMPACT OF THE COVID-19 PANDEMIC ON THE ACTIVITY OF A RAPID-ACCESS GERIATRIC DAY HOSPITAL SERVICE. Age Ageing 2022. [PMCID: PMC9620317 DOI: 10.1093/ageing/afac218.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background In the 1970s, Jack Flanagan developed the first Geriatric Day Hospital (GDH) in Ireland. Since, the GDH model of care has evolved to accommodate for the growing demands of our ageing population. Before the COVID-19 pandemic, the operational scope of our GDH was extended to allow for the rapid medical and multidisciplinary assessment and follow-up of older patients. During the pandemic, the GDH did not suspend operations and remained open as a COVID-negative ambulatory pathway. We evaluated the activity of this GDH service. Methods Retrospective Service Evaluation Approval was granted by our Research & Innovation Office (Reference: 7419). Pseudonymised data corresponding to all GDH attendances between January 2017 and December 2021 were retrieved from the hospital electronic records. Yearly trends in proportions were tested with the Chi-square for trend statistic. Trends in monthly attendances were assessed via Statistical Process Control (SPC) charts with three-sigma limits. Statistical significance was set at p<0.05. Results There were 27,278 attendances of patients aged 65 and over to the GDH over the 5-year period (6,362, 5,978, 6,115, 4,306, and 4,517, respectively). Mean age was 82 every year. Of the 7,813 new episodes, yearly proportions referred directly by primary care teams were 10.4%, 29.5%, 38.6%, 24.5%, and 16.3% (p<0.001). SPC charts showed that Apr-May 2020 and Jan-Feb 2021 had significantly lower numbers of review attendances (50-59 and 146-142, respectively, average 324 p/m). However, new appointments did not significantly decline (average 130 p/m). Of the 7,813 new episodes, 2,595 (33.2%) were seen by Physiotherapy, and 1,860 (23.8%) by Occupational Therapy. Conclusion Our GDH saw a sustained number of new attendances and demonstrated increased community availability during the unprecedented COVID-19 crisis, especially during the first wave of the pandemic when hospital access was most affected. A rapid access GDH model can facilitate integrated care at times of crisis to promote ageing in place.
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Affiliation(s)
- K Moloney
- St. James's Hospital , Dublin, Ireland
| | - T Byrne
- St. James's Hospital , Dublin, Ireland
| | - S Mathews
- St. James's Hospital , Dublin, Ireland
| | - M Foran
- St. James's Hospital , Dublin, Ireland
| | - B Conroy
- St. James's Hospital , Dublin, Ireland
| | | | - N Murphy
- St. James's Hospital , Dublin, Ireland
| | - A Dillon
- St. James's Hospital , Dublin, Ireland
| | - K Doyle
- St. James's Hospital , Dublin, Ireland
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26
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Dyer A, Dolphin H, Laird E, Hoey L, McNulty H, Hughes C, Ward M, Strain JJ, O'Kane M, Tracey F, Molloy A, Cunningham C, McCarroll K. 17 CROSS-SECTIONAL AND LONGITUDINAL RELATIONSHIPS BETWEEN MOBILITY, NEUROPSYCHOLOGICAL PERFORMANCE AND FALLS IN COMMUNITY-DWELLING OLDER ADULTS: DATA FROM TUDA. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.013] [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
Impaired mobility is associated with incident cognitive impairment and dementia. However, the complex bi-directional temporal relationships between subtle impairments in neuropsychological performance, mobility trajectories and falls is poorly understood.
Methods
Using data from the Trinity, Ulster Department of Agriculture (TUDA/TUDA5+) study, we evaluated cross-sectional and longitudinal relationships between impaired mobility, neuropsychological performance and falls using regression models adjusted for important clinical confounders. Older adults with potential cognitive impairment (Mini-Mental State Examination score <25) were excluded. Detailed neuropsychological assessment was performed using the RBANS (Repeatable Battery for Neuropsychological Assessment) and FAB (Frontal Assessment Battery). Impaired mobility was assessed using Irish population-specific age/sex/height-specific Timed-Up-and-Go (TUG) cut-offs.
Results
Of 4,103 participants (72.9 ± 7.9 years; 67.4% female), just under one-fifth (17.5%) met criteria for impaired mobility. Older adults with impaired mobility had significantly greater likelihood of impaired neuropsychological performance, in particular for language (OR 1.77; 1.35-2.31; p<0.001) and attention (OR 1.69; 1.37-2.08; p<0.001) domains. In 953 participants followed for a median 5.2 (IQR: 4.83-7.26) years, impaired mobility at baseline significantly predicted incident impairment in immediate memory (OR 2.56; 1.33-4.95; p<0.001). Stronger relationships were seen for impaired neuropsychological performance predicting mobility decline rather than impaired mobility predicting cognitive decline (all p<0.001). Both impaired mobility and neuropsychological performance were associated with incident falls, particularly for impairments in executive function and attention (all p<0.001). Impaired mobility in isolation had poor performance as a sole test to predict incident cognitive impairment (AUC: 0.55-0.65).
Conclusion
In both cross-sectional and longitudinal analyses, impaired mobility is associated with subtle impairments in neuropsychological performance. Whilst impaired neuropsychological performance was a greater predictor of impaired mobility rather than vice versa, our findings highlight the complex relationship between mobility and cognitive trajectories in older adults, emphasising the need for comprehensive cognitive and falls assessment in those presenting with new-onset subtle impairments in mobility and cognition.
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Affiliation(s)
- A Dyer
- Tallaght University Hospital Age-Related Healthcare, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - H Dolphin
- Tallaght University Hospital Age-Related Healthcare, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M O'Kane
- Altnagelvin Hospital, Western Health and Social Care Trust Clinical Chemistry, , Londonderry, United Kingdom
| | - F Tracey
- Northern Health and Social Care Trust Causeway Hospital, , Coleraine, United Kingdom
| | - A Molloy
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - C Cunningham
- Mercer's Institute for Successful Aging , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - K McCarroll
- Mercer's Institute for Successful Aging , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
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27
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Rice C, Byrne L, Ortuno RR, Kenny RA, Cunningham C, Govern MM, Dsouza A, Prabhukeluskar S, Quinlan P. 110 DEVELOPMENT AND DELIVERY OF A MULTI-DISCIPLINARY HYBRID EDUCATION PROGRAM IN SYNCOPE AND RELATED DISORDERS DURING THE COVID-19 PANDEMIC. Age Ageing 2022. [PMCID: PMC9620586 DOI: 10.1093/ageing/afac218.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Syncope and related disorders is an important area for training of all health professionals. During the COVID-19 pandemic, we adapted the delivery of our annual face-to-face certified program to a 9-month hybrid program. Here, we describe the development, delivery, and evaluation of such new program. Methods A pre-existing curriculum was modified to incorporate online content, online lecture delivery and interactive group learning, in addition to individual practical placements in a syncope management unit, in line with government and hospital infection control guidance at the time. Monthly content included video consultant case presentations, ECG analysis and interpretation, and instructional videos of diagnostic testing and relevant technologies. A comprehensive online week-long lecture program was developed. Results The lecture week included 30 clinical lectures, 10 clinical case presentations and 10 ‘how to’ practical videos for testing/monitoring procedures. Further learning over zoom incorporated learner case presentations in a small group format. At the completion of the course the leaners attended a final online half day of lectures and completed the multi choice question examination. Conclusion “Thank you so much for putting together such a fantastic week of training.” “The quality and expertise of the speakers was outstanding.” “I have taken a huge amount away to incorporate into my practice and local unit.” The above learner feedback is consistent with our aim to deliver a high-quality specialist program for those interested in advancing the management of syncope and related disorders. Over time, this specialist training will aid the development of regional syncope management units across Ireland. The benefits of a hybrid learning model include multiple options to cater for all categories of learners, thus suggesting it is the cornerstone of future learning modalities.
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Affiliation(s)
- C Rice
- St. James’s Hospital , Dublin, Ireland
| | - L Byrne
- St. James’s Hospital , Dublin, Ireland
| | - RR Ortuno
- St. James’s Hospital , Dublin, Ireland
- Trinity College Dublin , Dublin, Ireland
| | - RA Kenny
- St. James’s Hospital , Dublin, Ireland
- Trinity College Dublin , Dublin, Ireland
| | | | - MM Govern
- St. James’s Hospital , Dublin, Ireland
| | - A Dsouza
- St. James’s Hospital , Dublin, Ireland
| | | | - P Quinlan
- Trinity College Dublin , Dublin, Ireland
- St. James’s Hospital , Dublin, Ireland
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28
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McDonagh L, McCarroll K, Lannon R, Cunningham C, Connolly K, Murphy N, Horgan F. 123 LEVELS OF PHYSICAL PERFORMANCE AND PHYSICAL ACTIVITY IN OLDER ATTENDEES AT A BONE HEALTH CLINIC. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Osteoporosis and sarcopenia are two common conditions seen in community-dwelling older adults. Limited information on physical performance and activity exists in older adults at risk of osteo-sarcopenia. The aim of this study was to examine levels of physical performance and physical activity in patients attending a bone health clinic.
Methods
A cross-sectional study was conducted. Community-dwelling older adults attending a bone health clinic in an acute Irish hospital were invited to participate. Primary outcome measures for physical performance and activity were: grip strength, the Short Physical Performance Battery (SPPB), the Timed Up and Go test (TUG) and the International Physical Activity Questionnaire (IPAQ). Secondary outcomes included: Bone Mineral Density T-scores, diagnosis of probable sarcopenia, osteo-sarcopenia, frailty, fractures and falls history.
Results
104 participants took part in the study. Median age was 76 (IQR 12), ranging from 65 to 91 years. Females accounted for the majority (88.5%) of recruited participants. Osteoporosis was present in 63% and osteopenia in 31%. Low physical activity levels were identified in 29%. Probable sarcopenia ranged from 17 to 37%. Osteo-sarcopenia was identified in 9 to 33% depending on four possible definitions. The most common associations with osteo-sarcopenia were frailty (CFS) and low BMI. Using reduced multivariate regression analysis, physical performance (grip strength, SPPB, TUG) and physical activity (IPAQ) were negatively associated with increased age, comorbidities, frailty and falls. Increased age was associated with all four variables analysed. Comorbidities was associated with grip strength (p=0.005), SPPB (p=0.01), TUG (p=0.041). Frailty (CFS) was associated with SPPB (p< .001), TUG (p< .001), and IPAQ (p< .001). Fall(s) history was associated with SPPB (p< .001) and TUG (p=0.028).
Conclusion
A high proportion of participants were classified as having osteoporosis, probable sarcopenia and osteo-sarcopenia. Completing physical performance and activity measures could provide useful information to clinicians about patients and their potential risks/deficits.
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Affiliation(s)
| | | | - R Lannon
- MISA St. James' Hospital , Dublin, Ireland
| | | | - K Connolly
- Physiotherapy St. James' Hospital , Dublin, Ireland
| | - N Murphy
- Physiotherapy St. James' Hospital , Dublin, Ireland
| | - F Horgan
- RCSI Physiotherapy , Dublin, Ireland
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29
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O'Donnell D, Zainal T, Malomo K, Neasa F, Briggs R, Cunningham C, Romero-Ortuno R, Rice C, Kenny RA, Lavan AH. 281 PREVALENCE OF STOPPFALL FALLS-RISK-INCREASING DRUGS (FRIDS) IN PATIENTS PRESENTING TO HOSPITAL WITH A FALL. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Falls cause presentation and admission to hospital. Falls-Risk-Increasing-Drugs (FRIDs) are a modifiable risk factor. STOPPFalls criteria was developed, using an expert Delphi panel, to achieve consensus on a comprehensive list of FRIDs. The aim of this study was to identify the prevalence of STOPPFall PRIDs in patients presenting to hospital with falls and identify whether review by a specialist Falls and Syncope Service (FASS) reduces FRIDs.
Methods
This was a retrospective observational study. Patients ≥65 years reviewed by the hospital FASS in the emergency department (over 6-months) and in house (over 2-months), were included. Medication appropriateness at admission and discharge were assessed using STOPPFall criteria. Ethical approval was received from the local research and innovation office (ref7013).
Results
Of 156 patients, 87(55.8%) were ≥65 years; 46% female, mean age 78.1(SD7.5) years. The mean number of conditions was 4(SD4.4); the mean number of regular medications was 6.9(SD4.5). Reasons for referral to FASS included falls (34.5%), dizziness/near fall (35.6%), and transient loss of consciousness (29.9%). For 21.8% there was an associated injury; 11.5% a fracture. Thirty-seven (42.5%) had experienced at least one fall in the previous 12-months.
Sixty-four (73.6%) were on ≥1 STOPPFall FRID. The most common STOPPFall FRID prescribed to older adults were diuretics (24.1%), anti-depressants (20.7%) and benzodiazepines/benzodiazepine-related drugs (13.8%). At least 1 STOPPFall FRID was stopped in 31.3%. The most commonly deprescribed STOPPFall FRIDs were diuretics (20%), alpha blockers (6%) and benzodiazepines/benzodiazepine-related drugs (4.7%). Adults <65years (n=69) were more likely to be prescribed a STOPPFall FRID at admission than older adults (≥65years); 88.4% vs 73.6%, p=0.021.
Conclusion
STOPPFall FRIDs are prevalent in fallers of all ages. Even one review by a specialist FASS leads to medication optimization. The effectiveness of STOPPFalls criteria in the prevention of falls should be evaluated further in intervention studies.
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Affiliation(s)
- D O'Donnell
- Mercer’s Institute for Successful Ageing (MISA), St. James's Hospital , Dublin, Ireland
| | - T Zainal
- Mercer’s Institute for Successful Ageing (MISA), St. James's Hospital , Dublin, Ireland
| | - K Malomo
- Mercer’s Institute for Successful Ageing (MISA), St. James's Hospital , Dublin, Ireland
| | - F Neasa
- Mercer’s Institute for Successful Ageing (MISA), St. James's Hospital , Dublin, Ireland
| | - R Briggs
- Mercer’s Institute for Successful Ageing (MISA), St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Discipline of Medical Gerontology, , Dublin, Ireland
| | - C Cunningham
- Mercer’s Institute for Successful Ageing (MISA), St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Discipline of Medical Gerontology, , Dublin, Ireland
| | - R Romero-Ortuno
- Mercer’s Institute for Successful Ageing (MISA), St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Discipline of Medical Gerontology, , Dublin, Ireland
| | - C Rice
- Mercer’s Institute for Successful Ageing (MISA), St. James's Hospital , Dublin, Ireland
| | - RA Kenny
- Mercer’s Institute for Successful Ageing (MISA), St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Discipline of Medical Gerontology, , Dublin, Ireland
| | - AH Lavan
- Mercer’s Institute for Successful Ageing (MISA), St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Discipline of Medical Gerontology, , Dublin, Ireland
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30
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Breslin L, Bradley E, Fitzpatrick D, Laird E, Hoey L, Hughes C, McNulty H, Strain JJ, Ward M, Tracey F, Molloy A, Cunningham C, McCarroll K. 261 HIGH FRACTURE RISK IN OLDER IRISH ADULT FALLERS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.229] [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] Open
Abstract
Abstract
Background
Fracture risk due to falls depends on several factors including bone density, quality and size, hip geometry (axis length), direction of fall (forward, backwards or sideways), body mass index (BMI), type of surface impacted, body site of impact and mechanism of fall (eg syncope). We aimed to identify the fracture risk per fall in frail older Irish adults.
Methods
Participants were from the hypertensive and cognitive cohort of the Trinity, Ulster, Dept Agriculture (TUDA) study of Irish adults (aged >60) recruited from hospital outpatient services and GP practises. Falls and falls resulting in fracture in the previous year were self-reported so those with an MMSE < 25 were excluded to avoid recall bias. We identified fallers, recurrent fallers and fractures due to falls in the previous year.
Results
892 fallers, mean age 76.3 ± 8.4 yrs, 65.2% female. 23.8% had 2 falls and 24.2% ≥3 falls. Mean timed up and go was 17.3 ± 9.5 seconds. Commonest fracture due to falls were hip (20.1%), upper limb (18.5%) and lower limb (17.9%) with one fracture of neck and skull. Fracture rate per fall was 7.1%: 1.7% for hip, 1.3% for lower and 1.2% for upper limb. Annual fracture rate per faller was 16.5%. The only predictors of fall with fracture versus no fracture were female sex (OR 2.4, 1.6-3.6, P<0.001) and lower body mass index (P=0.001).
Conclusion
We identified similar hip fracture rates (1.7%) due to falls as in other studies. However, one in six fallers had sustained a fracture in the previous year reflecting the high proportion of recurrent fallers. Lower BMI and female sex predicted fall with fracture as both are strongly correlated with risk of osteoporosis. Recent guidelines now factor in recurrent falls when estimating the probability of future osteoporotic fractures.
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Affiliation(s)
- L Breslin
- Mercer's Institute for Successful Ageing, St. James Hospital , Dublin, Ireland
| | - E Bradley
- Mercer's Institute for Successful Ageing, St. James Hospital , Dublin, Ireland
| | - D Fitzpatrick
- Mercer's Institute for Successful Ageing, St. James Hospital , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, , Coleraine, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, , Coleraine, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, , Coleraine, United Kingdom
| | - F Tracey
- Northern Health and Social Care Trust Causeway Hospital, , Coleraine, United Kingdom
| | - A Molloy
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - C Cunningham
- Trinity College Dublin Mercer's Institute for Successful Ageing, St. James's Hospital, Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - K McCarroll
- Trinity College Dublin Mercer's Institute for Successful Ageing, St. James's Hospital, Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
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31
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Feely O, Laird E, Hoey L, Hughes C, McNulty H, Ward M, Strain JJ, Tracey F, Molloy A, Cunningham C, Fallon N, Lannon R, McCarroll K. 126 CENTRAL ADIPOSITY IS ASSOCIATED WITH INCREASED PREVALENCE OF VERTEBRAL FRACTURES. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.105] [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
Increased body weight and obesity are associated with greater bone mineral density (BMD) though effects on fracture risk appear to be site specific. In particular, the relationship between Body Mass Index (BMI), abdominal weight and Vertebral Fractures (VF) is complex. Some studies have found greater incidence of VF's with obesity though results are inconsistent. Recent evidence supports a stronger association between measures of abdominal fat and VF's. We aimed to examine the association between central adiposity and VF's in older Irish adults.
Methods
Participants were from a large cross-sectional study of older Irish adults (aged >60) attending GP or hospital outpatient services. VF diagnosis was based on self-report (ie. clinical vertebral fracture) so we excluded those with a Mini Mental State Examination (MMSE) < 25. BMD was measured with DXA and patients taking antiresorptive or anabolic therapies were excluded. The relationship of waist hip ratio (a surrogate marker of central adiposity) with VF's was explored in regression models.
Results
2055 identified, mean age 69.8 ± 6.3 years (range 60-99), 58.6% female. Vertebral fracture prevalence was 6.3% (n=130). Waist hip ratio was positively associated with presence of a vertebral fracture after adjusting for age, sex, BMI, timed up and go, smoking, serum vitamin D, lumbar spine BMD and steroid use > 3 months (beta: 0.04, P<0.001).
Conclusion
We identified that central adiposity (as measured by waist/hip ratio) was associated with VF presence independent of several factors including BMI and spine BMD. This suggests that body fat distribution and/or altered bone quality may play a role. Visceral body fat (which is correlated with waist hip ratio) is associated with increased production of adipocytokines, altered vertebral geometry and micro-architecture, increased vertebral bone marrow fat and greater loading forces on the spine, all of which may mediate increased VF risk.
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Affiliation(s)
- O Feely
- St. James's Hospital Mercer's Institute for Successful Ageing, , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - F Tracey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - A Molloy
- Northern Health and Social Care Trust Causeway Hospital, , Coleraine, United Kingdom
| | - C Cunningham
- St. James's Hospital Mercer's Institute for Successful Ageing, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - N Fallon
- St. James's Hospital Mercer's Institute for Successful Ageing, , Dublin, Ireland
| | - R Lannon
- St. James's Hospital Mercer's Institute for Successful Ageing, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - K McCarroll
- St. James's Hospital Mercer's Institute for Successful Ageing, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
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Sherman SM, Brewer N, Bartholomew K, Bromhead C, Crengle S, Cunningham C, Douwes J, Foliaki S, Grant J, Maxwell A, McPherson G, Scott N, Wihongi H, Potter JD. Human papillomavirus self-testing among unscreened and under-screened Māori, Pasifika and Asian women in Aotearoa New Zealand: A preference survey among responders and interviews with clinical-trial nonresponders. Health Expect 2022; 25:2914-2923. [PMID: 36161964 DOI: 10.1111/hex.13599] [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: 05/04/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Māori, Pasifika and Asian women are less likely to attend cervical screening and Māori and Pasifika women are more likely to be diagnosed with later-stage cervical cancer than other women in Aotearoa New Zealand. This study-with under-screened women taking part in a randomized-controlled trial comparing self-testing and standard screening-explored the acceptability of a human papillomavirus (HPV) self-test kit and the preferred method for receiving it. METHODS Māori, Pasifika and Asian women (N= 376) completed a cross-sectional postal questionnaire. Twenty-six women who had not accepted the trial invitation were interviewed to understand their reasons for nonparticipation. RESULTS Most women found the self-test kit easy and convenient to use and reported that they did not find it painful, uncomfortable or embarrassing. This was reflected in the preference for a self-test over a future smear test on the same grounds. Most women preferred to receive the kit by mail and take the test themselves, rather than having it done by a doctor or nurse. There was a range of preferences relating to how to return the kit. Phone calls with nonresponders revealed that, although most had received the test kit, the reasons for not choosing to be involved included not wanting to, being too busy or forgetting. CONCLUSION HPV self-testing was acceptable for Māori, Pasifika and Asian women in Aotearoa New Zealand. HPV self-testing has considerable potential to reduce the inequities in the current screening programme and should be made available with appropriate delivery options as soon as possible. PATIENT OR PUBLIC CONTRIBUTION This study explored the acceptability of HPV self-testing and their preferences for engaging with it among Māori, Pasifika and Asian women. Thus, women from these underserved communities were the participants and focus of this study.
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Affiliation(s)
| | - Naomi Brewer
- Research Centre for Hauora and Health, Massey University, Wellington, Aotearoa, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB), Auckland, New Zealand.,Auckland DHB, Auckland, New Zealand
| | - Collette Bromhead
- School of Health Sciences, Massey University, Wellington, Aotearoa, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin, Aotearoa, New Zealand
| | - Chris Cunningham
- Research Centre for Hauora and Health, Massey University, Wellington, Aotearoa, New Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University, Wellington, Aotearoa, New Zealand
| | - Sunia Foliaki
- Research Centre for Hauora and Health, Massey University, Wellington, Aotearoa, New Zealand
| | - Jane Grant
- Waitematā District Health Board (DHB), Auckland, New Zealand.,Auckland DHB, Auckland, New Zealand
| | - Anna Maxwell
- Waitematā District Health Board (DHB), Auckland, New Zealand.,Auckland DHB, Auckland, New Zealand
| | | | - Nina Scott
- Waitematā District Health Board (DHB), Auckland, New Zealand.,Hei Āhuru Mōwai
| | - Helen Wihongi
- Waitematā District Health Board (DHB), Auckland, New Zealand.,Auckland DHB, Auckland, New Zealand
| | - John D Potter
- Research Centre for Hauora and Health, Massey University, Wellington, Aotearoa, New Zealand
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Ladyman C, Sweeney B, Sharkey K, Bei B, Wright T, Mooney H, Huthwaite M, Cunningham C, Firestone R, Signal TL. A scoping review of non-pharmacological perinatal interventions impacting maternal sleep and maternal mental health. BMC Pregnancy Childbirth 2022; 22:659. [PMID: 35999501 PMCID: PMC9395885 DOI: 10.1186/s12884-022-04844-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/18/2021] [Accepted: 06/15/2022] [Indexed: 01/24/2023] Open
Abstract
Background A woman’s vulnerability to sleep disruption and mood disturbance is heightened during the perinatal period and there is a strong bidirectional relationship between them. Both sleep disruption and mood disturbance can result in significant adverse outcomes for women and their infant. Thus, supporting and improving sleep in the perinatal period is not only an important outcome in and of itself, but also a pathway through which future mental health outcomes may be altered. Methods Using scoping review methodology, we investigated the nature, extent and characteristics of intervention studies conducted during the perinatal period (pregnancy to one-year post-birth) that reported on both maternal sleep and maternal mental health. Numerical and descriptive results are presented on the types of studies, settings, sample characteristics, intervention design (including timeframes, facilitation and delivery), sleep and mood measures and findings. Results Thirty-seven perinatal interventions were identified and further described according to their primary focus (psychological (n = 9), educational (n = 15), lifestyle (n = 10), chronotherapeutic (n = 3)). Most studies were conducted in developed Western countries and published in the last 9 years. The majority of study samples were women with existing sleep or mental health problems, and participants were predominantly well-educated, not socio-economically disadvantaged, in stable relationships, primiparous and of White race/ethnicity. Interventions were generally delivered across a relatively short period of time, in either the second trimester of pregnancy or the early postnatal period and used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep and the Edinburgh Postnatal Depression Scale (EPDS) to measure mood. Retention rates were high (mean 89%) and where reported, interventions were well accepted by women. Cognitive Behavioural Therapies (CBT) and educational interventions were largely delivered by trained personnel in person, whereas other interventions were often self-delivered after initial explanation. Conclusions Future perinatal interventions should consider spanning the perinatal period and using a stepped-care model. Women may be better supported by providing access to a range of information, services and treatment specific to their needs and maternal stage. The development of these interventions must involve and consider the needs of women experiencing disadvantage who are predominantly affected by poor sleep health and poor mental health.
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Affiliation(s)
- Clare Ladyman
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - Bronwyn Sweeney
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - Katherine Sharkey
- The Warren Alpert Medical School, Brown University, 222 Richmond St, Providence, RI, 02903, USA
| | - Bei Bei
- Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk Clayton Campus, Clayton, Victoria, 3800, Australia
| | - Tanya Wright
- School of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Hannah Mooney
- Ngāti Raukawa, Te Atiawa, Ngā Rauru, Te Āti Haunui-a-Pāpārangi, School of Social Work, College of Health, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, 23 Mein St, Newtown, Wellington, 6242, New Zealand
| | - Chris Cunningham
- Ngāti Raukawa; Ngāti Toarangatira; Te Atiawa; Te Ati Haunui-a-Pāpārangi, Research Centre for Hauora & Health, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - Ridvan Firestone
- Research Centre for Hauora & Health, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand.
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Bennett J, Shorter C, Kvalsvig A, Telfar Barnard L, Wilson N, Crane J, Douwes J, Cunningham C, Taptiklis P, Phipps R, Trompetter B, Plagmann M, Boulic M, Summers J, Berry TA, Baker MG, Howden-Chapman P. Indoor air quality, largely neglected and in urgent need of a refresh. N Z Med J 2022; 135:136-139. [PMID: 35999791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Julie Bennett
- Senior Research Fellow, Department of Public Health, University of Otago, Wellington
| | - Caroline Shorter
- Senior Research Fellow, Department of Medicine, University of Otago, Wellington
| | - Amanda Kvalsvig
- Senior Research Fellow, Health Environment and Infection Research Unit (HEIRU), Department of Public Health, University of Otago Wellington
| | | | - Nick Wilson
- Professor of Public Health, Health Environment and Infection Research Unit, University of Otago, Wellington
| | - Julian Crane
- Research Professor, Department of Medicine, University of Otago, Wellington
| | - Jeroen Douwes
- Professor of Public Health, Research Centre for Hauora and Health, Massey University, Wellington
| | - Chris Cunningham
- Professor of Māori & Public Health, Research Centre for Hauora and Health, Massey University, Wellington and He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington
| | | | - Robyn Phipps
- Professor of Building Science, School of Architecture, Victoria University of Wellington and He Kāinga Oranga/Housing and Health Research Programme
| | - Bill Trompetter
- Senior Scientist, GNS Science, NZ Indoor Air Quality Research Centre, Chair of Indoor air quality special interest group for CASANZ
| | - Manfred Plagmann
- Principal Scientist, BRANZ Ltd., NZ Indoor Air Quality Research Centre
| | - Mikael Boulic
- Senior Lecturer, School of Built Environment, Massey University, Auckland
| | - Jennifer Summers
- Senior Research Fellow, Health Environment and Infection Research Unit, University of Otago, Wellington
| | - Terri-Ann Berry
- Director (ESRC) and Associate Professor, Environmental Solutions Research Centre (ESRC) and School of Construction and Engineering, Unitec Institute of Technology, Auckland
| | - Michael G Baker
- Professor of Public Health, He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington
| | - Philippa Howden-Chapman
- Distinguished Professor, He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington
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Floudas A, Smith C, Tynan O, Neto N, Krishna V, Wade S, Hanlon M, Cunningham C, Marzaioli V, Canavan M, Fletcher J, Cole S, Hao LY, Nagpal S, Monaghan M, Veale D, Fearon U. OP0068 DISTINCT STROMAL AND IMMUNE CELL INTERACTIONS SHAPE THE PATHOGENESIS OF RHEUMATOID AND PSORIATIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1811] [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: 11/03/2022]
Abstract
BackgroundRheumatoid (RA) and psoriatic arthritis (PsA) are common autoimmune and autoinflammatory diseases of unknown aetiology characterised by complex synovial pathology with a detrimental effect on the patient’s quality of life. Significant differences in pathophysiology may explain distinct clinical manifestations and account for differential responses to specific therapeutics. Recent implementation of single cell transcriptomic analysis of sorted synovial cells has revealed the diverse cellular landscape of the RA synovial stromal and immune cell compartments, however, a complete analysis of immune and stromal cells in tandem, for RA and PsA patient synovial tissue has not been performed.ObjectivesTo combine novel scRNA transcriptomic approaches and ex vivo assays in order to: identify differences in the cellular landscape of RA and PsA synovial tissue inflammation and immune – stromal cell interactions that drive pathology in RA and PsA.MethodsSingle cell transcriptomic profiling of 178,000 synovial tissue cells from 5 PsA and 4 RA patients, importantly, without prior sorting of immune and stromal cells. This approach enabled the generation of a unique cell atlas of intact synovial tissue identifying immune and stromal cell interactions. State of the art data integration and annotation techniques identified and characterised 18 stromal and 14 immune cell clusters. Bioinformatic examination of cell-cell communication via construction of receptor-ligand interaction networks with further in vitro validation of stromal and immune cell crosstalk through flow cytometric analysis, multiplex ELISA and mitochondrial and single cell metabolic profiling by multiphoton and florescent lifetime imaging microscopy, seahorse.ResultsFollowing quality control and data integration the PsA and RA cellular landscape was generated and nine mega clusters indicative of fibroblasts, endothelial cells, pericytes, macrophages, dendritic cells (DC), B cells, plasma cells, T cells and NKT consisting of several sub clusters were identified. Distinct points of transcriptomic deviation and convergence between RA and PsA were identified for each of the major cell types of the joint. Specifically, cell cycle and trajectory analysis revealed that only a fraction of synovial T cells are actively proliferating. Additionally, the differential usage of immunoglobulin light chains by memory and plasma cells indicates that plasma cells are potentially not derived from the local memory B cell pool of the synovial tissue. Importantly, we report distinct fibroblast and endothelial cell transcriptomes indicating differentially abundant subpopulations in RA and PsA characterised by distinct transcription factor usage and signalling pathway enrichment. Specifically transcriptomic imputation analysis revealed abundance of invasive FAPα+THY1+ regulated by transcription factor TEAD1 in RA compared to PsA synovial tissue. In order to identify potential cell-cell communication driving inflammation in RA and PsA, novel receptor–ligand interaction networks were generated and downstream of the receptor, target characterisation was performed. Herein we identify RA-specific synovial T cell-derived TGF-β and macrophage IL-1β synergy in driving the transcriptional profile of FAPα+THY1+ invasive synovial-fibroblasts, expanded in RA compared to PsA synovial tissue biopsies (Figure 1). Ex vivo treatment of RA patient synovial fibroblasts identified TGF-b and IL-1b synergy are a major driver of IL-6 production, fibroblast activation and adhesion molecule expression. Interestingly, the aforementioned proinflammatory changes of RA patient synovial fibroblasts were coupled with significant alterations in mitochondrial eccentricity and size and a marked metabolic adaptation towards a strongly glycolytic profile (Figure 1).Figure 1.ConclusionDisrupting specific immune and stromal cell interactions offers novel opportunities for targeted therapeutic intervention in RA and PsA.Disclosure of InterestsAchilleas Floudas: None declared, Conor Smith: None declared, Orla Tynan: None declared, Nuno Neto: None declared, Vinod Krishna Employee of: Janssen Pharmaceuticals, Sarah Wade: None declared, Megan Hanlon: None declared, Clare Cunningham: None declared, Viviana Marzaioli: None declared, Mary Canavan: None declared, Jean Fletcher: None declared, Suzanne Cole Employee of: Janssen Pharmaceuticals, Ling-Yang Hao Employee of: Janssen Pharmaceuticals, Sunil Nagpal Employee of: Janssen Pharmaceuticals, GSK, Michael Monaghan: None declared, Douglas Veale Consultant of: Janssen, Eli Lilly, Pfizer, Ursula Fearon Consultant of: Janssen, Eli Lilly, Pfizer.
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Tamm A, Jones HJ, Perry W, Campbell D, Carten R, Davies J, Galdikas A, English L, Garbett A, Glampson B, Harris S, Khan K, Little S, Malcomson L, Matharu S, Mayer E, Mercuri L, Morris EJ, Muirhead R, Norris R, O'Hara C, Papadimitriou D, Peek N, Renehan A, Roadknight G, Starling N, Teare M, Turner R, Várnai KA, Wasan H, Woods K, Cunningham C. Establishing a colorectal cancer research database from routinely collected health data: the process and potential from a pilot study. BMJ Health Care Inform 2022; 29:bmjhci-2021-100535. [PMID: 35738723 PMCID: PMC9226931 DOI: 10.1136/bmjhci-2021-100535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/25/2022] [Indexed: 11/03/2022] Open
Abstract
ObjectiveColorectal cancer is a common cause of death and morbidity. A significant amount of data are routinely collected during patient treatment, but they are not generally available for research. The National Institute for Health Research Health Informatics Collaborative in the UK is developing infrastructure to enable routinely collected data to be used for collaborative, cross-centre research. This paper presents an overview of the process for collating colorectal cancer data and explores the potential of using this data source.MethodsClinical data were collected from three pilot Trusts, standardised and collated. Not all data were collected in a readily extractable format for research. Natural language processing (NLP) was used to extract relevant information from pseudonymised imaging and histopathology reports. Combining data from many sources allowed reconstruction of longitudinal histories for each patient that could be presented graphically.ResultsThree pilot Trusts submitted data, covering 12 903 patients with a diagnosis of colorectal cancer since 2012, with NLP implemented for 4150 patients. Timelines showing individual patient longitudinal history can be grouped into common treatment patterns, visually presenting clusters and outliers for analysis. Difficulties and gaps in data sources have been identified and addressed.DiscussionAlgorithms for analysing routinely collected data from a wide range of sites and sources have been developed and refined to provide a rich data set that will be used to better understand the natural history, treatment variation and optimal management of colorectal cancer.ConclusionThe data set has great potential to facilitate research into colorectal cancer.
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Affiliation(s)
- Andres Tamm
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute and the Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helen Js Jones
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William Perry
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Des Campbell
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Rachel Carten
- Royal Marsden NHS Foundation Trust, London, UK
- Croydon University Hospital, Croydon, UK
| | - Jim Davies
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, Oxfordshire, UK
| | - Algirdas Galdikas
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Louise English
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Alex Garbett
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Ben Glampson
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Steve Harris
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, Oxfordshire, UK
| | - Khurum Khan
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephanie Little
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lee Malcomson
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Sheila Matharu
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Erik Mayer
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery & Cancer, Imperial College London, London, London, UK
| | - Luca Mercuri
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Eva Ja Morris
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute and the Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rebecca Muirhead
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Norris
- NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Catherine O'Hara
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Dimitri Papadimitriou
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Niels Peek
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Manchester, UK
| | - Andrew Renehan
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Gail Roadknight
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Naureen Starling
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Marion Teare
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Rachel Turner
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Kinga A Várnai
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Harpreet Wasan
- NIHR Imperial Biomedical Research Centre, London, UK
- iCare & Imperial College Healthcare NHS Trust, London, UK
| | - Kerrie Woods
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris Cunningham
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Tynan O, Cunningham C, Hanlon M, Floudas A, Canavan M, Fearon U, Veale D. POS0419 DIFFERENTIAL miRNA EXPRESSION AND ENDOTHELIAL CELL FUNCTION IN RHEUMATOID ARTHRITIS AND PSORIATIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1813] [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: 11/03/2022]
Abstract
BackgroundRheumatoid arthritis (RA) and Psoriatic arthritis (PsA) constitute forms of inflammatory arthritis (IA) characterised by enhanced angiogenesis, immune cell infiltration, and generation of a hypoxic microenvironment leading to an invasive synovial pannus that results in bone and cartilage destruction. However, significant differences in circulating biomarkers in addition to disease pathogenesis at the clinical, immunological, cellular, and molecular levels have been identified that differentiate the two pathotypes.ObjectivesThe aim of this study was to examine circulatory miRNA as cellular biomarkers that can distinguish RA form PsA and to evaluate the potential implication for disease pathogenesis. Furthermore, this study aimed to examine the differential effect of the joint microenvironment on endothelial cell (EC) function in both RA and PsA.MethodsRA, PsA and healthy controls (HC) were recruited from St. Vincent’s University Hospital, and serum was collected. Multiplex analysis of 68 serum miRNAs was performed using the FirePlex miRNA Immunology-V2 panel (FirePlex Bioworks Inc). Receiver operator characteristic (ROC) curves were generated to determine sensitivity and specificity of specific miRNAs whilst DNA intelligent analysis (DIANA)-mirPath and STRING software were used to analyse pathways targeted by the dysregulated miRNAs. Additionally, human umbilical vein endothelial cells (HUVEC) were cultured with RA and PsA synovial fluid (SF). Angiogenesis, invasion, and cellular adhesion were quantified by Matrigel tube formation assays, wound healing assays, and adhesion assays. Real-time cellular bioenergetics was analysed in HUVEC in response to RA and PsA SF using the Seahorse XFe96 Analyser.Results7 miRNAs; miR-126-3p, miR-29b-3p, miR-22-3p, miR-223-3p, miR-320a, let-7g-5e, and let-7g-5p (all**p≤0.01), were significantly elevated in RA serum compared to both PsA patients and HC, with ROC curve analysis demonstrating the predictive accuracy with which each miRNA differentiated between RA and PsA (all <0.05). Biplot analysis further identified that three miRNA, miR-29b-3p, miR-22-3p, and miR-223-3p demonstrated the greatest separation between RA and PsA (all p<0.05). DIANA and STRING analysis identified the P13K-Akt pathway as being the primary target of these 3 miRNAs with specific gene targets involved in this pathway including factors all importantly associated with endothelial cell migration, proliferation, invasion, and angiogenesis. Next, we examined the effect of the joint microenvironment on endothelial cell function and demonstrated that PsA SF significantly enhanced EC tube formation (p<0.05) and EC leukocyte adhesion (p<0.05), with RASF only significantly inducing EC leukocyte adhesion. Finally, metabolic analysis of endothelial cells demonstrated that PsA SF significantly induced baseline glycolysis (p<0.05), baseline OCR (p<0.05), maximal respiratory capacity (p<0.05) and spare respiratory capacity (p<0.05), with no effect observed for RA SF.ConclusionCirculating miRNAs may be valuable as diagnostic biomarkers that can distinguish RA from PsA. Additionally, the joint microenvironment induces EC function and metabolic capacity, with these effects more pronounced in response to PsA SF compared to RA SF.References[1]Cunningham, C. C., S. Wade, A. Floudas, C. Orr, T. McGarry, S. Wade, S. Cregan, U. Fearon, and D. J. Veale. 2021. Serum miRNA Signature in Rheumatoid Arthritis and “At-Risk Individuals”. Front Immunol 12.[2]Wade, S. M., T. McGarry, S. C. Wade, U. Fearon, and D. J. Veale. 2020. Serum MicroRNA Signature as a Diagnostic and Therapeutic Marker in Patients with Psoriatic Arthritis. J Rheumatol 47: 1760-1767[3]Fromm, S., C. C. Cunningham, M. R. Dunne, D. J. Veale, U. Fearon, and S. M. Wade. 2019. Enhanced angiogenic function in response to fibroblasts from psoriatic arthritis synovium compared to rheumatoid arthritis. Arthritis Res Ther 21: 297.Disclosure of InterestsNone declared.
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Ramsay I, Sharrocks K, Warne B, Sithole N, Ravji P, Bousfield R, Jones N, Leong CE, Suliman M, Tsui R, Toleman MS, Moody C, Smith R, Whitehorn J, Gouliouris T, Penciu F, Hofling C, Cunningham C, Enoch DA, Moore E. Investigation of healthcare-associated SARS-CoV-2 infection: Learning outcomes from an investigative process in the initial phase of the pandemic. J Infect Prev 2022; 23:197-205. [PMID: 36003131 PMCID: PMC9117956 DOI: 10.1177/17571774221092553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Healthcare-associated (HCA) SARS-CoV-2 infection is a significant contributor
to the spread of the 2020 pandemic. Timely review of HCA cases is essential
to identify learning to inform infection prevention and control (IPC)
policies and organisational response. Aim To identify key areas for improvement through rapid investigation of HCA
SARS-CoV-2 cases and to implement change. Methods Cases were identified based on date of first positive SARS-CoV-2 PCR sample
in relation to date of hospital admission. Cases were reviewed using a
structured gap analysis tool to identify key learning points. These were
discussed in weekly multidisciplinary meetings to gain consensus on learning
outcomes, level of harm incurred by the patient and required actions.
Learning was then promptly fed back to individual teams and the
organisation. Findings Of the 489 SARS-CoV-2 cases admitted between 10th March and
23rd June 2020, 114 suspected HCA cases (23.3%) were
reviewed; 58/489 (11.8%) were ultimately deemed to be HCA. Five themes were
identified: individual patient vulnerability, communication, IPC
implementation, policy issues and organisational response. Adaptations to
policies based on these reviews were completed within the course of the
initial phase of the pandemic. Conclusion This approach enabled timely learning and implementation of control measures
and policy development.
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Affiliation(s)
- Isobel Ramsay
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Katherine Sharrocks
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ben Warne
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nyarie Sithole
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pooja Ravji
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rachel Bousfield
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nick Jones
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Clare E Leong
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mohamed Suliman
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rachel Tsui
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
| | | | - Christine Moody
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
| | - Richard Smith
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
| | - James Whitehorn
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Theodore Gouliouris
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Christian Hofling
- Infectious Diseases, Universidade Estadual de Campinas, Campinas, Brazil
| | - Chris Cunningham
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - David A Enoch
- Clinical Microbiology & Public Health Laboratory, Cambridge, UK
| | - Elinor Moore
- Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Slevin F, Hanna CR, Appelt A, Cunningham C, Marijnen CAM, Sebag-Montefiore D, Muirhead R. The Long and the Short of it: the Role of Short-course Radiotherapy in the Neoadjuvant Management of Rectal Cancer. Clin Oncol (R Coll Radiol) 2022; 34:e210-e217. [PMID: 34955376 DOI: 10.1016/j.clon.2021.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/05/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Abstract
Total mesorectal excision is the cornerstone of treatment for rectal cancer. Multiple randomised trials have shown a reduction in local recurrence rates with the addition of preoperative radiotherapy, either as a 1-week hypofractionated short-course (SCRT) or a conventionally fractionated long-course (LCRT) schedule with concurrent chemotherapy. There is also increasing interest in the addition of neoadjuvant chemotherapy to radiotherapy with the aim of improving disease-free survival. The relative use of SCRT and LCRT varies considerably across the world. This is reflected in, and is probably driven in part by, disparity between international guideline recommendations. In addition, different approaches to treatment may exist both between and within countries, with variation related to patient, disease and treatment centre and financial factors. In this review, we will specifically focus on the use of SCRT for the treatment of rectal cancer. We will discuss the literature base and current guidelines, highlighting the challenges and controversies in clinical application of this evidence. We will also discuss potential future applications of SCRT, including its role in optimisation and intensification of treatment for rectal cancer.
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Affiliation(s)
- F Slevin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - C R Hanna
- Beatson West of Scotland Cancer Centre, Glasgow, UK; CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A Appelt
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - C Cunningham
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C A M Marijnen
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - D Sebag-Montefiore
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - R Muirhead
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Browne A, Fallon L, Wrenne A, Mellett H, Brady S, Cunningham C. An evaluation of nutritional status and specific nutritional issues during a rehabilitation period post COVID-19 infection. Clin Nutr ESPEN 2022. [PMCID: PMC8937562 DOI: 10.1016/j.clnesp.2022.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Park J, Le AK, Tseng TC, Yeh ML, Jun DW, Trinh H, Wong GLH, Chen CH, Peng CY, Kim SE, Oh H, Kwak MS, Cheung KS, Toyoda H, Hsu YC, Jeong JY, Yoon EL, Ungtrakul T, Zhang J, Xie Q, Ahn SB, Enomoto M, Shim JJ, Cunningham C, Jeong SW, Cho YK, Ogawa E, Huang R, Lee DH, Takahashi H, Tsai PC, Huang CF, Dai CY, Tseng CH, Yasuda S, Kozuka R, Li J, Wong C, Wong CC, Zhao C, Hoang J, Eguchi Y, Wu C, Tanaka Y, Gane E, Tanwandee T, Cheung R, Yuen MF, Lee HS, Yu ML, Kao JH, Yang HI, Nguyen MH. Progression Rates by Age, Sex, Treatment, and Disease Activity by AASLD and EASL Criteria: Data for Precision Medicine. Clin Gastroenterol Hepatol 2022; 20:874-885.e4. [PMID: 34089852 DOI: 10.1016/j.cgh.2021.05.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/30/2021] [Revised: 05/05/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Antiviral treatment criteria are based on disease progression risk, and hepatocellular carcinoma (HCC) surveillance recommendations for patients with chronic hepatitis B (CHB) without cirrhosis is based on an annual incidence threshold of 0.2%. However, accurate and precise disease progression estimate data are limited. Thus, we aimed to determine rates of cirrhosis and HCC development stratified by age, sex, treatment status, and disease activity based on the 2018 American Association for the Study of Liver Diseases and 2017 European Association for the Study of the Liver guidelines. METHODS We analyzed 18,338 patients (8914 treated, 9424 untreated) from 6 centers from the United States and 27 centers from Asia-Pacific countries. The Kaplan-Meier method was used to estimate annual progression rates to cirrhosis or HCC in person-years. RESULTS The cohort was 63% male, with a mean age of 46.19 years, with baseline cirrhosis of 14.3% and median follow up of 9.60 years. By American Association for the Study of Liver Diseases criteria, depending on age, sex, and disease activity, annual incidence rates ranged from 0.07% to 3.94% for cirrhosis, from 0.04% to 2.19% for HCC in patients without cirrhosis, and from 0.40% to 8.83% for HCC in patients with cirrhosis. Several subgroups of patients without cirrhosis including males younger than 40 years of age and females younger than 50 years of age had annual HCC risk near or exceeding 0.2%. Similar results were found using European Association for the Study of the Liver criteria. CONCLUSION There is great variability in CHB disease progression rates even among "lower-risk" populations. Future CHB modeling studies, public health planning, and HCC surveillance recommendation should be based on more precise disease progression rates based on sex, age, and disease activity, plus treatment status.
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Affiliation(s)
- Jiyoon Park
- Department of Medicine, Santa Clara Valley Medical Center, Santa Clara, California; Division of Gastroenterology and Hepatology, Stanford University Medical Center, California
| | - An K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, California
| | - Tai-Chung Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Dae Won Jun
- Department of Gastroenterology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Huy Trinh
- San Jose Gastroenterology, San Jose, California
| | - Grace L H Wong
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chien-Hung Chen
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Yuan Peng
- Department of Gastroenterology, China Medical University Hospital, Taichung, Taiwan
| | - Sung Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Hyunwoo Oh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min-Sun Kwak
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ka Shing Cheung
- Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yao-Chun Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Jae Yoon Jeong
- Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Eileen L Yoon
- Department of Gastroenterology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Teerapat Ungtrakul
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Jian Zhang
- Chinese Hospital, San Francisco, California
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - Masaru Enomoto
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Chris Cunningham
- Research Centre for Maori Health and Development, Massey University, Wellington, New Zealand
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Dong-Hyun Lee
- Department of Gastroenterology, Good Gang-An Hospital, Busan, Republic of Korea
| | | | - Pei-Chien Tsai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Hao Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Satoshi Yasuda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ritsuzo Kozuka
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Jiayi Li
- Palo Alto Medical Foundation, Mountain View Division, Mountain View, California
| | | | - Clifford C Wong
- Wong Clinics, San Francisco, California; Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Changqing Zhao
- Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Joseph Hoang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, California
| | - Yuichiro Eguchi
- Department of Internal Medicine, Saga University Hospital, Saga, Japan
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ed Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - Tawesak Tanwandee
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, California
| | - Man-Fung Yuen
- Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Hyo-Suk Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Horng Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, California; Department of Epidemiology and Population Health, Stanford University, Stanford, California.
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Cunningham C, Sung H, Benoit J, Conway J, Scott S. Web-Based Knowledge Translation Tools for Parents of Children with Heart Failure: An Environmental Scan. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Al-Najami I, Kristian Baelum J, Jones HJS, Perry W, Cunningham C. ROAD: A standardized method for endoscopic assessment of rectal tumours - A video vignette. Colorectal Dis 2022; 24:539. [PMID: 34837301 DOI: 10.1111/codi.16006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/14/2021] [Accepted: 11/20/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Issam Al-Najami
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Department of Colorectal Surgery, Odense University Hospital, Odense, Denmark
| | | | - Helen J S Jones
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William Perry
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris Cunningham
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Loughrey MB, Webster F, Arends MJ, Brown I, Burgart LJ, Cunningham C, Flejou JF, Kakar S, Kirsch R, Kojima M, Lugli A, Rosty C, Sheahan K, West NP, Wilson RH, Nagtegaal ID. Dataset for Pathology Reporting of Colorectal Cancer: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Ann Surg 2022; 275:e549-e561. [PMID: 34238814 PMCID: PMC8820778 DOI: 10.1097/sla.0000000000005051] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study to describe a new international dataset for pathology reporting of colorectal cancer surgical specimens, produced under the auspices of the International Collaboration on Cancer Reporting (ICCR). BACKGROUND Quality of pathology reporting and mutual understanding between colorectal surgeon, pathologist and oncologist are vital to patient management. Some pathology parameters are prone to variable interpretation, resulting in differing positions adopted by existing national datasets. METHODS The ICCR, a global alliance of major pathology institutions with links to international cancer organizations, has developed and ratified a rigorous and efficient process for the development of evidence-based, structured datasets for pathology reporting of common cancers. Here we describe the production of a dataset for colorectal cancer resection specimens by a multidisciplinary panel of internationally recognized experts. RESULTS The agreed dataset comprises eighteen core (essential) and seven non-core (recommended) elements identified from a review of current evidence. Areas of contention are addressed, some highly relevant to surgical practice, with the aim of standardizing multidisciplinary discussion. The summation of all core elements is considered to be the minimum reporting standard for individual cases. Commentary is provided, explaining each element's clinical relevance, definitions to be applied where appropriate for the agreed list of value options and the rationale for considering the element as core or non-core. CONCLUSIONS This first internationally agreed dataset for colorectal cancer pathology reporting promotes standardization of pathology reporting and enhanced clinicopathological communication. Widespread adoption will facilitate international comparisons, multinational clinical trials and help to improve the management of colorectal cancer globally.
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Affiliation(s)
- Maurice B Loughrey
- Centre for Public Health, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
- Department of Cellular Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Fleur Webster
- International Collaboration on Cancer Reporting, Sydney, NSW, Australia
| | - Mark J Arends
- Division of Pathology, Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Ian Brown
- Envoi Pathology, Kelvin Grove, QLD, Australia
| | - Lawrence J Burgart
- Department of Pathology, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, Minneapolis, MN
| | - Chris Cunningham
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHSFT, Oxford, UK
| | - Jean-Francois Flejou
- Department of Pathology, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Sanjay Kakar
- Department of Pathology, University of California San Francisco, San Francisco, CA
| | - Richard Kirsch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Motohiro Kojima
- Division of Pathology, Research Center for Innovative Oncology, National Cancer Center, Chiba, Kashiwa, Japan
| | | | - Christophe Rosty
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Envoi Specialist Pathologists, Brisbane, QLD, Australia
- Department of Pathology, University of Melbourne, Melbourne, VIC, Australia
| | - Kieran Sheahan
- Department of Pathology, St Vincent's University Hospital & University College, Dublin, Ireland
| | - Nicholas P West
- Pathology and Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Richard H Wilson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
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O'Brien DM, Sagi-Kiss V, Palma-Duran SA, Cunningham C, Barrett B, Johnston CS, Midthune D, Kipnis V, Freedman LS, Tasevska N. An evaluation of the serum carbon isotope ratio as a candidate predictive biomarker of the dietary animal protein ratio (animal protein/total protein) in a 15-day controlled feeding study of US adults. Am J Clin Nutr 2022; 115:1134-1143. [PMID: 35030258 PMCID: PMC8970990 DOI: 10.1093/ajcn/nqac004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/10/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The serum natural abundance carbon isotope ratio (CIR) was recently identified as a candidate biomarker of animal protein intake in postmenopausal women. Such a biomarker would help clarify the relation between dietary protein source (plant or animal) and chronic disease risk. OBJECTIVES We aimed to evaluate the performance of the serum CIR as a biomarker of dietary protein source in a controlled feeding study of men and women of diverse age and BMI. METHODS We conducted a 15-d feeding study of 100 adults (age: 18-70 y, 55% women) in Phoenix, AZ. Participants were provided individualized diets that approximated habitual food intakes. Serum was collected at the end of the feeding period for biomarker measurements. RESULTS Median [IQR] animal protein intake was 67 g/d [55-88 g/d], which was 64% of total protein. The serum CIR was positively correlated with animal protein and inversely correlated with plant protein intake, leading to a strong correlation (r2 = 0.76) with the dietary animal protein ratio (APR; animal/total protein). Regressing serum CIR on the APR, serum nitrogen isotope ratio (NIR), gender, age, and body weight generated an R2 of 0.78. Following the measurement error model for predictive biomarkers, the resulting regression equation was then inverted to develop a calibrated biomarker equation for APR. Added sugars ratio (added/total sugars intake) and corn intakes also influenced the serum CIR but to a much lesser degree than the APR; variations in these intakes had only small effects on biomarker-estimated APR. CONCLUSIONS Based on our findings in this US cohort of mixed sex and age, we propose the serum CIR alongside NIR as a predictive dietary biomarker of the APR. We anticipate using this biomarker to generate calibrated estimates based on self-reported intake and ultimately to obtain more precise disease risk estimates according to dietary protein source.
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Affiliation(s)
| | - Virag Sagi-Kiss
- Present address for VS-K: School of Medicine, Imperial College London, London, United Kingdom
| | | | | | - Brian Barrett
- Information Management Services, Inc., Rockville, MD, USA
| | - Carol S Johnston
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Douglas Midthune
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Victor Kipnis
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Laurence S Freedman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Natasha Tasevska
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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Edge L, Cunningham C, Murphy N, Dillon A, Flynn S, O'Shaughnessy Í, Davis A, O'Rourke B, Brossier L, Doran C, Hennessy A, Kennedy U, McMahon G, McNamara R, Shields D, Staunton P, Horgan F. 142 FRAILTY IDENTIFICATION AND INTERDISCIPLINARY ASSESSMENT OF OLDER PEOPLE IN THE EMERGENCY DEPARTMENT. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.142] [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: 02/25/2023] Open
Abstract
Abstract
Background
Older People are attending Emergency Departments (EDs) in increasing numbers but the optimal assessment measures to use have yet to be established. This study examined the clinical utility of different assessments of strength, functional mobility, sarcopenia, cognition and frailty used by the physiotherapist in an interdisciplinary team (IDT) in the ED and determined any associations with clinical outcomes.
Methods
This observational cross-sectional study recruited adults ≥70 years who were assessed by an IDT on weekdays during working hours. Demographic variables such as age, gender, social situation, baseline mobility, falls and clinical measures such as Clinical Frailty Scale (CFS), 4AT, hand-held dynamometry, calf circumference and functional mobility in ED were recorded. Clinical outcomes were admission to hospital, discharge from ED with onward referral (ambulatory care or community) and discharge from ED with no referral. Ethical approval was obtained and SPSS was used for statistical analysis.
Results
Two hundred and fifty four participants were recruited, 58.3% female, mean age 80.23 (SD 6.56). Median CFS was 4 (IRQ 2.0), range 1–7 with 32.7% (n = 83) considered frail. Sarcopenia prevalence was 89.3% using grip strength and 7.1% using calf circumference. Grip strength predicted frailty even after adjusting for age (p < 0.0001), gender (p < 0.0001) and falls (p = 0.043). Admission to hospital was predicted by major diagnostic category (p = 0.016) and inability to sit to stand independently in ED (p < 0.0001). Seventy percent (n = 179) of participants were discharged from ED, with 27.6% referred to ambulatory care or community services. Onward referral was predicted by frailty (p = 0.016) and falls in the last six months (p = 0.028).
Conclusion
Grip strength in addition to a validated tool such as CFS may assist an experienced IDT in identifying frailty, which can in turn inform decision-making regarding ED disposition and pathways of care for older people. Functional assessment in the ED is also important to determine the need for hospital admission.
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Affiliation(s)
- L Edge
- St James's Hospital , Dublin, Ireland
| | | | - N Murphy
- St James's Hospital , Dublin, Ireland
| | - A Dillon
- St James's Hospital , Dublin, Ireland
| | - S Flynn
- St James's Hospital , Dublin, Ireland
| | | | - A Davis
- St James's Hospital , Dublin, Ireland
| | - B O'Rourke
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - L Brossier
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - C Doran
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | | | - U Kennedy
- St James's Hospital , Dublin, Ireland
| | - G McMahon
- St James's Hospital , Dublin, Ireland
| | | | - D Shields
- St James's Hospital , Dublin, Ireland
| | | | - F Horgan
- Royal College of Surgeons in Ireland , Dublin, Ireland
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Conroy B, Murphy N, Cunningham C, Horgan F. 184 ‘THROUGH THE LENS OF A CAMERA’—USING PHOTOVOICE TO EXPLORE OLDER ADULTS PERCEPTIONS AND EXPERIENCES OF COMMUNITY AMBULATION. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.184] [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: 02/25/2023] Open
Abstract
Abstract
Background
The ability of an older adult to walk independently outdoors in their community assists with maintaining independence, a healthy lifestyle and a good quality of life. The study qualitatively explored older persons’ perceptions and experiences of the variables associated with their ability to walk outdoors in their community, through the use of photographs and discussion.
Methods
This qualitative study employed Photovoice Methodology (Wang and Burris, 1997). Inclusion criteria were community dwelling older adults over 65 years old, attending a day hospital, able to ambulate at least 10 metres with/without an assistive device and no visual or fine motor limitations that would preclude using a camera. Participants attended an information session and received and practiced with a single use camera. Over one week they took photographs of perceived barriers or facilitators to community ambulation. The developed photographs formed the basis for focus group discussions. Focus groups were recorded; transcribed and thematic analysis was used to identify key themes.
Results
Eight participants, mean age of 78.8 years completed the Photovoice substudy. Five of the participants were female and six lived alone. One participant had experienced a fall in the past six months. Three key themes were identified; personal, environmental and strategic factors, all associated with an older adults’ ability to ambulate in the community. Each of these themes had a number of subthemes highlighting barriers and facilitators to community ambulation in this population.
Conclusion
This novel study design was well received. It provided real life experiences, insights and rich valuable data that may not be captured by other means. The findings demonstrate the multifactorial nature of independent community ambulation, both the personal and environmental factors associated with independent community ambulation in older adults. Physiotherapists should adopt a broader, holistic approach to the assessment and treatment of older adults, to promote the achievement of independent community ambulation.
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Affiliation(s)
- B Conroy
- Robert Mayne Day Hospital, St James' Hospital , Dublin, Ireland
| | - N Murphy
- St James' Hospital , Dublin, Ireland
| | - C Cunningham
- St James' Hospital , Dublin, Ireland
- Mercers Institute for Successful Ageing (MISA) , Dublin, Ireland
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48
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Lynch A, Quinn L, Briggs R, Tan T, Thorpe O, Romero-Ortuno R, Byrne T, Cunningham C, Lavin A. 161 THE ROLE OF THE GERIATRIC DAY HOSPITAL DURING THE COVID 19 PANDEMIC. Age Ageing 2021. [PMCID: PMC8690085 DOI: 10.1093/ageing/afab219.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- A Lynch
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Age Related Health Department, Tallaght University Hospital, Dublin, Ireland
| | - L Quinn
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - R Briggs
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - T Tan
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - O Thorpe
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - R Romero-Ortuno
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - T Byrne
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - C Cunningham
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - A Lavin
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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49
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O'Flaherty N, Moloney K, Ahmad R, Laird E, Hughes C, McNulty H, Ward M, Strain JJ, Molloy AM, Cunningham C, McCarroll K. 135 VITAMIN D FORTIFIED MILK—EFFECT ON VITAMIN D STATUS IN OLDER ADULTS. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.135] [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: 02/25/2023] Open
Abstract
Abstract
Background
Vitamin D fortified milk is used by some older adults to boost vitamin D status. Combined vitamin D/calcium supplements often cause gastrointestinal upset which reduces adherence. Consumption of fortified milk may be a more consistent and reliable way of increasing serum 25 hydroxyvitamin D [25(OH)D], though studies of it’s efficacy in older adults are limited.
Methods
We examined the vitamin D status of users of vitamin D fortified milk in participants of a longitudinal study of community dwelling Irish adults aged >60 yrs. Patients taking vitamin D supplements were excluded and independent effects were explored in multinomial regression models. Vitamin D deficiency was defined as a 25(OH)D level < 30 nmol/l.
Results
2496 participants were identified: mean age was 70.5 ± 7.0 years (range 60–96 yrs) and 145 (5.8%) reported using vitamin D fortified milk. In those who consumed fortified milk, there was a lower prevalence of vitamin D deficiency (17.9 vs 34.5%, P < 0.001). Vitamin D fortified milk also predicted less deficiency after adjusting for age, gender, season, BMI and physical frailty (OR 0.30. CI 0.19–0.48, P < 0.001).
Conclusion
Vitamin D fortified milk was associated with a 70% reduction in the risk of vitamin D deficiency in older adults not taking vitamin D supplements. Findings support the use of vitamin D fortified milk as an effective means of improving vitamin D status. Fortified milk also contains additional calcium and so can be used to augment daily calcium intake.
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Affiliation(s)
- N O'Flaherty
- MedEl Directorate, St James's Hospital , Dublin, Ireland
| | - K Moloney
- MedEl Directorate, St James's Hospital , Dublin, Ireland
| | - R Ahmad
- MedEl Directorate, St James's Hospital , Dublin, Ireland
| | - E Laird
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - C Hughes
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - J J Strain
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - A M Molloy
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - C Cunningham
- MedEl Directorate, St James's Hospital , Dublin, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital , Dublin, Ireland
| | - K McCarroll
- MedEl Directorate, St James's Hospital , Dublin, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital , Dublin, Ireland
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50
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Lynch A, Quinn L, Briggs R, Tan T, Thorpe O, Romero-Ortuno R, Byrne T, Cunningham C, Lavin A. 163 EVALUATING THE ROLE OF THE GERIATRIC DAY HOSPITAL IN MEDICATION OPTIMISATION. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.163] [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: 02/25/2023] Open
Abstract
Abstract
Background
The geriatric day hospital (GDH) provides outpatient geriatric medical, nursing and rehabilitation care to older adults. The aim of this study was to assess whether medication optimisation occurs in this setting. We believe the GDH would be an ideal location for mediation optimisation due to the stable community dwelling patients and close follow up by specialised physicians.
Methods
Electronic patient records of the new patients ≥65 years seen in the GDH over a 3-month period were reviewed. Potentially inappropriate prescriptions (PIPs) and potentially prescribing omissions (PPOs) were identified using the STOPP/START prescribing tool on admission to the GDH and again at discharge from the GDH.
Results
One-hundred and sixty-seven patient records were reviewed; mean age 80.8 (SD6.5) years, 62.9% female, median clinical frailty scale score 6 (IQR5–6), mean number of conditions 5.79 (SD3), mean number of medications 7.57 (SD3.7). Patients had a median of 4 (IQR2–7) consultations. The number of patients prescribed at least 1 STOPP-PIP reduced by 10% (42.4% vs 38%; p < 0.001). Vasodilator drugs in patients with orthostatic hypotension were deprescribed most frequently (6.5% vs 3%; p < 0.001). PPOs were reduced by 36% (47.5% vs 30.6%;p < 0.001). The largest improvement was identified in the prescription of vitamin D in patients experiencing falls (17.4% vs 13.8%;p < 0.001). Logistic regression was performed to ascertain the influence of age, gender, falls, dementia, co-morbidity number and medication number on the likelihood of a patient experiencing a PIP or PPO. For every medication prescribed, the odds of experiencing a PIP increased by 11.8% (OR1.187, 95%CI 1.052–1.339). Being female increased the odds of experiencing a PPO by 21.7% (OR2.17, 95%CI 10.53–4.468).
Conclusion
Medication optimisation is key in avoiding side effects from potentially inappropriate medications. The frequency of patient attendances coupled with geriatricians’ expertise makes the GDH an ideal setting for medication optimisation in multi-morbid frail community-dwelling older adults.
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Affiliation(s)
- A Lynch
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Age Related Health Care Department, Tallaght University Hospital , Dublin, Ireland
| | - L Quinn
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - R Briggs
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - T Tan
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - O Thorpe
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - R Romero-Ortuno
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - T Byrne
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - C Cunningham
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - A Lavin
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
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