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Baliousis M, Rennoldson M, Dawson DL, das Nair R. Group psychological intervention for emotional distress in haematopoietic stem cell transplantation: A feasibility randomised clinical trial. Eur J Oncol Nurs 2023; 65:102359. [PMID: 37315352 DOI: 10.1016/j.ejon.2023.102359] [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: 03/20/2023] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE Haematopoietic stem cell transplantation (HSCT) is an intensive procedure associated with elevated psychological distress, particularly during the initial stages. Based on self-regulatory theory, a prophylactic group intervention was developed to mitigate this distress by targeting perceptions of HSCT and coping. This study evaluated the feasibility of delivering the intervention and of conducting a randomised clinical trial to assess efficacy. METHODS Adults from consecutive referrals at two transplant centres were randomised to the intervention or to treatment as usual at each site. Psychological distress (primary outcome), HSCT perceptions, and coping were assessed at baseline, on transplant day, and two and four weeks after transplantation. RESULTS Of 99 eligible patients, 45 consented. Main barriers to consent were insufficient time prior to transplantation, competing priorities, being unwell, and travel distance. Of 21 participants randomised to the intervention, five attended. Main barriers to attendance included insufficient time prior to transplantation and having competing priorities. Groups could not be held sufficiently frequently to enable attendance prior to transplantation, as randomising participants to the control group limited accrual. Anxiety peaked two weeks following transplantation. Depression increased throughout the acute phase. Clinical levels of distress were observed in 42% of patients during HSCT. Intervention effects were small but sample sizes for a full trial appeared feasible. CONCLUSIONS Multimodal prehabilitation is required but there are specific barriers to delivering a group-based intervention and conducting a trial. Group prehabilitation requires customisation and better integration with routine care, such as patient screening, personalisation, and options for remote delivery.
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Affiliation(s)
| | - Michael Rennoldson
- Department of Clinical Psychology and Neuropsychology, Nottingham University Hospitals, Nottingham, UK
| | - David L Dawson
- School of Psychology, University of Lincoln, Lincoln, UK
| | - Roshan das Nair
- School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK; SINTEF Digital, Norway
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Dawson DL. PRESERVE trial confirms low risk for most inferior vena cava filters, but benefit remains uncertain. J Vasc Surg Venous Lymphat Disord 2023; 11:586. [PMID: 37080687 DOI: 10.1016/j.jvsv.2023.01.001] [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: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 04/22/2023]
Affiliation(s)
- David L Dawson
- Division of Vascular Surgery, Baylor Scott and White Medical Center, Temple, TX
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Badesha K, Wilde S, Dawson DL. Mental health mobile application self-help for adolescents exhibiting psychological distress: A single case experimental design. Psychol Psychother 2023; 96:223-248. [PMID: 36345016 PMCID: PMC10098610 DOI: 10.1111/papt.12436] [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: 04/04/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The present demand for child and adolescent mental health services exceeds the capacity for service provision. Greater research is required to understand the utility of accessible self-help interventions, such as mobile apps. This study sought to investigate whether use of a mental health app, underpinned by CBT, led to changes in psychological distress amongst adolescents. Mechanisms of change were examined, specifically whether changes are attributable to cognitive strategies. DESIGN This study utilised a multiple-baseline single-case experimental design, tracking variables across baseline and intervention phases. Surveys assessing participant experience were also administered. METHODS Five participants with moderate-to-severe levels of psychological distress engaged with a CBT-based app over five weeks. Participants were recruited from both a well-being service and the general population. Supplementary weekly calls to participants offered clarification of app content. RESULTS A small overall effect of the intervention of psychological distress was evident; however, outcomes were dependent on the analysis conducted. The intervention appeared to promote an increase in use of adaptive cognitive strategies but not negative thinking styles. The CBT app did not promote changes in participant well-being. Participant feedback highlighted practical challenges of utilising the app. CONCLUSIONS The clinical benefits of app-based CBT were small, and a range of barriers to engagement were recognised. While further research is required, caution should be exercised in the interpretation of studies reporting on app effectiveness.
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Affiliation(s)
- Kiran Badesha
- Clinical Psychology, University of Lincoln, Lincoln, UK
| | - Sarah Wilde
- Clinical Psychology, University of Lincoln, Lincoln, UK
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Baufeldt AL, Dawson DL. Mental Health Recovery Using the Individual Recovery Outcomes Counter (I.ROC) in a Community Rehabilitation Team: A Service Evaluation. J Psychosoc Rehabil Ment Health 2022; 10:1-12. [PMID: 36407017 PMCID: PMC9668232 DOI: 10.1007/s40737-022-00315-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
There are many definitions of recovery in mental health. Community Rehabilitation Teams (CRTs) aim to support the mental health recovery of people. The Individual Recovery Outcomes Counter (I.ROC) is a way to measure recovery. To determine if being supported by a CRT helps mental health recovery for people transitioning from an inpatient service to the community. Individual reliable and clinically meaningful change indices were calculated for a total of 31 people. Two I.ROC questionnaires were completed by 31 people. Of these 31 people, 14 people had three completed I.ROC questionnaires. Of the 31 people, 17 showed a positive reliable change and three people made a clinically meaningful change. Of the 14 people, one had a positive reliable change, two had a negative reliable change, and no-one had a clinically meaningful change. The I.ROC shows the CRT to successfully support recovery in people with mental health difficulties.
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Affiliation(s)
| | - David L. Dawson
- College of Social Sciences, University of Lincoln, Lincoln, UK
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Golijani-Moghaddam N, Dawson DL, Evangelou N, Turton J, Hawton A, Law GR, Roche B, Rowan E, Burge R, Frost AC, das Nair R. Strengthening Mental Abilities with Relational Training (SMART) in multiple sclerosis (MS): study protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2022; 8:195. [PMID: 36056385 PMCID: PMC9439942 DOI: 10.1186/s40814-022-01152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Multiple sclerosis (MS) is a chronic condition of the central nervous system, affecting around 1 in every 600 people in the UK, with 130 new diagnoses every week. Cognitive difficulties are common amongst people with MS, with up to 70% experiencing deficits in higher-level brain functions—such as planning and problem-solving, attention, and memory. Cognitive deficits make it difficult for people with MS to complete everyday tasks and limit their abilities to work, socialise, and live independently. There is a clear need—and recognised research priority—for treatments that can improve cognitive functioning in people with MS. The absence of effective cognitive interventions exacerbates burdens on the services accessed by people with MS—requiring these services to manage sequelae of untreated cognitive deficits, including reduced quality of life, greater disability and dependence, and poorer adherence to disease-modifying treatments. Our planned research will fill the evidence gap through developing—and examining the feasibility of trialling—a novel online cognitive rehabilitation programme for people with MS (SMART). The SMART programme directly trains relational skills (the ability to flexibly relate concepts to one another) based on theory that these skills are critical to broader cognitive functioning. Methods The primary objective of this study aims to conduct a feasibility study to inform the development of a definitive trial of SMART for improving cognitive functioning in people with MS. The secondary objective is to develop the framework for a cost-effectiveness analysis alongside a definitive trial, and the exploratory objective is to assess the signal of efficacy. Discussion As a feasibility trial, outcomes are unlikely to immediately effect changes to NHS practice. However, this is a necessary step towards developing a definitive trial—and will give us a signal of efficacy, a prerequisite for progression to a definitive trial. If found to be clinically and cost-effective, the latter trial could create a step-change in MS cognitive rehabilitation—improving service delivery and optimising support with limited additional resources. Trial registration Registration ID: ClnicalTrials.gov: NCT04975685—registered on July 23rd, 2021. Protocol version: 2.0, 25 November 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01152-7.
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Affiliation(s)
- Nima Golijani-Moghaddam
- School of Psychology, University of Lincoln, Sarah Swift Building, Brayford Pool, Lincoln, LN6 7TS, UK.
| | - David L Dawson
- School of Psychology, University of Lincoln, Sarah Swift Building, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Nikos Evangelou
- School of Medicine, University of Nottingham, C floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - James Turton
- Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Annie Hawton
- University of Exeter, Stocker Rd, Exeter, EX4 4PY, UK
| | - Graham R Law
- Lincoln Clinical Trials Unit (LinCTU), Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Bryan Roche
- Department Psychology, Maynooth University, Co. Kildare, Ireland
| | - Elise Rowan
- Lincoln Clinical Trials Unit (LinCTU), Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Rupert Burge
- School of Psychology, University of Lincoln, Sarah Swift Building, Brayford Pool, Lincoln, LN6 7TS, UK
| | | | - Roshan das Nair
- Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
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Staton A, Wilde S, Dawson DL. The Effectiveness of Eye Movement Desensitisation and Reprocessing (EMDR) for Medically Unexplained Symptoms: A Systematic Literature Review. J EMDR Prac Res 2022. [DOI: 10.1891/emdr-2022-0017] [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: 11/25/2022]
Abstract
IntroductionIt has been hypothesised that certain persistent physical symptoms (PPS) may be linked to unresolved traumatic or distressing somatic-symptom related memories. EMDR intervention targets and reintegrates distressing memories, thus reducing the re-experiencing of physical sensations. The primary aim of this review was to examine effectiveness of EMDR for PPS. Secondary aims were to investigate effectiveness of EMDR on secondary outcomes (post-traumatic stress, anxiety, and depression), and to evaluate the acceptability of EMDR for this client group.MethodSix electronic databases (PsycInfo, PsycArticles, CINAHL, MEDLINE, Web of Science and SCOPUS) were searched for peer-reviewed literature, with no restrictions on publication dates. Twenty-eight studies met inclusion criteria. Studies were included if the primary aim of EMDR intervention was to reduce intensity, frequency or reported distress associated with PPS. Studies were quality appraised using the MMAT tool prior to narrative synthesis of key findings.ResultsStudies varied in design and included RCT, UCT, case study and case series. EMDR treatment length varied between studies; 1–20 sessions. All studies reported significant improvement in PPS at post-test. Effect sizes were available to report in five studies and ranged from moderate to large. Improvement in secondary outcomes were reported in all repeated measure studies. Where available, large effect sizes were reported for reduction in anxiety and depression. Overall drop-out rates in studies with representative samples was low (10.6%). Quality of research varied; low (42.8%), medium (21.4%), and high (35.7%).ConclusionsThere is promising emerging evidence for effectiveness and acceptability of EMDR for a range of PPS. However, firm conclusions on efficacy cannot be made. Whilst comparisons between PPS presentations cannot be drawn due to methodological differences, the findings for pain and tinnitus are the most compelling due to methodological quality. High-quality sufficiently powered RCTs are recommended to determine efficacy.
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Frost AC, Golijani-Moghaddam N, Burge R, Dawson DL, Evangelou N, Roche B, Turton J, Hawton A, Law G, Rowan E, das Nair R. Usability and acceptability of a cognitive training intervention (SMART) for people with multiple sclerosis (MS): A prefeasibility formative evaluation. NIHR Open Res 2022; 2:39. [PMID: 37881304 PMCID: PMC10593333 DOI: 10.3310/nihropenres.13274.1] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 10/27/2023]
Abstract
Background Multiple sclerosis (MS) is a chronic autoimmune, inflammatory neurological disease of the central nervous system (CNS), increasing in incidence and prevalence across both developed and developing countries. Cognitive difficulties are common in MS sufferers with 70% experiencing difficulties in higher-level brain functioning such as planning, attention, problem solving, and memory. Computerised cognitive training programmes may hold promise as a treatment option for improving cognitive function in people with MS, subject to exploring and addressing potential barriers to usability and acceptability. Methods This study aimed to test the usability and acceptability of a computerised cognitive training intervention-Strengthening Mental Abilities Through Relational Training (SMART) -for people with MS, through a mostly qualitative prefeasibility design ( n= 12). There were two phases of testing: (1) initial usability testing via a think-aloud protocol ( n= 6) and (2) alpha-testing to assess experienced acceptability over a four-week period of engagement ( n= 6). Data from the two phases were subjected to Framework Analysis, wherein we deductively applied the Health IT Usability Evaluation Model and Theoretical Framework of Acceptability to assess usability and acceptability, respectively. Results Results show SMART to have satisfactory usability with participants reacting positively to the formatting, visuality, and process of the interface. Minor suggestions were made on how best to adapt SMART for people with MS, but the programme and facilitative support were generally perceived to be acceptable, with participants expressing positive feelings about taking part in the intervention, despite associated burdens. Conclusions This prefeasibility study provides preliminary evidence of the usability and acceptability of SMART as a computerised cognitive training programme for people with MS. We conclude that we can now move forward with a feasibility trial of SMART, with the intention of proceeding to a definitive trial with cost-effectiveness analysis.
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Affiliation(s)
- Alexandra C. Frost
- Institute of Mental Health, Innovation Park, Triumph Rd, Nottingham, NG7 2TU, UK
| | | | - Rupert Burge
- University of Lincoln, Sarah Swift Building, Brayford Pool, Lincoln, LN6 7TS, UK
| | - David L. Dawson
- University of Lincoln, Sarah Swift Building, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Nikos Evangelou
- School of Medicine, University of Nottingham, C floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Bryan Roche
- Department Psychology, Maynooth University, Mariavilla, Maynooth, W23 F2H6, Ireland
| | - James Turton
- University of Lincoln, Sarah Swift Building, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Annie Hawton
- Health Economics Group, University of Exeter Medical School, University of Exeter, Magdalen Road, Exeter, EX1 2LU, UK
| | - Graham Law
- Lincoln Clinical Trials Unit (LinCTU), Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Elise Rowan
- Lincoln Clinical Trials Unit (LinCTU), Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Roshan das Nair
- Institute of Mental Health, Innovation Park, Triumph Rd, Nottingham, NG7 2TU, UK
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Ismaeel A, Greathouse KL, Newton N, Miserlis D, Papoutsi E, Smith RS, Eidson JL, Dawson DL, Milner CW, Widmer RJ, Bohannon WT, Koutakis P. Phytochemicals as Therapeutic Interventions in Peripheral Artery Disease. Nutrients 2021; 13:2143. [PMID: 34206667 PMCID: PMC8308302 DOI: 10.3390/nu13072143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 12/12/2022] Open
Abstract
Peripheral artery disease (PAD) affects over 200 million people worldwide, resulting in significant morbidity and mortality, yet treatment options remain limited. Among the manifestations of PAD is a severe functional disability and decline, which is thought to be the result of different pathophysiological mechanisms including oxidative stress, skeletal muscle pathology, and reduced nitric oxide bioavailability. Thus, compounds that target these mechanisms may have a therapeutic effect on walking performance in PAD patients. Phytochemicals produced by plants have been widely studied for their potential health effects and role in various diseases including cardiovascular disease and cancer. In this review, we focus on PAD and discuss the evidence related to the clinical utility of different phytochemicals. We discuss phytochemical research in preclinical models of PAD, and we highlight the results of the available clinical trials that have assessed the effects of these compounds on PAD patient functional outcomes.
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Affiliation(s)
- Ahmed Ismaeel
- Department of Biology, Baylor University, Waco, TX 76798, USA; (A.I.); (K.L.G.); (E.P.)
| | - K. Leigh Greathouse
- Department of Biology, Baylor University, Waco, TX 76798, USA; (A.I.); (K.L.G.); (E.P.)
- Department of Human Sciences and Design, Baylor University, Waco, TX 76798, USA
| | - Nathan Newton
- Department of Chemistry and Biochemistry, Baylor University, Waco, TX 76798, USA;
| | - Dimitrios Miserlis
- Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA;
| | - Evlampia Papoutsi
- Department of Biology, Baylor University, Waco, TX 76798, USA; (A.I.); (K.L.G.); (E.P.)
| | - Robert S. Smith
- Department of Surgery, Baylor Scott & White Medical Center, Temple, TX 76508, USA; (R.S.S.); (J.L.E.); (D.L.D.); (C.W.M.); (W.T.B.)
| | - Jack L. Eidson
- Department of Surgery, Baylor Scott & White Medical Center, Temple, TX 76508, USA; (R.S.S.); (J.L.E.); (D.L.D.); (C.W.M.); (W.T.B.)
| | - David L. Dawson
- Department of Surgery, Baylor Scott & White Medical Center, Temple, TX 76508, USA; (R.S.S.); (J.L.E.); (D.L.D.); (C.W.M.); (W.T.B.)
| | - Craig W. Milner
- Department of Surgery, Baylor Scott & White Medical Center, Temple, TX 76508, USA; (R.S.S.); (J.L.E.); (D.L.D.); (C.W.M.); (W.T.B.)
| | - Robert J. Widmer
- Heart & Vascular Department, Baylor Scott & White Medical Center, Temple, TX 76508, USA;
| | - William T. Bohannon
- Department of Surgery, Baylor Scott & White Medical Center, Temple, TX 76508, USA; (R.S.S.); (J.L.E.); (D.L.D.); (C.W.M.); (W.T.B.)
| | - Panagiotis Koutakis
- Department of Biology, Baylor University, Waco, TX 76798, USA; (A.I.); (K.L.G.); (E.P.)
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Wright J, Moghaddam N, Dawson DL. Cognitive interviewing in patient-reported outcome measures: A systematic review of methodological processes. Qualitative Psychology 2021. [DOI: 10.1037/qup0000145] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dawson DL, Golijani-Moghaddam N. COVID-19: Psychological flexibility, coping, mental health, and wellbeing in the UK during the pandemic. J Contextual Behav Sci 2020; 17:126-134. [PMID: 32834970 PMCID: PMC7392106 DOI: 10.1016/j.jcbs.2020.07.010] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/03/2020] [Accepted: 07/25/2020] [Indexed: 01/05/2023]
Abstract
The COVID-19 pandemic has profoundly altered the daily lives of many people across the globe, both through the direct interpersonal cost of the disease, and the governmental restrictions imposed to mitigate its spread and impact. The UK has been particularly affected and has one of the highest mortality rates in Europe. In this paper, we examine the impact of COVID-19 on psychological health and well-being in the UK during a period of 'lockdown' (15th-21st May 2020) and the specific role of Psychological Flexibility as a potential mitigating process. We observed clinically high levels of distress in our sample (N = 555). However, psychological flexibility was significantly and positively associated with greater wellbeing, and inversely related to anxiety, depression, and COVID-19-related distress. Avoidant coping behaviour was positively associated with all indices of distress and negatively associated with wellbeing, while engagement in approach coping only demonstrated weaker associations with outcomes of interest. No relationship between adherence to government guidelines and psychological flexibility was found. In planned regression models, psychological flexibility demonstrated incremental predictive validity for all distress and wellbeing outcomes (over and above both demographic characteristics and COVID-19-specific coping responses). Furthermore, psychological flexibility and COVID-19 outcomes were only part-mediated by coping responses to COVID-19, supporting the position that psychological flexibility can be understood as an overarching response style that is distinct from established conceptualisations of coping. We conclude that psychological flexibility represents a promising candidate process for understanding and predicting how an individual may be affected by, and cope with, both the acute and longer-term challenges of the pandemic.
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Affiliation(s)
- David L. Dawson
- University of Lincoln, School of Psychology, University of Lincoln, Brayford Wharf East, Lincoln, LN5 7AY, UK
| | - Nima Golijani-Moghaddam
- University of Lincoln, School of Psychology, University of Lincoln, Brayford Wharf East, Lincoln, LN5 7AY, UK
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Dawson DL. Moving toward consensus for the best method to test for venous reflux in the vascular laboratory. J Vasc Surg Venous Lymphat Disord 2020; 8:501-502. [PMID: 32553649 DOI: 10.1016/j.jvsv.2020.03.015] [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: 03/15/2020] [Accepted: 03/31/2020] [Indexed: 11/29/2022]
Affiliation(s)
- David L Dawson
- Department of Surgery, Baylor Scott & White Health System, Temple, Tex.
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Charig R, Moghaddam NG, Dawson DL, Merdian HL, das Nair R. A lack of association between online pornography exposure, sexual functioning, and mental well-being. Sexual and Relationship Therapy 2020. [DOI: 10.1080/14681994.2020.1727874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ruth Charig
- Trent Doctorate in Clinical Psychology, School of Psychology, University of Lincoln, Lincoln, UK
| | - Nima G. Moghaddam
- Trent Doctorate in Clinical Psychology, School of Psychology, University of Lincoln, Lincoln, UK
| | - David L. Dawson
- Trent Doctorate in Clinical Psychology, School of Psychology, University of Lincoln, Lincoln, UK
| | - Hannah L. Merdian
- Trent Doctorate in Clinical Psychology, School of Psychology, University of Lincoln, Lincoln, UK
| | - Roshan das Nair
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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Logan MS, Dawson DL. Congenital left common carotid artery absence with internal and external carotid aberrancy. J Vasc Surg Cases Innov Tech 2020; 6:55. [PMID: 32072088 PMCID: PMC7016347 DOI: 10.1016/j.jvscit.2019.11.003] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/03/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Meryl S Logan
- Section of Vascular Surgery, Olin E. Teague Veterans' Medical Center, Temple, Tex
| | - David L Dawson
- Section of Vascular Surgery, Olin E. Teague Veterans' Medical Center, Temple, Tex
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Tyndall I, Waldeck D, Pancani L, Whelan R, Roche B, Dawson DL. The Acceptance and Action Questionnaire-II (AAQ-II) as a measure of experiential avoidance: Concerns over discriminant validity. Journal of Contextual Behavioral Science 2019. [DOI: 10.1016/j.jcbs.2018.09.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tanious A, Brooks JD, Wang LJ, Shames ML, Armstrong PA, Conrad MF, Dawson DL. Educational resources for vascular laboratory education in vascular surgery residencies and fellowships: Survey of Vascular Surgery Program Directors. J Vasc Surg 2019; 69:1918-1923. [PMID: 30622008 DOI: 10.1016/j.jvs.2018.10.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Registered Physician in Vascular Interpretation (RPVI) credential is a prerequisite for certification by the Vascular Surgery Board of the American Board of Surgery. Of concern, as more current trainees and recent program graduates take the Physician Vascular Interpretation (PVI) examination, vascular surgery trainee pass rates have decreased. Residents and fellows have a lower PVI examination pass rates than practicing vascular surgeons. The purpose of this study was to assess current vascular laboratory (VL) training for vascular surgery residents and fellows and to identify gaps that residency and fellowship programs might address. METHODS Program directors (PDs) of Accreditation Council for Graduate Medical Education-accredited vascular surgery programs (107 fellowships, 53 integrated residency programs) were surveyed using a web-based tool. Responses were submitted anonymously. Data collected included information about the program, the PD, accreditation status of the VL, and the curriculum used to meet the PVI prerequisites. Concurrent data (June 2017) on the credentials of all PDs were obtained from the Alliance for Physician Certification and Advancement (APCA). RESULTS Sixty-one of 117 PDs participated in the survey (52% response rate). Of these, 44 individuals (72% of responders) reported they held the RPVI and/or Registered Vascular Technologist credential. Records from APCA indicated that 51 of 117 PDs of accredited vascular surgery residencies and fellowships (44%) had an RPVI/Registered Vascular Technologist credential. Ninety-four percent reported that their VL was accredited. Practical VL experience for trainees was reported to be 20 hours or less by 62% of respondents. The use of a structured curriculum for practical experience was reported by only 15 programs. Programs with fellowships established for more than 10 years were more likely to have a structured program for didactic instruction (P = .03). Only 23 programs reported a dedicated VL rotation. Didactic instruction provided was 20 hours or less for 75% of the cohort. CONCLUSIONS In the absence of a standardized VL curriculum, there is variation in the VL instruction provided to trainees. Fellowship programs with longer histories have more structured instruction, but time allocated to VL education is substantially less than the 30 hours of didactic and 40 hours of practical experience recommended by the APCA. Programs and learners may benefit from the development of VL training guidelines and curriculum resources.
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Affiliation(s)
- Adam Tanious
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
| | - James D Brooks
- Division of Vascular and Endovascular Surgery, University of South Florida, Tampa, Fla
| | - Linda J Wang
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Murray L Shames
- Division of Vascular and Endovascular Surgery, University of South Florida, Tampa, Fla
| | - Paul A Armstrong
- Division of Vascular and Endovascular Surgery, University of South Florida, Tampa, Fla
| | - Mark F Conrad
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - David L Dawson
- Division of Vascular Surgery, University of California, Davis, Davis, Calif
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Duffy A, Dawson DL, Moghaddam NG, das Nair R. Do thinking styles play a role in whether people pathologise their pornography use? Sexual and Relationship Therapy 2019. [DOI: 10.1080/14681994.2017.1412417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Athena Duffy
- Trent Doctorate in Clinical Psychology, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - David L Dawson
- Trent Doctorate in Clinical Psychology, University of Lincoln, Lincoln, UK
| | - Nima G Moghaddam
- Trent Doctorate in Clinical Psychology, University of Lincoln, Lincoln, UK
| | - Roshan das Nair
- Trent Doctorate in Clinical Psychology, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Triumph Road, Jubilee Campus, Nottingham, UK
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Dawson DL, Sandri GDA, Tenorio E, Oderich GS. Up-and-Over Technique for Implantation of Iliac Branch Devices After Prior Aortic Endograft Repair. J Endovasc Ther 2018; 25:21-27. [PMID: 29313456 DOI: 10.1177/1526602817747283] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe a modified up-and-over access technique for treatment of iliac artery aneurysms in patients with prior bifurcated stent-grafts for endovascular aneurysm repair (EVAR). TECHNIQUE This technique uses a coaxial 12-F flexible sheath that is docked with a through-and-through wire into a 7-F sheath advanced from the contralateral femoral approach. This maneuver allows both sheaths to be moved as a unit while maintaining position of the apex of the system as it loops over the flow divider, avoiding damage to or displacing the extant endograft. Once the 12-F sheath is positioned in the iliac limb of the aortic stent-graft and secured in place with the through-and-through wire, the repair is extended into the internal iliac artery using a bridging stent-graft or covered stent introduced via a coaxial sheath. CONCLUSION The up-and-over technique with a flexible 12-F sheath mated with a 7-F sheath from the opposite side allows bilateral femoral access to be used for iliac branch device placement after prior aortic endograft procedures that create a higher, acutely angled bifurcation. Use of a through-and-through wire and a coaxial sheath for stent delivery creates a very stable platform for intervention.
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Affiliation(s)
- David L Dawson
- 1 Department of Surgery, Division of Vascular Surgery, University of California Davis, Sacramento, CA, USA
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Baliousis M, Rennoldson M, Dawson DL, Mills J, das Nair R. Perceptions of Hematopoietic Stem Cell Transplantation and Coping Predict Emotional Distress During the Acute Phase After Transplantation. Oncol Nurs Forum 2017; 44:96-107. [PMID: 27991602 DOI: 10.1188/17.onf.96-107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To test whether a widely used model of adjustment to illness, the self-regulatory model, explains the patterns of distress during acute hematopoietic stem cell transplantation (HSCT). According to the model, perceptions of HSCT, coping, and coping appraisals are associated with distress.
. DESIGN Longitudinal, correlational.
. SETTING The Centre for Clinical Haematology at Nottingham City Hospital and the Department of Haematology at Royal Hallamshire Hospital in Sheffield, both in the United Kingdom.
. SAMPLE 45 patients receiving mostly autologous transplantations for a hematologic malignancy.
. METHODS Patients were assessed at baseline, on transplantation day, and two and four weeks after transplantation using three questionnaires. MAIN RESEARCH VARIABLES Psychological distress, including depression, anxiety, stress, and overall distress (DASS-21); use of different coping styles (Brief COPE); and perceptions of HSCT and coping appraisals (Brief IPQ).
. FINDINGS As suggested by the self-regulatory model, greater distress was associated with negative perceptions of HSCT, controlling for the effects of confounding variables. Mixed support was found for the model's predictions about the impact of coping styles on distress. Use of active and avoidant coping styles was associated with more distress during the acute phase after HSCT.
. CONCLUSIONS Negative perceptions of HSCT and coping contribute to psychological distress during the acute phase after HSCT and suggest the basis for intervention.
. IMPLICATIONS FOR NURSING Eliciting and discussing patients' negative perceptions of HSCT beforehand and supporting helpful coping may be important ways to reduce distress during HSCT.
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Dawson DL. Invited commentary. J Vasc Surg 2017; 66:1517. [DOI: 10.1016/j.jvs.2017.05.037] [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] [Received: 04/29/2017] [Accepted: 05/03/2017] [Indexed: 10/18/2022]
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Simon MA, Russo RM, Davidson AJ, Faulconer ER, DeSoucy E, Loja MN, Johnson MA, Williams TK, DuBose JJ, Dawson DL. Case of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Use in Penetrating Abdominal Aortic Injury. JEVTM 2017. [DOI: 10.26676/jevtm.v1i1.12] [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: 11/04/2022]
Abstract
We present the successful utilization of REBOA in a case of penetrating abdominal aortic injury. This allowed for hemorrhagic control and exposure of a large aortic defect at the level of the celiac access, which otherwise would have been difficult to control in an open fashion. Although use in this specific injury pattern in the literature is limited, REBOA can be a life-saving maneuver.
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Ramsden S, Tickle A, Dawson DL, Harris S. Perceived barriers and facilitators to positive therapeutic change for people with intellectual disabilities: Client, carer and clinical psychologist perspectives. J Intellect Disabil 2016; 20:241-262. [PMID: 26483080 DOI: 10.1177/1744629515612627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 06/05/2023]
Abstract
Studies have highlighted successful outcomes of psychological therapies for people with intellectual disabilities. However, processes underlying these outcomes are uncertain. Thematic analysis was used to explore the perceptions of three clinical psychologists, six clients and six carers of barriers and facilitators to therapeutic change for people with intellectual disabilities. Six themes were identified relating to: what the client brings as an individual and with regard to their wider system; therapy factors, including the therapeutic relationship and adaptations; psychologists acting as a 'mental health GP' to coordinate care; systemic dependency; and the concept of the revolving door in intellectual disability services. The influence of barriers and facilitators to change is complex, with facilitators overcoming barriers and yet simultaneously creating more barriers. Given their potential impact on the psychologists' roles and access to therapy for people with intellectual disabilities, findings suggest these factors should be formulated as part of the therapeutic process.
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Affiliation(s)
- Sarah Ramsden
- University of Lincoln, UK; Lincolnshire Partnership NHS Foundation Trust, UK
| | - Anna Tickle
- The University of Nottingham, UK; Nottinghamshire Healthcare NHS Foundation Trust, UK
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Abstract
Virtual reality (VR) simulations have long been used for training in aviation and other professions. High-fidelity endovascular procedure simulators are now available, providing procedure simulations with real-time interactions; two-dimensional graphic displays of angiographic anatomy; mechanical interfaces with guidewires, sheaths, and catheters that provide some degree of haptic feedback; modeling of physiologic and pharmacology responses; and other features. Simulators have been incorporated into training programs for physicians learning carotid artery stenting (CAS). For the first time, US Food and Drug Administration approval of a new device (CAS systems) has included a requirement for physician training that incorporates the use of VR simulators. Early experience has shown that simulation is well accepted by trainees, performance on simulators improves with training and practice, and simulation prior to first performing endovascular procedures can improve clinical performance. Specific to CAS, the value of education programs using simulators appears to be tangible as trained but inexperienced CAS operators have clinical results comparable to those of physicians with extensive CAS experience.
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Affiliation(s)
- David L Dawson
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, CA 95817, USA.
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Brough JL, Moghaddam NG, Gresswell DM, Dawson DL. The impact of receiving a diagnosis of Non-Epileptic Attack Disorder (NEAD): A systematic review. J Psychosom Res 2015; 79:420-7. [PMID: 26526318 DOI: 10.1016/j.jpsychores.2015.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/15/2015] [Accepted: 09/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Clinicians have reported observations of the immediate cessation of non-epileptic attacks after the diagnosis of NEAD is presented. OBJECTIVE The purpose of this systematic review was to examine the impact of receiving a diagnosis of NEAD. SEARCH STRATEGY A literature search across the databases Medline, PsycINFO, EMBASE, and CINAHL, and additional hand searching, identified six original studies meeting criteria for the review. SELECTION CRITERIA Included studies were original peer-reviewed articles investigating the impact of receiving a diagnosis of NEAD on adult populations with at least one outcome measured pre- and post-diagnosis. ANALYSIS The studies were assessed for methodological quality, including biases. This assessment was developed to include criteria specific to research regarding NEAD and diagnosis. RESULTS Six identified studies, with a total of 153 NEAD participants, examined the impact of receiving a diagnosis on seizure frequency. Two of the six also examined the impact on health-related quality of life. The findings were inconsistent, with approximately half the participants experiencing seizure reduction or cessation post-diagnosis. Diagnosis appeared to have no significant impact on health-related quality of life. The overall evidence lacked quality, particularly in study design and statistical rigour. CONCLUSIONS Mixed results and a lack of high quality evidence were found. Concerns are considered regarding the appropriateness of seizure frequency as the primary outcome measure and the use of epilepsy control groups. Indications for future research include: measuring more meaningful outcomes, using larger samples and power calculations, and ensuring consistent and standard methods for communicating the diagnosis and recording outcomes.
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Affiliation(s)
- Jenna L Brough
- Department of Doctoral Clinical Psychology, University of Lincoln, Bridge House, Brayford Pool, Lincoln LN7 6TS, UK.
| | - Nima G Moghaddam
- Department of Doctoral Clinical Psychology, University of Lincoln, Bridge House, Brayford Pool, Lincoln LN7 6TS, UK
| | - David M Gresswell
- Department of Doctoral Clinical Psychology, University of Lincoln, Bridge House, Brayford Pool, Lincoln LN7 6TS, UK
| | - David L Dawson
- Department of Doctoral Clinical Psychology, University of Lincoln, Bridge House, Brayford Pool, Lincoln LN7 6TS, UK
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Dimaro LV, Roberts NA, Moghaddam NG, Dawson DL, Brown I, Reuber M. Implicit and explicit self-esteem discrepancies in people with psychogenic nonepileptic seizures. Epilepsy Behav 2015; 46:109-17. [PMID: 25922151 DOI: 10.1016/j.yebeh.2015.03.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/22/2015] [Accepted: 03/28/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Self-esteem (SE), or one's sense of competence and worth, is reduced in many mental and physical disorders. Low SE is associated with perceived stigma and disability and poor treatment outcomes. The present study examined implicit and explicit SE (automatic and deliberate views about the self) in people with epilepsy and people with psychogenic nonepileptic seizures (PNESs). Discrepancies between implicit SE and explicit SE have been found to correlate with psychological distress in disorders often associated with PNESs but are relatively unexplored in PNESs. We hypothesized that, compared with epilepsy, PNESs would be associated with lower self-reported SE and greater discrepancies between implicit SE and explicit SE. METHODS Thirty adults with PNESs, 25 adults with epilepsy, and 31 controls without a history of seizures were asked to complete the Rosenberg Self-esteem Scale as a measure of explicit SE and an Implicit Relational Assessment Procedure as a measure of implicit SE. The State-Trait Anxiety Inventory and Patient Health Questionnaire-15 (a somatic symptom inventory) were also administered. RESULTS We found significant group differences in explicit (p<0.001) but not implicit SE. Patients with PNESs reported lower SE than the other groups. No group differences were found in implicit SE. Implicit-explicit SE discrepancies were larger in the group with PNESs than in the other groups (p<0.001). Higher frequency of PNESs (but not epileptic seizures) was associated with lower explicit SE (rs=-.83, p<0.01) and greater SE discrepancies (i.e., lower explicit relative to implicit SE; rs=.65, p<0.01). These relationships remained significant when controlling for anxiety and somatization. CONCLUSION Patients with PNESs had lower explicit SE than those with epilepsy or healthy controls. In keeping with our expectations, there were greater discrepancies between implicit SE and explicit SE among patients with PNESs than in the other groups. Our results, including the strong relationship between PNES frequency, anxiety, and explicit-implicit SE discrepancies, support the interpretation that PNESs serve to reduce cognitive dissonance, perhaps protecting patients' implicit SE.
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Affiliation(s)
- Lian V Dimaro
- University of Nottingham, Institute of Work, Health & Organisations, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, UK.
| | - Nicole A Roberts
- School of Social and Behavioral Sciences, Arizona State University, 4701 W. Thunderbird Road, MC 3051, Glendale, AZ 85306, USA.
| | - Nima G Moghaddam
- Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK.
| | - David L Dawson
- Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK.
| | - Ian Brown
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Armstrong EJ, Wu J, Singh GD, Dawson DL, Pevec WC, Amsterdam EA, Laird JR. Smoking cessation is associated with decreased mortality and improved amputation-free survival among patients with symptomatic peripheral artery disease. J Vasc Surg 2014; 60:1565-71. [DOI: 10.1016/j.jvs.2014.08.064] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
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Westin GG, Armstrong EJ, Javed U, Balwanz CR, Saeed H, Pevec WC, Laird JR, Dawson DL. Endovascular therapy is effective treatment for focal stenoses in failing infrapopliteal vein grafts. Ann Vasc Surg 2014; 28:1823-31. [PMID: 25106106 DOI: 10.1016/j.avsg.2014.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/10/2014] [Accepted: 07/15/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the efficacy of endovascular therapy for maintaining patency and preserving limbs among patients with failing infrapopliteal bypass grafts. METHODS We gathered data from a registry of catheter-based procedures for peripheral artery disease. Of 1554 arteriograms performed from 2006 to 2012, 30 patients had interventions for failing bypass vein grafts to infrapopliteal target vessels. The first intervention for each patient was used in this analysis. Duplex ultrasonography was used within 30 days after intervention and subsequently at 3- to 6-month intervals for graft surveillance. RESULTS Interventions were performed for duplex ultrasonography surveillance findings in 21 patients and for symptoms of persistent or recurrent critical limb ischemia in 9 patients. Procedural techniques included cutting balloon angioplasty (83%), conventional balloon angioplasty (7%), and stent placement (10%). Procedural success was achieved in all cases. There were no procedure-related complications, amputations, or deaths within 30 days. By Kaplan-Meier analysis, 37% of the patients were free from graft restenosis at 12 months and 31% were at 24 months. Receiver-operating characteristic analysis indicated that a lesion length of 1.75 cm best predicted freedom from restenosis (C statistic: 0.74). Residual stenosis (P = 0.03), patency without reintervention (P = 0.01), and assisted patency with secondary intervention (P = 0.02) rates were superior for short lesions compared with long lesions. The cohort had acceptable rates of adverse clinical outcomes, with 96% of patients free from amputation at both 12 and 24 months; clinical outcomes were also better in patients with short lesions. CONCLUSIONS In this single-center experience with endovascular therapies to treat failing infrapopliteal bypass grafts, rates of limb preservation were high, but the majority of patients developed graft restenosis within 12 months. Grafts with longer stenoses fared poorly by comparison. These data suggest that endovascular interventions to restore or prolong graft patency may be associated with maintained graft patency and that close follow-up with vascular laboratory surveillance is essential.
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Affiliation(s)
- Gregory G Westin
- Division of Vascular and Endovascular Surgery, New York University Medical Center, New York, NY.
| | - Ehrin J Armstrong
- Division of Cardiology, University of Colorado Denver and VA Eastern Colorado Healthcare System, Denver, CO
| | - Usman Javed
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA
| | - Christopher R Balwanz
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, MO
| | - Haseeb Saeed
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA
| | - William C Pevec
- Division of Vascular and Endovascular Surgery and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA
| | - John R Laird
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA
| | - David L Dawson
- Division of Vascular and Endovascular Surgery and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA
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Dimaro LV, Dawson DL, Roberts NA, Brown I, Moghaddam NG, Reuber M. Anxiety and avoidance in psychogenic nonepileptic seizures: the role of implicit and explicit anxiety. Epilepsy Behav 2014; 33:77-86. [PMID: 24632427 DOI: 10.1016/j.yebeh.2014.02.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [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: 10/05/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 01/22/2023]
Abstract
This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit-explicit anxiety discrepancies were only identified in patients with PNESs (p<.001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r=.63, p<.01) and frequency of seizures (r=.67, p<.01); implicit anxiety correlated with frequency of seizures only (r=.56, p<.01). Our findings demonstrate the role of implicit anxiety in PNESs and provide additional support for the contribution of explicit anxiety and experiential avoidance to this disorder.
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Affiliation(s)
- Lian V Dimaro
- Nottinghamshire Healthcare NHS Trust, Rampton Hospital, Retford, Nottinghamshire DN22 0PD, UK.
| | - David L Dawson
- Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK.
| | - Nicole A Roberts
- School of Social and Behavioural Sciences, Arizona State University, 4701 W, Thunderbird Road, MC 3051, Glendale, AZ 85306, USA.
| | - Ian Brown
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK.
| | - Nima G Moghaddam
- Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Westin GG, Armstrong EJ, Bang H, Yeo KK, Anderson D, Dawson DL, Pevec WC, Amsterdam EA, Laird JR. Association between statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia. J Am Coll Cardiol 2014; 63:682-690. [PMID: 24315911 PMCID: PMC3944094 DOI: 10.1016/j.jacc.2013.09.073] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/10/2013] [Accepted: 09/23/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine the associations between statin use and major adverse cardiovascular and cerebrovascular events (MACCE) and amputation-free survival in critical limb ischemia (CLI) patients. BACKGROUND CLI is an advanced form of peripheral arterial disease associated with nonhealing arterial ulcers and high rates of MACCE and major amputation. Although statin medications are recommended for secondary prevention in peripheral arterial disease, their effectiveness in CLI is uncertain. METHODS We reviewed 380 CLI patients who underwent diagnostic angiography or therapeutic endovascular intervention from 2006 through 2012. Propensity scores and inverse probability of treatment weighting were used to adjust for baseline differences between patients taking and not taking statins. RESULTS Statins were prescribed for 246 (65%) patients. The mean serum low-density lipoprotein (LDL) level was lower in patients prescribed statins (75 ± 28 mg/dl vs. 96 ± 40 mg/dl, p < 0.001). Patients prescribed statins had more baseline comorbidities including diabetes, coronary artery disease, and hypertension, as well as more extensive lower extremity disease (all p values <0.05). After propensity weighting, statin therapy was associated with lower 1-year rates of MACCE (stroke, myocardial infarction, or death; hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.28 to 0.99), mortality (HR: 0.49, 95% CI: 0.24 to 0.97), and major amputation or death (HR: 0.53, 95% CI: 0.35 to 0.98). Statin use was also associated with improved lesion patency among patients undergoing infrapopliteal angioplasty. Patients with LDL levels >130 mg/dl had increased HRs of MACCE and mortality compared with patients with lower levels of LDL. CONCLUSIONS Statins are associated with lower rates of mortality and MACCE and increased amputation-free survival in CLI patients.
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Affiliation(s)
- Gregory G Westin
- School of Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California
| | - Ehrin J Armstrong
- Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, UC Davis, Davis, California
| | - Khung-Keong Yeo
- Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California
| | - David Anderson
- School of Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California
| | - David L Dawson
- Division of Vascular and Endovascular Surgery, the Vascular Center, Sacramento, California
| | - William C Pevec
- Division of Vascular and Endovascular Surgery, the Vascular Center, Sacramento, California
| | - Ezra A Amsterdam
- Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California
| | - John R Laird
- Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California.
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Armstrong EJ, Saeed H, Alvandi B, Singh S, Singh GD, Yeo KK, Anderson D, Westin GG, Dawson DL, Pevec WC, Laird JR. Nitinol Self-Expanding Stents vs. Balloon Angioplasty for Very Long Femoropopliteal Lesions. J Endovasc Ther 2014; 21:34-43. [DOI: 10.1583/13-4399mr.1] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Singh GD, Armstrong EJ, Yeo KK, Singh S, Westin GG, Pevec WC, Dawson DL, Laird JR. Endovascular recanalization of infrapopliteal occlusions in patients with critical limb ischemia. J Vasc Surg 2014; 59:1300-7. [PMID: 24393279 DOI: 10.1016/j.jvs.2013.11.061] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular therapies are increasingly used for treatment of critical limb ischemia (CLI). Infrapopliteal (IP) occlusions are common in CLI, and successful limb salvage may require restoration of arterial flow in the distribution of a chronically occluded vessel. We sought to describe the procedural characteristics and outcomes of patients with IP occlusions who underwent endovascular intervention for treatment of CLI. METHODS All patients with IP interventions for treatment of CLI from 2006 to 2012 were included. Angiographic and procedural data were compared between patients who underwent intervention for IP occlusions vs IP stenosis. Restenosis was determined by Doppler ultrasound imaging. Limb salvage was the primary end point of the study. Additional end points included primary patency, primary assisted patency, secondary patency, occlusion crossing success, procedural success, and amputation-free survival. RESULTS A total of 187 patients with CLI underwent interventions for 356 IP lesions, and 77 patients (41%) had interventions for an IP occlusion. Patients with an intervention for IP occlusion were more likely to have zero to one vessel runoff (83% vs 56%; P < .001) compared with interventions for stenosis. Compared with IP stenoses, IP occlusions were longer (118 ± 86 vs 73 ± 67 mm; P < .001) and had a smaller vessel diameter (2.5 ± 0.8 vs 2.7 ± 0.5 mm; P = .02). Wire crossing was achieved in 83% of IP occlusions, and the overall procedural success for IP occlusions was 79%. The overall 1-year limb salvage rate was 84%. Limb salvage was highest in the stenosis group, slightly lower in the successful occlusion group, and lowest in the failed occlusion group (92% vs 75% vs 58%, respectively; P = .02). Unsuccessfully treated IP occlusions were associated with a significantly higher likelihood of major amputation (hazard ratio, 5.79; 95% confidence interval, 1.89-17.7) and major amputation or death (hazard ratio, 2.69; 95% confidence interval, 1.09-6.63). CONCLUSIONS Successful endovascular recanalization of IP occlusions can be achieved with guidewire and support catheter techniques in most patients. In patients selected for an endovascular-first approach for IP occlusions in CLI, this strategy can be successfully implemented with favorable rates of limb salvage.
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Affiliation(s)
- Gagan D Singh
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - Ehrin J Armstrong
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - Khung-Keong Yeo
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif; Division of Cardiovascular Medicine, National Heart Centre Singapore, Singapore
| | - Satinder Singh
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - Gregory G Westin
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - William C Pevec
- Division of Vascular and Endovascular Surgery and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - David L Dawson
- Division of Vascular and Endovascular Surgery and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif
| | - John R Laird
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, Calif.
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Abstract
This article systematically reviewed studies of parental bonding in people with eating disorders. MEDLINE, PsychINFO, EMBASE and CINAHL were searched to identify studies that compared parental bonding in people diagnosed with an eating disorder relative to non-clinical controls. Twenty-four studies were identified. Women with eating disorders typically reported lower parental care and higher parental protection compared to non-clinical, but not psychiatric, controls. Interestingly, a modest number of studies found that these relationships were mediated by avoidant problem solving style and several schemas from the Young Schema Questionnaire (YSQ; Schmidt, Joiner, Young, & Telch, 1995). While there are methodological limitations associated with the reviewed studies, they do offer some support for the proposal that difficulties in parent-child relationships predispose women to eating disorders and other psychiatric diagnoses.
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Affiliation(s)
- Amanda Tetley
- Trent Doctorate in Clinical Psychology, University of Nottingham and University of Lincoln, Institute of Work, Health and Organisations, Yang Fuji Building, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, United Kingdom.
| | - Nima G Moghaddam
- Trent Doctorate in Clinical Psychology, University of Nottingham and University of Lincoln, Institute of Work, Health and Organisations, Yang Fuji Building, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, United Kingdom.
| | - David L Dawson
- Trent Doctorate in Clinical Psychology, University of Nottingham and University of Lincoln, Institute of Work, Health and Organisations, Yang Fuji Building, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, United Kingdom.
| | - Mike Rennoldson
- Trent Doctorate in Clinical Psychology, University of Nottingham and University of Lincoln, Institute of Work, Health and Organisations, Yang Fuji Building, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, United Kingdom.
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Golijani-Moghaddam N, Hart A, Dawson DL. The Implicit Relational Assessment Procedure: Emerging reliability and validity data. Journal of Contextual Behavioral Science 2013. [DOI: 10.1016/j.jcbs.2013.05.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mappin L, Dawson DL, Gresswell DM, Beckley K. Female-perpetrated intimate partner violence: an examination of three cases using multiple sequential functional analysis. Crim Behav Ment Health 2013; 23:290-303. [PMID: 23913714 DOI: 10.1002/cbm.1874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/17/2013] [Accepted: 05/28/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Recent empirical evidence suggests that women assault their intimate partners at approximately the same rate as men. However, a general historical reluctance to acknowledge women as significant perpetrators of intimate partner violence (IPV) has limited clinical understanding of this phenomenon and the processes by which such behaviour may develop. AIM The following paper uses multiple sequential functional analysis (MSFA), an idiographic case formulation method based on functional analysis, to explore the development and functional value of IPV in the case histories of three women. METHOD Data from comprehensive clinical interviews, file review and collateral professional interviews are synthesised using MSFA to examine the development and maintenance of IPV across each participant's lifespan. RESULTS Although there appeared to be important differences between participants, the analyses broadly indicated that all three participants used violence instrumentally to achieve some aspect of control or coercion over their intimate partners, and to meet their primary intimacy needs. CONCLUSIONS The MSFA appears to be a useful methodology for understanding female-perpetrated IPV and, importantly, may lend itself more readily to effective formulation-informed interventions than other qualitative-narrative case methods. The strengths and limitations of MSFA as a pragmatic case formulation method are discussed.
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Westin GG, Armstrong EJ, Singh S, Saeed H, Pevec WC, Laird JR, Dawson DL. Endovascular Therapy Is Effective Treatment for Focal Stenoses in Failing Infrapopliteal Grafts. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.05.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Armstrong EJ, Singh S, Singh GD, Yeo KK, Ludder S, Westin G, Anderson D, Dawson DL, Pevec WC, Laird JR. Angiographic characteristics of femoropopliteal in-stent restenosis: association with long-term outcomes after endovascular intervention. Catheter Cardiovasc Interv 2013; 82:1168-74. [PMID: 23630047 DOI: 10.1002/ccd.24983] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [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: 04/04/2013] [Accepted: 04/21/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The purpose of this study was to identify the relationship between angiographic patterns of restenosis and outcomes after endovascular treatment of femoro-popliteal in-stent restenosis (FP-ISR). BACKGROUND ISR is a frequent clinical problem after femoro-popliteal stenting. METHODS This was a single center study of all endovascular interventions for FP-ISR from 2006 to 2012. Class I ISR was defined as focal lesions ≤50 mm; Class II ISR as lesions > 50 mm; and Class III ISR as stent chronic total occlusion. Recurrent ISR was defined as peak systolic velocity ratio > 2.4 by duplex ultrasound. RESULTS Among 75 cases of FP-ISR, 28 (37%) were Class I, 22 (29%) were Class II, and 25 (33%) were Class III. The mean lesion length was 26 mm for Class I, 135 mm for Class II, and 178 mm for Class III ISR. Patients with Class III ISR more frequently had ISR extending into both the superficial femoral and popliteal artery (48% vs. 18%, P = 0.005). Balloon angioplasty was used most frequently to treat Class I ISR, while adjunctive atherectomy and/or stenting was used for almost all cases of Class III ISR. During 2-year follow-up, rates of repeat restenosis were 39% for Class I, 67% for Class II, and 72% for Class III ISR (P = 0.04). Rates of stent occlusion were 8% for Class I, 11% for Class II, and 52% for Class III ISR (P = 0.009). Class III ISR was associated with significantly increased risk of recurrent ISR (HR 2.4, 95% CI 1.1-5.6) and recurrent occlusion (HR 5.8, 95% CI 1.8-19.0) compared to other types of ISR. CONCLUSION Angiographic patterns of FP-ISR are important determinants of subsequent outcomes. Repeat restenosis and occlusion remain common despite currently available technologies.
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Affiliation(s)
- Ehrin J Armstrong
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, California
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Baker AC, Chew V, Li CS, Lin TC, Dawson DL, Pevec WC, Hedayati N. Application of duplex ultrasound imaging in determining in-stent stenosis during surveillance after mesenteric artery revascularization. J Vasc Surg 2012; 56:1364-71; discussion 1371. [DOI: 10.1016/j.jvs.2012.03.283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 02/16/2012] [Accepted: 03/19/2012] [Indexed: 10/27/2022]
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Taylor KL, Luta G, Miller AB, Church TR, Kelly SP, Muenz LR, Davis KM, Dawson DL, Edmond S, Reding D, Mabie JE, Riley TL. Long-term disease-specific functioning among prostate cancer survivors and noncancer controls in the prostate, lung, colorectal, and ovarian cancer screening trial. J Clin Oncol 2012; 30:2768-75. [PMID: 22734029 DOI: 10.1200/jco.2011.41.2767] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Within the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), we assessed the long-term disease-specific functioning among prostate cancer (PCa) survivors versus noncancer controls, the impact of trial arm (screening/usual care) on functioning, and the effect of treatment modality on functioning. PATIENTS AND METHODS PCa survivors (n = 529), 5 to 10 years postdiagnosis, were frequency-matched to noncancer controls (n = 514) for race, screening center, year of enrollment, and trial arm. Participants completed a telephone interview regarding PCa-specific symptomatology. Weights accounted for patient selection from the five PLCO screening centers. Propensity-score methods were used to balance groups of interest with respect to demographic and medical characteristics. RESULTS Weighted linear regression analyses revealed poorer sexual and urinary function among PCa survivors compared with noncancer controls (P < .001). Trial arm was not significantly related to any outcome (P > .31). Compared with radical prostatectomy patients (n = 201), radiation-therapy patients (n = 110) reported better sexual (P < .05) and urinary (P < .001) functioning but poorer bowel outcomes (P < .05). Survivors who received treatment combinations including androgen deprivation (n = 207) reported significantly poorer hormone-related symptoms compared with radical prostatectomy patients (P < .05). CONCLUSION This study demonstrated the persistence of clinically significant, long-term PCa treatment-related sexual and urinary adverse effects up to 10 years postdiagnosis. To our knowledge, this was the first comparison of prostate-related dysfunction among screened survivors versus screened noncancer controls and indicated that these long-term problems were attributable to PCa treatment and not to aging or comorbidities. Finally, differences in long-term adverse effects between treatment modalities are particularly relevant for patients and clinicians when making treatment decisions.
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Affiliation(s)
- Kathryn L Taylor
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven St, NW, Suite 4100, Washington, DC 20007, USA.
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Tian Y, Stamova B, Jickling GC, Liu D, Ander BP, Bushnell C, Zhan X, Davis RR, Verro P, Pevec WC, Hedayati N, Dawson DL, Khoury J, Jauch EC, Pancioli A, Broderick JP, Sharp FR. Effects of gender on gene expression in the blood of ischemic stroke patients. J Cereb Blood Flow Metab 2012; 32:780-91. [PMID: 22167233 PMCID: PMC3345909 DOI: 10.1038/jcbfm.2011.179] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study examined the effects of gender on RNA expression after ischemic stroke (IS). RNA obtained from blood of IS patients (n=51; 153 samples at < or =3, 5, and 24 hours) and from matched controls (n=52) were processed on Affymetrix microarrays. Analyses of covariance for stroke versus control samples were performed separately for both genders and the regulated genes for females compared with males. In all, 242, 227, and 338 male-specific genes were regulated at < or =3, 5, and 24 hours after IS, respectively, of which 59 were regulated at all time points. Overall, 774, 3,437, and 571 female-specific stroke genes were regulated at < or =3, 5, and 24 hours, respectively, of which 152 were regulated at all time points. Male-specific stroke genes were associated with integrin, integrin-liked kinase, actin, tight junction, Wnt/β-catenin, RhoA, fibroblast growth factors (FGF), granzyme, and tumor necrosis factor receptor (TNFR)2 signaling. Female-specific stroke genes were associated with p53, high-mobility group box-1, hypoxia inducible factor (HIF)1α, interleukin (IL)1, IL6, IL12, IL18, acute-phase response, T-helper, macrophage, and estrogen signaling. Cell death signaling was overrepresented in both genders, although the molecules and pathways differed. Gender affects gene expression in the blood of IS patients, which likely implies gender differences in immune, inflammatory, and cell death responses to stroke.
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Affiliation(s)
- Yingfang Tian
- Department of Neurology, the MIND Institute, University of California at Davis, Sacramento, CA, USA.
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Tian Y, Stamova B, Jickling GC, Xu H, Liu D, Ander BP, Bushnell C, Zhan X, Turner RJ, Davis RR, Verro P, Pevec WC, Hedayati N, Dawson DL, Khoury J, Jauch EC, Pancioli A, Broderick JP, Sharp FR. Y chromosome gene expression in the blood of male patients with ischemic stroke compared with male controls. ACTA ACUST UNITED AC 2012; 9:68-75.e3. [PMID: 22365286 DOI: 10.1016/j.genm.2012.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 01/04/2012] [Accepted: 01/09/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sex is suggested to be an important determinant of ischemic stroke risk factors, etiology, and outcome. However, the basis for this remains unclear. The Y chromosome is unique in males. Genes expressed in males on the Y chromosome that are associated with stroke may be important genetic contributors to the unique features of males with ischemic stroke, which would be helpful for explaining sex differences observed between men and women. OBJECTIVE We compared Y chromosome gene expression in males with ischemic stroke and male controls. METHODS Blood samples were obtained from 40 male patients ≤3, 5, and 24 hours after ischemic stroke and from 41 male controls (July 2003-April 2007). RNA was isolated from blood and was processed using Affymetrix Human U133 Plus 2.0 expression arrays (Affymetrix Inc., Santa Clara, California). Y chromosome genes differentially expressed between male patients with stroke and male control subjects were identified using an ANCOVA adjusted for age and batch. A P < 0.05 and a fold change >1.2 were considered significant. RESULTS Seven genes on the Y chromosome were differentially expressed in males with ischemic stroke compared with controls. Five of these genes (VAMP7, CSF2RA, SPRY3, DHRSX, and PLCXD1) are located on pseudoautosomal regions of the human Y chromosome. The other 2 genes (EIF1AY and DDX3Y) are located on the nonrecombining region of the human Y chromosome. The identified genes were associated with immunology, RNA metabolism, vesicle fusion, and angiogenesis. CONCLUSIONS Specific genes on the Y chromosome are differentially expressed in blood after ischemic stroke. These genes provide insight into potential molecular contributors to sex differences in ischemic stroke.
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Affiliation(s)
- Yingfang Tian
- Department of Neurology and the MIND Institute, University of California at Davis, Sacramento, California 95817, USA.
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40
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Stamova B, Tian Y, Jickling G, Bushnell C, Zhan X, Liu D, Ander BP, Verro P, Patel V, Pevec WC, Hedayati N, Dawson DL, Jauch EC, Pancioli A, Broderick JP, Sharp FR. The X-chromosome has a different pattern of gene expression in women compared with men with ischemic stroke. Stroke 2011; 43:326-34. [PMID: 22052522 DOI: 10.1161/strokeaha.111.629337] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Differences in ischemic stroke between men and women have been mainly attributed to hormonal effects. However, sex differences in immune response to ischemia may exist. We hypothesized that differential expression of X-chromosome genes in blood immune cells contribute to differences between men and women with ischemic stroke. METHODS RNA levels of 683 X-chromosome genes were measured on Affymetrix U133 Plus2.0 microarrays. Blood samples from patients with ischemic stroke were obtained at ≤ 3 hours, 5 hours, and 24 hours (n=61; 183 samples) after onset and compared with control subjects without symptomatic vascular diseases (n=109). Sex difference in X-chromosome gene expression was determined using analysis of covariance (false discovery rate ≤ 0.05, fold change ≥ 1.2). RESULTS At ≤ 3, 5, and 24 hours after stroke, there were 37, 140, and 61 X-chromosome genes, respectively, that changed in women; and 23, 18, and 31 X-chromosome genes that changed in men. Female-specific genes were associated with post-translational modification, small-molecule biochemistry, and cell-cell signaling. Male-specific genes were associated with cellular movement, development, cell-trafficking, and cell death. Altered sex specific X-chromosome gene expression occurred in 2 genes known to be associated with human stroke, including galactosidase A and IDS, mutations of which result in Fabry disease and Hunter syndrome, respectively. CONCLUSIONS There are differences in X-chromosome gene expression between men and women with ischemic stroke. Future studies are needed to decipher whether these differences are associated with sexually dimorphic immune response, repair or other mechanisms after stroke, or whether some of them represent risk determinants.
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Affiliation(s)
- Boryana Stamova
- Departments of Neurology, University of California at Davis, MIND Institute and Department of Neurology, 2805 50th Street, Sacramento CA 95817, USA.
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41
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Dawson DL. Re: Ronald A. Bergman, “Thoughts on Human Variation”. Clin Anat 2011; 24:943. [DOI: 10.1002/ca.21239] [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] [Received: 06/12/2011] [Accepted: 06/21/2011] [Indexed: 11/10/2022]
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42
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Baker AC, Chew V, Li CS, Lin TC, Dawson DL, Pevec WC, Hedayati N. Duplex Ultrasound Criteria for Re-intervention after Mesenteric Artery Revascularization. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.05.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Dawson DL, Mitchell EL, Lee JT, Mills JL, Laird JR, Hedayati N, Lee ES, Pevec WC. Validation of Simulation as a Tool for Assessing Endovascular Procedural Competency. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hedayati N, Del Pizzo DJ, Harris SE, Kuskowski M, Pevec WC, Lee ES, Pifer C, Dawson DL. Predictors of diagnostic success with renal artery duplex ultrasonography. Ann Vasc Surg 2011; 25:515-9. [PMID: 21549921 DOI: 10.1016/j.avsg.2011.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 11/30/2010] [Accepted: 02/08/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Renal artery duplex ultrasonography (RA-DUS) is commonly used for the evaluation and follow-up of renal artery atherosclerotic disease. In a complete study, renal artery flow is evaluated from the vessel origin to the intraparenchymal branches. The quality of RA-DUS is in part technologist-dependent, but many factors may affect the ability to complete a diagnostic examination. This study evaluated the clinical and technical factors that predict the ability to obtain a complete RA-DUS examination. METHODS A prospective evaluation of all patients undergoing RA-DUS between July 2008 and February 2009 was performed. Factors such as patient age, gender, body mass index, technologists' years of experience, patient care setting (inpatient vs. outpatient), bedside examination, smoking before the examination, fasting status, and recent abdominal surgery were all recorded. Multivariate logistic regression analysis was performed. A p value of ≤ 0.05 was considered significant. RESULTS During the study period, 250 patients underwent RA-DUS (mean age: 59.9 ± 17.8 years, 57% [143] female). A total of 87 (35%) examinations were incomplete. This included nondiagnostic examinations which did not exhibit any segment of the renal artery. Factors that were associated with an incomplete examination included technologists' years of experience (OR = 0.92, p = 0.042), bedside examination (OR = 4.17, p = 0.016), and recent abdominal surgery (OR = 3.45, p = 0.047). Body mass index, fasting status, and smoking before the examination did not affect the ability to obtain a complete study. CONCLUSIONS One-third of the RA-DUS studies were classified as incomplete by the strict criteria used in this prospective study. An experienced ultrasound technologist is more likely to obtain a complete RA-DUS examination. Recent abdominal surgery and bedside examinations were predictive of a limited examination as well. Vascular laboratories should consider these factors when scheduling examinations so as to obtain complete RA-DUS studies, as well as improve the cost-effectiveness of resource utilization.
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Affiliation(s)
- Nasim Hedayati
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Davis, Sacramento, CA, USA.
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Humphries MD, Pevec WC, Laird JR, Yeo KK, Hedayati N, Dawson DL. Early duplex scanning after infrainguinal endovascular therapy. J Vasc Surg 2010; 53:353-8. [PMID: 20974524 DOI: 10.1016/j.jvs.2010.08.045] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [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: 05/10/2010] [Revised: 07/20/2010] [Accepted: 08/16/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Duplex ultrasound scanning (DUS) has benefit for intraoperative and subsequent evaluation of surgical bypasses in the lower extremities. The utility of DUS after endovascular revascularizations is not established. This study was performed to evaluate whether DUS findings after infrainguinal endovascular interventions for critical limb ischemia (CLI) were predictive of need for reintervention or amputation. METHODS To identify the study cohort, peripheral interventions for CLI (Rutherford grades 4, 5, 6) over a 24-month period (2006-2007) were reviewed. DUS findings were considered indicative of hemodynamic stenosis if the peak systolic velocity (PSV) was ≥ 180 cm/s or the PSV velocity ratio was ≥ 2.0. Demographic, clinical, procedural, and outcomes were examined. SVS and TASC II classifications and reporting standards were used. Arteriograms were reviewed and treated segments were categorized as patent (<30% residual stenosis) or abnormal (≥ 30% residual stenosis). RESULTS There were 122 infrainguinal interventions for CLI in 113 patients (53% male; mean age 71 years). Risk factors included diabetes: 61%; renal failure: 20%; and smoking (within 1 year): 40%. DUS was performed within 30 days of the index procedure in 90 cases. Fifty patients had an abnormal early duplex and 40 patients had a normal duplex. In patients with a normal duplex ultrasound the amputation rate was 5% vs 20% in the group with an abnormal duplex (P = .04). Primary patency was 56% in the normal duplex group and 46% in the abnormal duplex group (P = .18). Early duplex ultrasound was able to identify a residual stenosis not seen on completion angiography in 56% of cases. CONCLUSIONS Duplex scanning detects residual stenosis missed with conventional angiography after infrainguinal interventions. An abnormal DUS in the first 30 days after an intervention is associated with an increased risk of amputation. This suggests a possible role for intraprocedural DUS, as well as routine postprocedure DUS, close clinical follow-up, and consideration of reintervention for residual abnormalities in patients treated for CLI.
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Affiliation(s)
- Misty D Humphries
- University of California Davis Medical Center, Sacramento, CA 95817, USA
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Humphries MD, Dawson DL. Asymptomatic bilateral external iliac vein aneurysms in a young athlete: case report and literature review. Vasc Endovascular Surg 2010; 44:594-6. [PMID: 20519280 DOI: 10.1177/1538574410366488] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Iliac vein aneurysms are an exceedingly uncommon problem faced by vascular specialists. We report a case of a healthy 32 year old woman who had large asymptomatic bilateral external iliac vein aneurysms found incidentally on CT scan. They may present with thromboembolism, spontaneous rupture, or they may be asymptomatic. In evaluating these aneurysms, it is important to obtain volumetric imaging data that can be rendered in 3-dimensions and reconstructed in multiple planes. With our patient, it was the multiplanar reconstructions that best demonstrated the fusiform morphology of the aneurysms. Treatment for asymptomatic external iliac veins is controversial.
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Affiliation(s)
- Misty Dawn Humphries
- Division of Vascular and Endovascular Surgery University of California-Davis Vascular Center, CA, USA.
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Dorfman CS, Williams RM, Kassan EC, Red SN, Dawson DL, Tuong W, Parker ER, Ohene-Frempong J, Davis KM, Krist AH, Woolf SH, Schwartz MD, Fishman MB, Cole C, Taylor KL. The development of a web- and a print-based decision aid for prostate cancer screening. BMC Med Inform Decis Mak 2010; 10:12. [PMID: 20199680 PMCID: PMC2845091 DOI: 10.1186/1472-6947-10-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [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: 07/16/2009] [Accepted: 03/03/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Whether early detection and treatment of prostate cancer (PCa) will reduce disease-related mortality remains uncertain. As a result, tools are needed to facilitate informed decision making. While there have been several decision aids (DAs) developed and tested, very few have included an exercise to help men clarify their values and preferences about PCa screening. Further, only one DA has utilized an interactive web-based format, which allows for an expansion and customization of the material. We describe the development of two DAs, a booklet and an interactive website, each with a values clarification component and designed for use in diverse settings. METHODS We conducted two feasibility studies to assess men's (45-70 years) Internet access and their willingness to use a web- vs. a print-based tool. The booklet was adapted from two previous versions evaluated in randomized controlled trials (RCTs) and the website was created to closely match the content of the revised booklet. Usability testing was conducted to obtain feedback regarding draft versions of the materials. The tools were also reviewed by a plain language expert and the interdisciplinary research team. Feedback on the content and presentation led to iterative modifications of the tools. RESULTS The feasibility studies confirmed that the Internet was a viable medium, as the majority of men used a computer, had access to the Internet, and Internet use increased over time. Feedback from the usability testing on the length, presentation, and content of the materials was incorporated into the final versions of the booklet and website. Both the feasibility studies and the usability testing highlighted the need to address men's informed decision making regarding screening. CONCLUSIONS Informed decision making for PCa screening is crucial at present and may be important for some time, particularly if a definitive recommendation either for or against screening does not emerge from ongoing prostate cancer screening trials. We have detailed our efforts at developing print- and web-based DAs to assist men in determining how to best meet their PCa screening preferences. Following completion of our ongoing RCT designed to test these materials, our goal will be to develop a dissemination project for the more effective tool. TRIAL REGISTRATION NCT00623090.
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Affiliation(s)
- Caroline S Dorfman
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW Suite 4100, Washington, DC 20007-2401, USA
| | - Randi M Williams
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW Suite 4100, Washington, DC 20007-2401, USA
| | - Elisabeth C Kassan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW Suite 4100, Washington, DC 20007-2401, USA
| | - Sara N Red
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW Suite 4100, Washington, DC 20007-2401, USA
| | - David L Dawson
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW Suite 4100, Washington, DC 20007-2401, USA
| | - William Tuong
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW Suite 4100, Washington, DC 20007-2401, USA
| | - Elizabeth R Parker
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW Suite 4100, Washington, DC 20007-2401, USA
| | | | - Kimberly M Davis
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW Suite 4100, Washington, DC 20007-2401, USA
| | - Alexander H Krist
- Department of Family Medicine, Virginia Commonwealth University, PO Box 980251 Richmond VA 23298-0251, USA
| | - Steven H Woolf
- Department of Family Medicine, Virginia Commonwealth University, PO Box 980251 Richmond VA 23298-0251, USA
| | - Marc D Schwartz
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW Suite 4100, Washington, DC 20007-2401, USA
| | - Mary B Fishman
- Division of General Internal Medicine, Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007, USA
| | - Carmella Cole
- Division of General Internal Medicine, Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010, USA
| | - Kathryn L Taylor
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW Suite 4100, Washington, DC 20007-2401, USA
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Clarkson R, Murphy GH, Coldwell JB, Dawson DL. What characteristics do service users with intellectual disability value in direct support staff within residential forensic services? J Intellect Dev Disabil 2009; 34:283-289. [PMID: 19860579 DOI: 10.3109/13668250903285630] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND This study explores the perceptions of a group of adults with intellectual disability regarding direct support staff. METHOD Semi-structured interviews relating to experiences of direct support staff were developed from two focus groups. These interviews were conducted with 11 adults with intellectual disability residing within a forensic inpatient service. RESULTS Interpretative Phenomenological Analysis (IPA) revealed two superordinate themes; namely, staff relationship factors and positive and negative attributes of staff. The participants valued relationships with staff based on qualities such as honesty, trust, and a caring, nurturing manner that enabled individuals to feel safe. Staff characteristics such as immaturity, inexperience, and a short temper appeared to lead to feelings of discontentment amongst the participants. CONCLUSIONS The implications of the findings are discussed in relation to clinical practice, staff recruitment, and training.
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Lee ES, Dawson DL. The management of large bilateral internal iliac artery aneurysms using the T-Stat Colon Oximeter. Ann Vasc Surg 2009; 24:115.e1-4. [PMID: 19762207 DOI: 10.1016/j.avsg.2009.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 07/02/2009] [Accepted: 07/13/2009] [Indexed: 11/18/2022]
Abstract
Internal iliac artery (IIA) aneurysms are rare and the repair of these aneurysms is associated with high risk of morbidity and mortality. Bilateral IIA aneurysms add an increased concern for ischemic complications. A case is presented where the use of a Food and Drug Administration-approved device, the T-Stat Colon Oximeter, allowed additional information for the safe and successful hybrid exclusion of bilateral large IIA aneurysms. A staged approach with the use of Amplatzer plugs, Powerlink device, Zenith iliac plug, and a femoral-femoral bypass allowed successful exclusion of the IIA aneurysms. The immediate and 18-month follow-up of the IIA aneurysms are reported.
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Affiliation(s)
- Eugene S Lee
- Department of Surgery, University of California, Davis, Sacramento, CA, USA.
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Abstract
Abdominal aortic aneurysms are rare in young women. We report the case of a 31-year-old woman who underwent open surgical repair of a symptomatic 7-cm abdominal aortic aneurysm (AAA). The patient had no identifiable AAA risk factors. Laboratory and pathological analyses demonstrated a nonspecific inflammatory component.
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Affiliation(s)
- John M Moos
- Department of General Surgery, USC/LA County, Los Angeles, California, USA.
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