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Meskell P, Biesty LM, Dowling M, Roche K, Meehan E, Glenton C, Devane D, Shepperd S, Booth A, Cox R, Chan XHS, Houghton C. Factors that impact on recruitment to vaccine trials in the context of a pandemic or epidemic: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 9:MR000065. [PMID: 37655964 PMCID: PMC10472890 DOI: 10.1002/14651858.mr000065.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND The World Health Organization declared the COVID-19 pandemic on 11 March 2020. Vaccine development and deployment were swiftly prioritised as a method to manage and control disease spread. The development of an effective vaccine relies on people's participation in randomised trials. Recruitment to vaccine trials is particularly challenging as it involves healthy volunteers who may have concerns around the potential risks and benefits associated with rapidly developed vaccines. OBJECTIVES To explore the factors that influence a person's decision to participate in a vaccine trial in the context of a pandemic or epidemic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was June 2021. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perspectives of adults aged 18 years or older who were invited to take part in vaccine trials in the context of a pandemic or epidemic. DATA COLLECTION AND ANALYSIS We assessed the title, abstracts and full texts identified by the search. We used a sampling frame to identify data-rich studies that represented a range of diseases and geographical spread. We used QSR NVivo to manage extracted data. We assessed methodological limitations using an adapted version of the Critical Skills Appraisal Programme (CASP) tool for qualitative studies. We used the 'best-fit framework approach' to analyse and synthesise the evidence from our included studies. We then used the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) assessment to assess our confidence in each finding and develop implications for practice. MAIN RESULTS We included 34 studies in our review. Most studies related to HIV vaccine trials. The other studies related to Ebola virus, tuberculosis, Zika virus and COVID-19. We developed 20 key findings, under three broad themes (with seven subthemes), that described the factors that people consider when deciding whether to take part in a vaccine trial for a pandemic or epidemic disease. Our GRADE-CERQual confidence was high in nine of the key findings, moderate in 10 key findings and low in one key finding. The main reason for downgrading review findings were concerns regarding the relevance and adequacy of the underlying data. As a result of the over-representation of HIV studies, our GRADE-CERQual assessment of some findings was downgraded in terms of relevance because the views described may not reflect those of people regarding vaccine trials for other pandemic or epidemic diseases. Adequacy relates to the degree of richness and quantity of data supporting a review finding. Moderate concerns about adequacy resulted in a downgrading of some review findings. Some factors were considered to be under the control of the trial team. These included how trial information was communicated and the inclusion of people in the community to help with trial information dissemination. Aspects of trial design were also considered under control of the trial team and included convenience of participation, provision of financial incentives and access to additional support services for those taking part in the trial. Other factors influencing people's decision to take part could be personal, from family, friends or wider society. From a personal perceptive, people had concerns about vaccine side effects, vaccine efficacy and possible impact on their daily lives (carer responsibilities, work, etc.). People were also influenced by their families, and the impact participation may have on relationships. The fear of stigma from society influenced the decision to take part. Also, from a societal perspective, the level of trust in governments' involvement in research and trial may influence a person's decision. Finally, the perceived rewards, both personal and societal, were influencing factors on the decision to participate. Personal rewards included access to a vaccine, improved health and improved disease knowledge, and a return to normality in the context of a pandemic or epidemic. Potential societal rewards included helping the community and contributing to science, often motivated by the memories of family and friends who had died from the disease. AUTHORS' CONCLUSIONS This review identifies many of the factors that influence a person's decision to take part in a vaccine trial, and these reflect findings from reviews that examine trials more broadly. However, we also recognise some factors that become more important in connection with a vaccine trial in the context of a pandemic or epidemic. These factors include the potential stigma of taking part, the possible adverse effects of a vaccine, the added motivation for helping society, the role of community leaders in trial dissemination, and the level of trust placed in governments and companies developing vaccines. These specific influences need to be considered by trial teams when designing, and communicating about, vaccine trials in the context of a pandemic or epidemic.
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Affiliation(s)
- Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | | | - Elaine Meehan
- Ageing Research Centre, School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, ScHARR, Sheffield, UK
| | - Rebecca Cox
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
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Saab MM, Murphy M, Meehan E, Dillon CB, O'Connell S, Hegarty J, Heffernan S, Greaney S, Kilty C, Goodwin J, Hartigan I, O'Brien M, Chambers D, Twomey U, O'Donovan A. Suicide and Self-Harm Risk Assessment: A Systematic Review of Prospective Research. Arch Suicide Res 2022; 26:1645-1665. [PMID: 34193026 DOI: 10.1080/13811118.2021.1938321] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. METHOD Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. RESULTS Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. CONCLUSIONS There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide.HIGHLIGHTSThere is insufficient evidence to support using standalone risk assessment tools.There are mixed findings relating to clinician assessment of risk.Structured professional judgment is widely accepted for risk assessment.
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3
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Hegarty J, Flaherty SJ, Saab MM, Goodwin J, Walshe N, Wills T, McCarthy VJ, Murphy S, Cutliffe A, Meehan E, Landers C, Lehane E, Lane A, Landers M, Kilty C, Madden D, Tumelty M, Naughton C. An International Perspective on Definitions and Terminology Used to Describe Serious Reportable Patient Safety Incidents: A Systematic Review. J Patient Saf 2021; 17:e1247-e1254. [PMID: 32271529 PMCID: PMC8612884 DOI: 10.1097/pts.0000000000000700] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Patients are unintentionally, yet frequently, harmed in situations that are deemed preventable. Incident reporting systems help prevent harm, yet there is considerable variability in how patient safety incidents are reported. This may lead to inconsistent or unnecessary patterns of incident reporting and failures to identify serious patient safety incidents. This systematic review aims to describe international approaches in relation to defining serious reportable patient safety incidents. METHODS Multiple electronic and gray literature databases were searched for articles published between 2009 and 2019. Empirical studies, reviews, national reports, and policies were included. A narrative synthesis was conducted because of study heterogeneity. RESULTS A total of 50 articles were included. There was wide variation in the terminology used to represent serious reportable patient safety incidents. Several countries defined a specific subset of incidents, which are considered sufficiently serious, yet preventable if appropriate safety measures are taken. Terms such as "never events," "serious reportable events," or "always review and report" were used. The following dimensions were identified to define a serious reportable patient safety incident: (1) incidents being largely preventable; (2) having the potential for significant learning; (3) causing serious harm or have the potential to cause serious harm; (4) being identifiable, measurable, and feasible for inclusion in an incident reporting system; and (5) running the risk of recurrence. CONCLUSIONS Variations in terminology and reporting systems between countries might contribute to missed opportunities for learning. International standardized definitions and blame-free reporting systems would enable comparison and international learning to enhance patient safety.
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Affiliation(s)
| | | | | | - John Goodwin
- From the Catherine McAuley School of Nursing and Midwifery
| | - Nuala Walshe
- From the Catherine McAuley School of Nursing and Midwifery
| | - Teresa Wills
- From the Catherine McAuley School of Nursing and Midwifery
| | | | - Siobhan Murphy
- From the Catherine McAuley School of Nursing and Midwifery
| | - Alana Cutliffe
- From the Catherine McAuley School of Nursing and Midwifery
| | - Elaine Meehan
- From the Catherine McAuley School of Nursing and Midwifery
| | - Ciara Landers
- From the Catherine McAuley School of Nursing and Midwifery
| | - Elaine Lehane
- From the Catherine McAuley School of Nursing and Midwifery
| | - Aoife Lane
- From the Catherine McAuley School of Nursing and Midwifery
| | | | - Caroline Kilty
- From the Catherine McAuley School of Nursing and Midwifery
| | | | - Mary Tumelty
- School of Law, University College Cork, Cork, Ireland
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4
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O'Carroll S, Cremin M, Meehan E, O'Leary H, Galvin R, Fitzgerald L, O'Connell P, Mukherjee P. 87 PREDICTIVE VALIDITY OF SCREENING TOOLS USED BY A FRAILTY INTERVENTION TEAM IN AN IRISH EMERGENCY DEPARTMENT: A RETROSPECTIVE COHORT STUDY. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Various screening tools exist to identify frail and at-risk older adults in the emergency department (ED). This can facilitate targeted assessment and management, leading to improve outcomes. This study evaluated the predictive validity of four screening tools used by an ED-based team of allied health professionals.
Methods
The Variable Indicative of Placement (VIP) tool, Think Frailty Tool, Clinical Frailty Scale (CFS) and 4AT were administered to adults aged ≥75 years as part of assessment by the Frailty Intervention Therapy Team in an Irish ED. Outcomes were hospital admission; re-attendance within 28 or 90 days; and death within 28 or 365 days. Scores were dichotomised, and for each outcome, relative risks and sensitivity, specificity, positive and negative predictive values were calculated.
Results
Over the six-month period, 429 individuals (median age:82 years) were assessed. Of these, 59% were VIP-positive, 81% screened at-risk of frailty on the Think Frailty Tool, 56% screened positive for frailty on the CFS, and 16% screened positive on the 4AT. Hospital admission, re-attendance at 28 and 90 days, and death within 28 and 365 days were 56%, 12%, 27%, 5%, and 23%, respectively. Positive screens on the VIP, Think Frailty Tool, CFS and 4AT were associated with significantly increased risk of hospital admission and death within 28 or 365 days (p < 0.05). Positive screens on the Think Frailty Tool and CFS were also associated with increased risk of 90-day re-attendance (p < 0.05). Of the four tools, the Think Frailty Tool had the highest sensitivity (86%–100%) for all outcomes. The CFS showed high sensitivity for detecting death within 28 or 365 days (95% and 84%, respectively), but lower sensitivity (68%–75%) for other outcomes. The 4AT demonstrated the lowest sensitivity for all outcomes (20%–46%).
Conclusion
The Think Frailty Tool and CFS were the most useful for predicting adverse outcomes in this group.
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Affiliation(s)
| | - M Cremin
- University Hospital Kerry , Tralee, Ireland
| | - E Meehan
- University of Limerick , Limerick, Ireland
| | - H O'Leary
- University Hospital Kerry , Tralee, Ireland
| | - R Galvin
- University of Limerick , Limerick, Ireland
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5
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Goodwin J, Kilty C, Meehan E, Murphy M, Dillon C, Heffernan S, Greaney S, O'Brien M, Chambers D, Twomey U, Horgan A. Healthcare staff's views on responding to suicide and self-harm: Part II. Perspect Psychiatr Care 2021; 57:1743-1750. [PMID: 33616213 DOI: 10.1111/ppc.12744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/04/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To report on healthcare staff's views of the barriers to preventing suicide and self-harm. DESIGN AND METHODS Using a qualitative approach, data were collected through "World Café" discussion forums and written submissions, and analyzed using reflexive thematic analysis. FINDINGS Healthcare staff, including psychiatric nurses, perceived that a whole of society approach was needed for suicide and self-harm prevention. Support for those at the front line is needed as well as clear referral pathways and interagency working. PRACTICE IMPLICATIONS Formalized support for staff working in healthcare should be given with a flexible and inclusive approach to service delivery adopted.
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Affiliation(s)
- John Goodwin
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland.,ENGAGE (Interdisciplinary Clinical Mental Health Research Network), Cork, Republic of Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland
| | - Elaine Meehan
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland
| | - Margaret Murphy
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland
| | - Christina Dillon
- School of Public Health, University College Cork, Cork, Republic of Ireland
| | - Sinead Heffernan
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland
| | - Sonya Greaney
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland.,HSE South, HSE, Cork, Republic of Ireland
| | - Maidy O'Brien
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland
| | | | - Una Twomey
- Service Improvement, HSE, Cork, Republic of Ireland
| | - Aine Horgan
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland.,ENGAGE (Interdisciplinary Clinical Mental Health Research Network), Cork, Republic of Ireland
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6
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Kilty C, Goodwin J, Hartigan I, Meehan E, Murphy M, Dillon C, Heffernan S, Hegarty J, Greaney S, O'Brien M, Chambers D, Twomey U, Horgan A. Healthcare staff's views on responding to suicide and self-harm: Part I. Perspect Psychiatr Care 2021; 57:1693-1699. [PMID: 33616214 DOI: 10.1111/ppc.12737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/23/2020] [Accepted: 01/16/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To explore healthcare staff's knowledge and awareness of, and responses to, suicide and self-harm. DESIGN AND METHODS A qualitative design was adopted, and data were collected using a "World Café" approach (n = 143 participants), in addition to written submissions (n = 10). Data were analyzed using reflexive thematic analysis. FINDINGS There was variation relating to awareness of and responses to suicide and self-harm. Participants highlighted the need for further staff education and training, and a review of standardized assessment tools and referral processes. PRACTICE IMPLICATIONS Tailored training and education resources are required for healthcare staff. Clear protocols for assessing, treating, and referring people deemed at risk of suicide and self-harm are needed.
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Affiliation(s)
- Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - John Goodwin
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland.,ENGAGE (Interdisciplinary Clinical Mental Health Research Network), University College Cork, Cork, Republic of Ireland
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Elaine Meehan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Margaret Murphy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Christina Dillon
- School of Public Health, University College Cork, Cork, Republic of Ireland
| | - Sinead Heffernan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Sonya Greaney
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland.,HSE South, HSE Mental Health Services, Cork, Republic of Ireland
| | - Maidy O'Brien
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | | | - Una Twomey
- Service Improvement, HSE, Cork, Republic of Ireland
| | - Aine Horgan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland.,ENGAGE (Interdisciplinary Clinical Mental Health Research Network), University College Cork, Cork, Republic of Ireland
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7
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Meehan E, Gallagher AL, Ryan J, Kerr C, O' Sullivan R, Galvin R, Manikandan M, Wormald A, Robinson K. Unmet healthcare needs in adults with childhood-onset neurodisabilities: a protocol for a systematic review. HRB Open Res 2021; 4:107. [PMID: 36071876 PMCID: PMC9399657 DOI: 10.12688/hrbopenres.13309.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background
Many adults with childhood-onset neurodisabilities, such as those with intellectual disability or cerebral palsy, report difficulties accessing the healthcare that they require when they are no longer eligible for paediatric services. Compared to the general population, this population is at greater risk of developing many ageing-related diseases and has higher rates of preventable deaths and premature mortality. Addressing unmet healthcare needs is essential to ensuring equitable access in a quality healthcare system. The aim of this systematic review is to synthesise the current available evidence related to unmet healthcare needs in adults with a range of childhood-onset neurodisabilities.
Methods
A systematic review of quantitative research studies of adults with a range of diagnoses that fall under the neurodisability umbrella and outcomes related to unmet healthcare needs will be undertaken. The Conducting Systematic Reviews and Meta-Analyses of Observational Studies (COSMOS-E) guidelines will be adhered to. Searches of key databases will be undertaken, and a two-phase screening process carried out by pairs of independent reviewers to select studies that meet the inclusion criteria. Data will be extracted using a purposefully designed form. Risk of bias will be assessed using the Joanna Briggs Institute Critical Appraisal Tools. If it is possible to pool prevalence data, a meta-analysis will be undertaken. Where pooling of data is not possible, a structured synthesis approach will be used, and results will be presented in tables and summarised narratively.
Conclusions
In recent years, there has been increased emphasis placed on promoting positive ageing and improving the healthcare experiences throughout the lifespan for people with neurodisabilities. Findings of this systematic review can inform decision-making related to healthcare for this vulnerable population and has the potential to contribute to reducing preventable deaths and premature mortality and promoting positive and healthy ageing for this group.
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Affiliation(s)
- Elaine Meehan
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Aoife L. Gallagher
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Implementation Science and Technology Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jennifer Ryan
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Rose Galvin
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Manjula Manikandan
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrew Wormald
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
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8
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Mc Carthy V, Goodwin J, Saab MM, Kilty C, Meehan E, Connaire S, Buckley C, Walsh A, O'Mahony J, O'Donovan A. Nurses and midwives' experiences with peer-group clinical supervision intervention: A pilot study. J Nurs Manag 2021; 29:2523-2533. [PMID: 34213054 DOI: 10.1111/jonm.13404] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/31/2021] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to evaluate differences in supervisees' understanding of clinical supervision and their perceptions of organisational functioning before and after engaging in peer-group clinical supervision. BACKGROUND Protected reflective time allows discussion of complex issues affecting health care. Peer-group clinical supervision is one model of clinical supervision that could facilitate this, but it is poorly understood. METHODS A pre-post intervention pilot study was performed. The intervention was delivered over a 12-month period. Data were collected using surveys on demographic and work-related factors and experience of clinical supervision pre- and post intervention. RESULTS Adaptability increased significantly between the pre- and post surveys. The post survey data showed finding time for clinical supervision scoring lowest with open-ended comments reinforcing this. The supervisees found the sessions to offer a safe place despite initial concerns. CONCLUSION The peer-group model of clinical supervision allowed supervisees to build a rapport and trust with their colleagues and share experiences. IMPLICATIONS FOR NURSING MANAGEMENT The benefits to participating in peer-group clinical supervision traversed the individual and organisation. These data support the implementation of such sessions while addressing workload and time pressures to aid participation.
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Affiliation(s)
- Vera Mc Carthy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Elaine Meehan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sinead Connaire
- Nursing and Midwifery Planning and Development Unit, Health Service Executive, Dublin, Ireland
| | - Carmel Buckley
- Nursing and Midwifery Planning and Development Unit, Health Service Executive, Dublin, Ireland
| | - Anne Walsh
- Nursing and Midwifery Planning and Development Unit, Health Service Executive, Dublin, Ireland
| | - James O'Mahony
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Aine O'Donovan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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9
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Dillon CB, Saab MM, Meehan E, Goodwin MJ, Murphy M, Heffernan MS, Greaney MS, Kilty C, Hartigan I, Chambers D, Twomey U, Horgan A. Staff awareness of suicide and self-harm risk in healthcare settings: A mixed-methods systematic review. J Affect Disord 2020; 276:898-906. [PMID: 32739708 DOI: 10.1016/j.jad.2020.07.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Suicide risk screening in healthcare settings plays a significant role in suicide prevention. Healthcare staff who are poorly informed about self-harm and suicide risk are less likely to identify and subsequently screen at-risk individuals. This mixed-method systematic review aimed to appraise and synthesise evidence from studies that explored and promoted healthcare staff's knowledge and awareness of suicide and self-harm risk in healthcare settings. METHODS Electronic databases (CINAHL, MEDLINE, APA PsycInfo, APA PsycARTICLES, Psychology and behavioural Science Collection, ERIC, and SocINDEX), the Cochrane Library, and various grey literature databases were searched for relevant studies. The level of evidence and methodological quality of the included studies were assessed. RESULTS Eighteen empirical studies were included. Levels of knowledge about suicide and self-harm risk varied significantly across the reviewed studies. Face-to-face group training and educational programmes, digital or online educational programmes, and an educational poster campaign were amongst the strategies used to promote awareness of suicide and self-harm risk, with the majority marginally succeeding in doing so. LIMITATIONS The reviewed studies were heterogeneous in terms of design, interventions, and outcome measures which made it difficult to make comparisons. The overall level of scientific evidence was classified as being relatively low. The lack of blinding and lack of a control group were amongst the limitations for experimental studies. CONCLUSIONS Long-term, routine face-to-face group training programmes should be established to educate healthcare staff about suicide risk across all professions and in specific patient groups.
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Affiliation(s)
- Christina B Dillon
- Environmental Research Institute/School of Public Health, University College Cork, Ireland.
| | - Mohamad M Saab
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Elaine Meehan
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Mr John Goodwin
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Margaret Murphy
- School of Nursing and Midwifery, University College Cork, Ireland
| | | | | | - Caroline Kilty
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Irene Hartigan
- School of Nursing and Midwifery, University College Cork, Ireland
| | | | - Una Twomey
- Health Service Executive Southern Area, Ireland
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Ireland.
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10
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Naughton C, Meehan E, Lehane E, Landers C, Flaherty SJ, Lane A, Landers M, Kilty C, Saab M, Goodwin J, Walshe N, Wills T, Mccarthy V, Murphy S, Mccarthy J, Cummins H, Madden D, Hegarty J. Ethical frameworks for quality improvement activities: an analysis of international practice. Int J Qual Health Care 2020; 32:558-566. [DOI: 10.1093/intqhc/mzaa092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
To examine international approaches to the ethical oversight and regulation of quality improvement and clinical audit in healthcare systems
Data sources
We searched grey literature including websites of national research and ethics regulatory bodies and health departments of selected countries.
Study selection
National guidance documents were included from six countries: Ireland, England, Australia, New Zealand, the United States of America and Canada.
Data extraction
Data were extracted from 19 documents using an a priori framework developed from the published literature.
Results
We organized data under five themes: ethical frameworks; guidance on ethical review; consent, vulnerable groups and personal health data. Quality improvement activity tended to be outside the scope of the ethics frameworks in most countries. Only New Zealand had integrated national ethics standards for both research and quality improvement. Across countries, there is consensus that this activity should not be automatically exempted from ethical review but requires proportionate review or organizational oversight for minimal risk projects. In the majority of countries, there is a lack of guidance on participant consent, use of personal health information and inclusion of vulnerable groups in routine quality improvement.
Conclusion
Where countries fail to provide specific ethics frameworks for quality improvement, guidance is dispersed across several organizations which may lack legal certainty. Our review demonstrates a need for appropriate oversight and responsive infrastructure for quality improvement underpinned by ethical frameworks that build equivalence with research oversight. It outlines aspects of good practice, especially The New Zealand framework that integrates research and quality improvement ethics.
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Affiliation(s)
- Corina Naughton
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Elaine Meehan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Elaine Lehane
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Ciara Landers
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Sarah Jane Flaherty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Aoife Lane
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Margaret Landers
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Mohamad Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - John Goodwin
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Nuala Walshe
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Teresa Wills
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Vera Mccarthy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Siobhan Murphy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Joan Mccarthy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Helen Cummins
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Deirdre Madden
- School of Law, University College Cork, Aras na Laoi, Cork T12 T656, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, Cork T12 AK54, Ireland
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11
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Zarmpi P, Flanagan T, Meehan E, Mann J, Østergaard J, Fotaki N. Biopharmaceutical implications of excipient variability on drug dissolution from immediate release products. Eur J Pharm Biopharm 2020; 154:195-209. [PMID: 32681966 DOI: 10.1016/j.ejpb.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
Elucidating the impact of excipient variability on oral product performance in a biopharmaceutical perspective would be beneficial and allow excipient implementation on Quality by Design (QbD) approaches. The current study investigated the impact of varying viscosity of binders (hypromellose (HPMC)) and superdisintegrants (sodium starch glycolate (SSG)) and particle size distribution of lubricants (magnesium stearate (MgSt)) on the in vitro dissolution of a highly and a poorly soluble drug from immediate release formulations. Compendial (pharmacopoeia buffers) and biorelevant (media simulating the gastrointestinal fluids) media and the USP 2 and USP 4 apparatuses were used to assess the exerted excipient effects on drug dissolution. Real-time dissolution UV imaging provided mechanistic insights into disintegration and dissolution of the immediate release formulations. Varying the viscosity type of HPMC or SSG did not significantly affect drug dissolution irrespective of the compound used. Faster drug dissolution was observed when decreasing the particle size of MgSt for the highly soluble drug. The use of real-time dissolution UV Imaging revealed the influential role of excipient variability on tablet disintegration, as for the highly soluble drug, tablets containing high viscosity HPMC or low particle size MgSt disintegrated faster as compared to the control tablets while for the poorly soluble drug, slower tablet disintegration was observed when increasing the viscosity of the HPMC as compared to the control tablets. Changes in drug dissolution when varying excipients may be anticipated if the excipient change has previously affected drug solubility. The use of multivariate data analysis revealed the influential biopharmaceutical factors such as critical excipient types/properties, drug aqueous solubility, medium/hydrodynamic characteristics affecting the impact of excipient variability on in vitro drug dissolution.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom; Currently at UCB Pharma, Chemin du Foriest, B - 1420 Braine-l'Alleud, Belgium
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - J Østergaard
- Department of Pharmacy, Faculty of Health and Medicinal Sciences, University of Copenhagen, Denmark
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom.
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12
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Meehan E, Foley T, Kelly C, Burgess Kelleher A, Sweeney C, Hally RM, Detering K, Cornally N. Advance Care Planning for Individuals With Chronic Obstructive Pulmonary Disease: A Scoping Review of the Literature. J Pain Symptom Manage 2020; 59:1344-1361. [PMID: 31837455 DOI: 10.1016/j.jpainsymman.2019.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 01/25/2023]
Abstract
CONTEXT Individuals with chronic obstructive pulmonary disease (COPD) typically experience a gradual worsening of the illness in the years before death. Owing to difficulties in predicting the disease trajectory or the timing of acute exacerbations, advance care planning (ACP) may be of particular importance for individuals with COPD. OBJECTIVES The objective of this study was to review and summarize the available literature on current practices around ACP in COPD. METHODS A scoping review of the literature was conducted following the Arksey and O'Malley framework. Original research studies of any design were included. RESULTS Twenty-eight studies were included. Across studies, there was agreement that ACP should be incorporated into routine COPD management. There was evidence that this does not occur in everyday practice, with conversations tending to focus on day-to-day symptom management. Barriers included prognosis uncertainty, insufficient time and training, and a lack of protocols for who is responsible for initiating ACP. Facilitators included the use of transition points for identifying the appropriate time to initiate ACP, and an increased focus on ACP in professional education. The occurrence of repeated episodes of acute care was identified as a key transition point for identifying the palliative stage of COPD and an appropriate time to initiate ACP. CONCLUSION The findings of this review confirm agreement among health care professionals and patients with COPD and their carers that ACP should be incorporated into routine COPD management. The use of transition points may help health care professionals overcome the barrier of prognosis uncertainty and identify patients who might benefit from ACP.
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Affiliation(s)
- Elaine Meehan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Tony Foley
- School of Medicine, University College Cork, Cork, Ireland
| | - Claire Kelly
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | | | - Ruth M Hally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Karen Detering
- Advance Care Planning Australia, Austin Health, Melbourne, Australia
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.
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13
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Impact of Magnesium Stearate Presence and Variability on Drug Apparent Solubility Based on Drug Physicochemical Properties. AAPS J 2020; 22:75. [PMID: 32440810 PMCID: PMC7242257 DOI: 10.1208/s12248-020-00449-w] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/20/2020] [Indexed: 11/30/2022]
Abstract
Excipients are major components of oral solid dosage forms, and changes in their critical material attributes (excipient variability) and/or amount (excipient variation) in pharmaceutical formulations may present a challenge for product performance. Understanding the biopharmaceutical factors affecting excipient performance is recommended for the successful implementation of excipient variability on Quality by Design (QbD) approaches. The current study investigated the impact of magnesium stearate (MgSt) variability on the apparent solubility of drugs with a wide range of physicochemical properties (drug ionization, drug lipophilicity, drug aqueous solubility). Compendial and biorelevant media were used to assess the role of gastrointestinal (GI) conditions on the excipient effects on drug apparent solubility. The lipophilic nature of MgSt decreased the apparent solubility of most compounds. The reduction in drug apparent solubility was more pronounced for highly soluble and/or highly ionized drugs and in presence of more highly crystalline or smaller particle size MgSt. The use of multivariate data analysis revealed the critical physicochemical and biopharmaceutical factors and the complex nature of excipient variability on the reduction in drug apparent solubility. The construction of a roadmap combining drug, excipient and medium characteristics allowed the identification of the cases where the presence of excipient or excipient variability may present risks for oral drug performance.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK.,UCB Pharma, Chemin du Foriest, B-1420, Braine-l'Alleud, Belgium
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - Nikoletta Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK.
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14
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Biopharmaceutical Understanding of Excipient Variability on Drug Apparent Solubility Based on Drug Physicochemical Properties: Case Study-Hypromellose (HPMC). AAPS J 2020; 22:49. [PMID: 32072317 PMCID: PMC7028811 DOI: 10.1208/s12248-019-0411-1] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/21/2019] [Indexed: 02/07/2023]
Abstract
Identification of the biopharmaceutical risks of excipients and excipient variability on oral drug performance can be beneficial for the development of robust oral drug formulations. The current study investigated the impact of Hypromellose (HPMC) presence and varying viscosity type, when used as a binder in immediate release formulations, on the apparent solubility of drugs with wide range of physicochemical properties (drug ionization, drug lipophilicity, drug aqueous solubility). The role of physiological conditions on the impact of excipients on drug apparent solubility was assessed with the use of pharmacopoeia (compendial) and biorelevant media. Presence of HPMC affected drug solubility according to the physicochemical properties of studied compounds. The possible combined effects of polymer adsorption (drug shielding effect) or the formation of a polymeric viscous layer around drug particles may have retarded drug dissolution leading to reduced apparent solubility of highly soluble and/or highly ionized compounds and were pronounced mainly at early time points. Increase in the apparent solubility of poorly soluble low ionized drugs containing a neutral amine group was observed which may relate to enhanced drug solubilization or reduced drug precipitation. The use of multivariate data analysis confirmed the importance of drug physicochemical properties on the impact of excipients on drug apparent solubility and revealed that changes in HPMC material properties or amount may not be critical for oral drug performance when HPMC is used as a binder. The construction of a roadmap combining drug, excipient, and medium characteristics allowed the identification of the cases where HPMC presence may present risks in oral drug performance and bioavailability.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK.,UCB Pharma, Chemin du Foriest, 1420, Braine-l'Alleud, Belgium
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
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15
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Surface dissolution UV imaging for characterization of superdisintegrants and their impact on drug dissolution. Int J Pharm 2020; 577:119080. [PMID: 31988030 DOI: 10.1016/j.ijpharm.2020.119080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/15/2022]
Abstract
Superdisintegrants are a key excipient used in immediate release formulations to promote fast tablet disintegration, therefore understanding the impact of superdisintegrant variability on product performance is important. The current study examined the impact of superdisintegrant critical material attributes (viscosity for sodium starch glycolate (SSG), particle size distribution (PSD) for croscarmellose sodium (CCS)) on their performance (swelling) and on drug dissolution using surface dissolution UV imaging. Acidic and basic pharmacopoeia (compendial) media were used to assess the role of varying pH on superdisintegrant performance and its effect on drug dissolution. A highly soluble (paracetamol) and a poorly soluble (carbamazepine) drug were used as model compounds and drug compacts and drug-excipient compacts were prepared for the dissolution experiments. The presence of a swelled SSG or CCS layer on the compact surface, due to the fast excipient hydration capacity, upon contact with dissolution medium was visualized. The swelling behaviour of superdisintegrants depended on excipient critical material attributes and the pH of the medium. Drug dissolution was faster in presence compared to superdisintegrant absence due to improved compact wetting or compact disintegration. The improvement in drug dissolution was less pronounced with increasing SSG viscosity or CCS particle size. Drug dissolution was slightly more complete in basic compared to acidic conditions in presence of the studied superdisintegrants for the highly soluble drug attributed to the increased excipient hydration capacity and the fast drug release through the swelled excipient structure. The opposite was observed for the poorly soluble drug as potentially the improvement in drug dissolution was compromised by drug release from the highly swelled structure. The use of multivariate data analysis revealed the influential role of excipient and drug properties on the impact of excipient variability on drug dissolution.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom.
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16
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D'Aprano A, Gibb S, Riess S, Cooper M, Mountford N, Meehan E. Important components of a programme for children with medical complexity: An Australian perspective. Child Care Health Dev 2020; 46:90-103. [PMID: 31782538 DOI: 10.1111/cch.12721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Children with medical complexity (CMC) have high care needs, often unmet by traditional healthcare models. In response to this need, the Complex Care Service (CCS) at The Royal Children's Hospital (RCH), Melbourne was created. Although preliminary parent satisfaction data were available, we lacked knowledge of how the various components of the expanded service were valued and contributed to overall caregiver satisfaction. AIM The aims of this study were to (a) determine what caregivers value most about the CCS and (b) explore caregiver perceptions of care. METHODS All caregivers of children enrolled in the RCH CCS in April 2017 were invited to participate. A purposefully designed survey explored caregiver perceptions of care, including patient quality of care; the extent to which the CCS components added value and satisfaction; and frequency of contact. Participants were also invited to answer open-ended questions and provide general comments. RESULTS Responses were received from 53 families (51%). We found that 24-hr phone advice, coordination of appointments, a key contact, and access to timely information were the most important components of the service. More than 90% of caregivers indicated that they were satisfied with care and that the CCS improved their child's quality of care. Coordination, communication, family-centred care, quality care, and access were emergent themes within comments. CONCLUSION This study provides important information regarding the design and operation of services for CMC throughout Australia and further afield. Our findings highlight the importance of the key contact and family-centred care. This has implications for practice, as maintaining service quality, as the CCS expands and is implemented more widely, is a major sustainability challenge. It is crucial that we have a detailed understanding of what elements are required to support effective care coordination, to achieve successful implementation on a larger scale.
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Affiliation(s)
- Anita D'Aprano
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia.,Population Health Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Susie Gibb
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia.,Department of Neurodevelopment & Disability, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Suzi Riess
- Population Health Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment & Disability, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia
| | - Monica Cooper
- Department of Neurodevelopment & Disability, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicki Mountford
- Quality and Improvement, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia
| | - Elaine Meehan
- Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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17
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Burgess Kelleher A, Sweeney C, Foley T, Hally RM, Meehan E, Savage E, Korn B, Cornally N. An e-Delphi Study to Identify Priority Areas for Education on Advance Care Planning in COPD Management. Respir Care 2019; 65:347-354. [DOI: 10.4187/respcare.07072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Meehan E, Sweeney C, Foley T, Lehane E, Burgess Kelleher A, Hally RM, Shanagher D, Korn B, Rabbitte M, Detering KM, Cornally N. Advance care planning in COPD: guidance development for healthcare professionals. BMJ Support Palliat Care 2019; 12:bmjspcare-2019-002002. [PMID: 31685522 DOI: 10.1136/bmjspcare-2019-002002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/19/2019] [Accepted: 10/21/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine current practices, attitudes and levels of confidence related to advance care planning (ACP) in patients with chronic obstructive pulmonary disease (COPD) among healthcare professionals working in Ireland. This will inform future clinical guidance development. METHODS A cross-sectional survey of healthcare professionals. RESULTS There were 143 participants (109 general practitioners, 25 nurses, 7 physiotherapists and 2 consultant physicians). The majority (82%, n=117) cared for patients with COPD weekly, but only 23% (n=33) had initiated ACP with a patient with COPD over the previous 6 months. Overall, 59% (n=85) answered ≥6 of 8 general knowledge questions correctly. Participants demonstrated positive attitudes towards ACP (mean score 3.6/5.0), but confidence levels were low (2.2/4.0). Most thought ACP was appropriate for patients with severe or very severe COPD (71%, n=101%, and 91%, n=130, respectively) but were unsure or felt that it was not appropriate for those with mild-moderate COPD. However, almost all participants (97%, n=139) stated that if a patient expressed a desire to have ACP discussions, they would comply. Topics most likely to be discussed related to diagnosis and treatment options. Death and end-of-life issues were rarely discussed. The death of a family member or friend and participation in support groups were identified as new 'triggers' for initiating ACP. CONCLUSIONS Targeted education to improve general knowledge and confidence levels among healthcare professionals, together with initiatives to increase public awareness of ACP so that patients themselves might be more inclined to start the discussion, may help increase the uptake of ACP for this patient group.
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Affiliation(s)
| | | | - Tony Foley
- School of Medicine, University College Cork, Cork, Ireland
| | - Elaine Lehane
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Ruth M Hally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Bettina Korn
- Hospice Friendly Hospital Programme, St. James's Hospital, Dublin, Ireland
| | - Mary Rabbitte
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | - Karen Margaret Detering
- Advance Care Planning Australia, Austin Health, Melbourne, Victoria, Australia
- Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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19
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Wong AL, Meehan E, Babl FE, Reid SM, Catto-Smith A, Williams K, Reddihough DS. Paediatric emergency department presentations due to feeding tube complications in children with cerebral palsy. J Paediatr Child Health 2019; 55:1230-1236. [PMID: 30697863 DOI: 10.1111/jpc.14386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/06/2017] [Revised: 11/03/2018] [Accepted: 01/01/2019] [Indexed: 10/27/2022]
Abstract
AIM To describe the characteristics of emergency department (ED) presentations due to complications from gastrostomy or gastrojejunal feeding tubes among children with cerebral palsy (CP), the complexity of complications and the management approaches taken. METHODS The Victorian CP Register was linked to the ED databases of Victoria's two tertiary paediatric hospitals, and data on presentations due to feeding tube complications were identified based on discharge diagnosis codes. Additional data on presentations were extracted from medical records. RESULTS Over 5 years, there were 234 ED presentations due to feeding tube-related complaints among a CP cohort (n = 2183). ED notes were located for 183 of the 234 presentations. The majority of presentations (90%) involved children with severe gross motor impairment. A total of 46% of presentations (n = 84) was triaged as lower urgency, and 68% (n = 124) took place between 08:00 am and 06:00 pm. The most common presenting complaint was tube dislodgement (n = 105; 70%). No investigations were recorded in the majority of cases, and in almost 90% of cases, the feeding tube was successfully replaced in the ED, usually by an ED physician (n = 74) and less frequently by a surgeon (n = 9), gastroenterologist (n = 2) or nurse (n = 8); 9% (n = 17) resulted in a hospital admission. CONCLUSIONS Most ED presentations due to feeding tube complaints in children with CP are in children with severe gross motor impairment but are able to be managed in the ED. As such, it is likely that care givers and other health professionals could manage some of the complications experienced in primary health-care settings closer to home.
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Affiliation(s)
- Ai-Lynn Wong
- Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Elaine Meehan
- Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Reid
- Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Catto-Smith
- Department of Gastroenterology, Hepatology and Liver Transplant, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Katrina Williams
- Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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20
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Meehan E, D’Aprano AL, Gibb SM, Mountford NJ, Williams K, Harvey AR, Connell TG, Cohen E. Comprehensive care programmes for children with medical complexity. Hippokratia 2019. [DOI: 10.1002/14651858.cd013329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elaine Meehan
- Murdoch Children's Research Institute; Neurodisability and Rehabilitation; 50 Flemington Road Melbourne Victoria Australia 3052
| | - Anita L D’Aprano
- The Royal Children's Hospital; General Medicine; Melbourne Australia
| | - Susan M Gibb
- The Royal Children's Hospital; Neurodevelopment and Disability; Melbourne Australia
| | - Nicki J Mountford
- The Royal Children's Hospital; Complex Care Hub; Melbourne Australia
| | - Katrina Williams
- The University of Melbourne; Department of Paediatrics; Melbourne Australia
| | - Adrienne R Harvey
- Murdoch Children's Research Institute; Neurodisability and Rehabilitation; 50 Flemington Road Melbourne Victoria Australia 3052
| | - Tom G Connell
- The Royal Children's Hospital; General Medicine; Melbourne Australia
| | - Eyal Cohen
- University of Toronto; Pediatrics and Health Policy, Management & Evaluation; The Hospital for Sick Children 555 University Avenue Toronto ON Canada M5G 1X8
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Meehan E, Williams K, Reid SM, Freed GL, Babl FE, Sewell JR, Vidmar S, Donath S, Reddihough DS. Comparing emergency department presentations among children with cerebral palsy with general childhood presentations: a data linkage study. Dev Med Child Neurol 2017; 59:1188-1195. [PMID: 28786475 DOI: 10.1111/dmcn.13518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 11/28/2022]
Abstract
AIM The aims of this study were to estimate the proportion of emergency department presentations attributable to children with cerebral palsy (CP), investigate the frequency of emergency department presentations in a CP cohort, and compare emergency department presentations among children with CP with those of other children. METHOD This was a retrospective cohort study. The Victorian Cerebral Palsy Register was linked to the Victorian Emergency Minimum Dataset. Data on emergency department presentations for the CP cohort occurring between 2007 and 2014 and population control data were obtained. RESULTS The CP cohort (n=1748) had 7015 emergency department presentations during the 7-year period, accounting for 0.4% of the 1.69 million age-specific presentations during that time. The number of annual presentations per 1000 children rose with increasing CP severity. Compared with presentations among the general population, higher proportions of presentations among the CP cohort were preceded by ambulance arrivals (27% vs 8%), triaged as urgent (66% vs 32%), and required hospital admission (38% vs 12%). INTERPRETATION The marked differences in presentations between the CP cohort and the general population in the proportions that were urgent and required ambulance arrivals and hospital admissions was an important finding. Strategies to ensure appropriate use of services, including encouragement to seek earlier assistance from primary care providers, may prevent problems escalating to the need for urgent care. WHAT THIS PAPER ADDS Children with cerebral palsy (CP) account for 0.4% of childhood emergency department presentations. More emergency department presentations among children with CP require ambulance arrival. More CP emergency department presentations are urgent and require hospital admission. Traditional emergency department triage scales seem less accurate for this group.
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Affiliation(s)
- Elaine Meehan
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Katrina Williams
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Reid
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Gary L Freed
- Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Jillian R Sewell
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Suzanna Vidmar
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Epidemiology & Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Susan Donath
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Epidemiology & Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Meehan E, Reid SM, Williams K, Freed GL, Sewell JR, Vidmar S, Donath S, Reddihough DS. Hospital admissions in children with cerebral palsy: a data linkage study. Dev Med Child Neurol 2017; 59:512-519. [PMID: 27900776 DOI: 10.1111/dmcn.13350] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 01/06/2023]
Abstract
AIM The overall aim was to investigate the feasibility and utility of linking a cerebral palsy (CP) register to an administrative data set for health services research purposes. We sought to compare CP hospital admissions to general childhood population admissions, and identify factors associated with type and frequency of admissions in a CP cohort. METHOD The CP register for Victoria, Australia was linked to the state's hospital admissions database. Data pertaining to the admissions of a CP cohort (n=1748) that took place between 2007 and 2014 were extracted. Population data were also obtained. RESULTS Overall, 80% of the CP cohort (n=1401) had at least admission between 2007 and 2014, accounting for 11 012 admissions or 1.5% of all admissions in their age group. Compared to general population admissions, CP admissions were more costly and more likely to be elective (66% vs 57%; p<0.001), medical (71% vs 57%; p<0.001), and to take place in metropolitan hospitals (92% vs 78%; p<0.001). Increased CP severity and complexity were associated with having more admissions and a higher proportion of admissions attributable to respiratory illness. INTERPRETATION By linking with administrative data sets, CP registers may be useful for health services research and inform health service delivery.
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Affiliation(s)
- Elaine Meehan
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Susan M Reid
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Katrina Williams
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Gary L Freed
- Health Systems and Workforce Unit, Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | - Jillian R Sewell
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Suzanna Vidmar
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Clinical Epidemiology and Biostatistics Unit, Data Science, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Susan Donath
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Clinical Epidemiology and Biostatistics Unit, Data Science, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Dinah S Reddihough
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia
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23
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Biopharmaceutical aspects and implications of excipient variability in drug product performance. Eur J Pharm Biopharm 2017; 111:1-15. [DOI: 10.1016/j.ejpb.2016.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 12/29/2022]
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Meehan E, Harvey A, Reid SM, Reddihough DS, Williams K, Crompton KE, Omar S, Scheinberg A. Therapy service use in children and adolescents with cerebral palsy: An Australian perspective. J Paediatr Child Health 2016; 52:308-14. [PMID: 26607781 DOI: 10.1111/jpc.13021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Accepted: 09/21/2015] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to describe the patterns of therapy service use for a sample of children and adolescents with cerebral palsy over a 1 year period and to identify factors associated with frequency of therapy and parental satisfaction with therapy frequency. METHODS Parents of 83 children completed a survey on their child's use of occupational therapy, physiotherapy and speech and language pathology services over the previous year. Participants were randomly selected from a sample stratified by age and Gross Motor Function Classification System (GMFCS) level. RESULTS During the year prior to survey completion, 83% of children had received occupational therapy, 88% had received physiotherapy and 60% had received speech and language pathology services. Frequency of therapy was higher for younger children (P < 0.01), those classified at GMFCS levels IV-V (P < 0.05) and those attending schools specifically for children with disabilities. CONCLUSIONS Current structures for therapy service delivery for children with cerebral palsy are systems-based, and age-based funding systems and the organisation of services around the education system are preventing the delivery of needs-based therapy. Paediatricians that care for children and young people with cerebral palsy need to pay particular attention to those that may miss out on therapy due to age or school type, and support these families in accessing appropriate therapy.
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Affiliation(s)
- Elaine Meehan
- Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Adrienne Harvey
- Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan M Reid
- Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Katrina Williams
- Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kylie E Crompton
- Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Suhaila Omar
- Victorian Paediatric Rehabilitation Service, Melbourne, Victoria, Australia
| | - Adam Scheinberg
- Victorian Paediatric Rehabilitation Service, Melbourne, Victoria, Australia
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Reddihough DS, Meehan E, Stott NS, Delacy MJ. The National Disability Insurance Scheme: a time for real change in Australia. Dev Med Child Neurol 2016; 58 Suppl 2:66-70. [PMID: 26782069 DOI: 10.1111/dmcn.13007] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 11/30/2022]
Abstract
In Australia, the supports and services for persons with disabilities have long been underfunded and fragmented. Often, individuals did not receive the services they needed, but rather the services they were entitled to based on how or when they acquired their disability. As a result, there was an increasing reliance on ageing carers, a lack of permanent and respite accommodation, and reduced employment and educational opportunities. Individuals with disabilities and their families were often isolated and financially disadvantaged. In March 2013, legislation was passed in Australia to establish a National Disability Insurance Scheme, a radical new way of funding disability services. No longer would funding be directed to agencies, but rather to individuals who would make their own plan and select their preferred services and service providers, giving them more control over the services and supports they receive. The hope is that this change from a welfare-driven to an insurance-based model will improve equity of service delivery, levels of participation, and overall quality of life among Australians with disabilities and their families.
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Affiliation(s)
- Dinah S Reddihough
- Developmental Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Elaine Meehan
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - N Susan Stott
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Michael J Delacy
- Queensland Cerebral Palsy Register, Cerebral Palsy League, Fortitude Valley, QLD, Australia
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26
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Reid SM, Meehan E, Gibson CS, Scott H, Delacy MJ. Biological sex and the risk of cerebral palsy in Victoria, Australia. Dev Med Child Neurol 2016; 58 Suppl 2:43-9. [PMID: 26762863 DOI: 10.1111/dmcn.13021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 11/26/2022]
Abstract
AIM Males typically outnumber females in cerebral palsy (CP) cohorts. To better understand this 'male disadvantage' and provide insight into causal pathways to CP, this study used 1983 to 2009 Australian CP and population birth cohorts to identify associations and trends with respect to biological sex and CP. METHOD Within birth gestation groups, sex ratios were calculated to evaluate any male excess in the CP cohort compared with livebirths, neonatal deaths, neonatal mortality and survival rates, neonatal survivors, and CP rates in survivors. Sex- and gestation-specific trends in neonatal mortality, CP rates, and CP sex ratios were assessed by plotting their annual frequencies and fitting quadratic curves. RESULTS Over-representation of males in preterm live births partly explained the male excess in the CP cohort after preterm birth, especially at 28 to 31 weeks. Higher CP rates in male neonatal survivors also contributed to the male excess in CP, particularly at <28 and 37+ weeks. Higher neonatal mortality rates in males at all gestations had little impact on the CP sex ratio. There was no clearly discernible change over time in the CP sex ratio. INTERPRETATION Gestation-specific associations between sex and CP provide insight into causal pathways to CP and suggest sex-specific differences in response to neuroprotective strategies.
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Affiliation(s)
- Susan M Reid
- Developmental Disability & Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Elaine Meehan
- Developmental Disability & Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Catherine S Gibson
- South Australian Birth Defects Register, Women's and Children's Hospital, Women's and Children's Health Network, Adelaide, SA, Australia
| | - Heather Scott
- South Australian Birth Defects Register, Women's and Children's Hospital, Women's and Children's Health Network, Adelaide, SA, Australia
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Smithers-Sheedy H, McIntyre S, Gibson C, Meehan E, Scott H, Goldsmith S, Watson L, Badawi N, Walker K, Novak I, Blair E. A special supplement: findings from the Australian Cerebral Palsy Register, birth years 1993 to 2006. Dev Med Child Neurol 2016; 58 Suppl 2:5-10. [PMID: 26762930 DOI: 10.1111/dmcn.13026] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/30/2022]
Abstract
AIM To briefly outline the strengths and limitations of cerebral palsy (CP) registers, and to report on findings of the Australian Cerebral Palsy Register (ACPR) pertaining to a population cohort of children with CP. METHOD De-identified data were extracted from the ACPR for people with CP in birth years 1993 to 2006, from South Australia, Victoria, and Western Australia. Live birth prevalence of CP was estimated and risk factors described. RESULTS The overall birth prevalence of CP (including those whose CP was postneonatally acquired) for the 1993 to 2006 birth cohort was 2.1 per 1000 live births (95% confidence interval [CI] 2.0-2.2). Excluding cases with a known postneonatal cause, the birth prevalence for pre/perinatally acquired CP was 2.0 per 1000 live births (95% CI 1.9-2.1). A downward trend in rates of CP in those born extremely preterm was evident over at least three consecutive periods across all three regions. Most (58.6%) children were born at term (≥ 37 wks). Male sex, early gestational age, low birthweight, and multiple birth were risk factors for CP. INTERPRETATION Overall rates of CP did not change during this period. The proportion of those with CP born extremely preterm decreased. The ACPR Group will investigate whether this pattern continues when data pertaining to the next birth cohort for all three regions becomes available.
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Affiliation(s)
- Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Gibson
- South Australian Birth Defects Register, Women's and Children's Hospital, Women's and Children's Health Network, Adelaide, SA, Australia
| | - Elaine Meehan
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Heather Scott
- South Australian Birth Defects Register, Women's and Children's Hospital, Women's and Children's Health Network, Adelaide, SA, Australia
| | - Shona Goldsmith
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Linda Watson
- Department of Health Western Australia, Perth, WA, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia.,The Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Karen Walker
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,The Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Iona Novak
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia
| | - Eve Blair
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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Reid SM, Meehan E, McIntyre S, Goldsmith S, Badawi N, Reddihough DS. Temporal trends in cerebral palsy by impairment severity and birth gestation. Dev Med Child Neurol 2016; 58 Suppl 2:25-35. [PMID: 26762733 DOI: 10.1111/dmcn.13001] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2015] [Indexed: 11/30/2022]
Abstract
AIM Our aim was to build on previous research indicating that rates of cerebral palsy (CP) in the Australian state of Victoria are declining, and examine whether severity of impairments is also decreasing. METHOD Data on individuals with CP were extracted from the Victorian Cerebral Palsy Register for birth years 1983 to 2009. The yearly rates of dichotomized categories for gross motor function, motor laterality, intellectual impairment, and epilepsy per 1000 neonatal survivors and proportions in the CP cohort were tabulated and plotted by birth gestation. Linear regression modelling was used to fit prediction curves; likelihood ratio tests were used to test for differences in trends between impairment severity groups. RESULTS Since the mid-1990s, CP rates declined in neonatal survivors of birth at all gestations. Our data suggest that the decreasing CP rates were associated with relatively greater decreases in the rates of Gross Motor Function Classification System levels III to V, bilateral CP, epilepsy, and intellectual impairment (all p<0.005). Some variation was seen between birth gestation groups. INTERPRETATION Declines in rates of CP of all levels of severity and complexity from the mid-1990s provides 'real-world' support for the effectiveness of concurrent neuroprotective strategies and continual innovation in perinatal practices.
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Affiliation(s)
- Susan M Reid
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Elaine Meehan
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Shona Goldsmith
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Grace Centre for Newborn Care, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | - Dinah S Reddihough
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia
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Smithers-Sheedy H, Raynes-Greenow C, Badawi N, Reid SM, Meehan E, Gibson CS, Dale RC, Jones CA. Neuroimaging findings in a series of children with cerebral palsy and congenital cytomegalovirus infection. Infect Disord Drug Targets 2015; 14:185-90. [PMID: 25809629 DOI: 10.2174/1871526515999150320154858] [Citation(s) in RCA: 7] [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: 10/23/2015] [Revised: 11/21/2014] [Accepted: 11/25/2014] [Indexed: 11/22/2022]
Abstract
UNLABELLED Congenital cytomegalovirus (cCMV) is a contributing cause of neurodevelopmental disabilities including cerebral palsy (CP). In this case series we reviewed the neuroimaging findings of children with CP and cCMV infection in the context of the children's clinical profile. PARTICIPANTS Children with CP and laboratory confirmed cCMV (n=12) reported to the Australian CP Register, born in South Australia and Victoria, 1993-2006, with magnetic resonance imaging (MRI) and/or computerized tomography (CT) report available. Clinical details and neuroimaging findings were tabulated and compared to published literature. Children in this series were mostly born at term (n=8), with symptoms or signs of cCMV (n=10) and had spastic quadriplegia (n=9), epilepsy (n=8), intellectual deficit (n=12), communication (n=10) and hearing impairments (n=9). All but one had abnormal neuroimaging findings reported on MRI or CT (n=11): most commonly brain malformations including disorders of neuronal migration (n=10), such as lissencephaly, pachygyria and polymicrogyria, and cerebellar hypoplasia (n=5). Other findings included ventricular dilatation (n=8), calcifications (n=7) and white matter abnormalities (n=6). This study suggests that brain malformations, calcifications, ventricular dilatation and cerebellar hypoplasia are common neuroimaging patterns in children with CP and cCMV infection. The presence of these findings should prompt investigations for congenital cytomegalovirus.
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Affiliation(s)
| | | | | | | | | | | | | | - Cheryl A Jones
- Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145 Australia.
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Meehan E, Freed GL, Reid SM, Williams K, Sewell JR, Rawicki B, Reddihough DS. Tertiary paediatric hospital admissions in children and young people with cerebral palsy. Child Care Health Dev 2015; 41:928-37. [PMID: 26032706 DOI: 10.1111/cch.12263] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 12/17/2014] [Revised: 04/30/2015] [Accepted: 05/03/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many previous studies that have investigated hospital admissions in children and young people with cerebral palsy lack information on cerebral palsy severity and complexity. Consequently, little is known about factors associated with the frequency and type of hospital admissions in this population. This study used hospital admission data available for all children and young people known to a population-based cerebral palsy register to describe the patterns of use of tertiary paediatric hospital services over a 5-year period. METHODS This was a retrospective cohort analysis of routinely collected admission data from the two tertiary paediatric hospitals in the Australian state of Victoria. Data on admissions of individuals born between 1993 and 2008 registered on the Victorian Cerebral Palsy Register were analysed (n = 2183). RESULTS Between 2008 and 2012, 53% of the cohort (n = 1160) had at least one same-day admission, and 46% (n = 996) had one or more multi-day admissions. Those with a moderate to severe motor impairment and those with a co-diagnosis of epilepsy had more admissions, and for multi-day admissions, longer lengths of stay, P < 0.05. Across all severity levels, respiratory and musculoskeletal diseases were the most frequently reported reasons for medical and surgical admissions, respectively. All-cause readmission rates for urgent multi-day stays within 7, 30 and 365 days of an index admission were 10%, 23% and 63%, respectively. CONCLUSIONS The reasons for hospital admissions reported here reflect the range of comorbidities experienced by children and young people with cerebral palsy. This study highlights priority areas for prevention, early diagnosis and medical management in this group. Improved primary and secondary prevention measures may decrease non-elective hospital admissions and readmissions in this group and reduce paediatric inpatient resource use and healthcare expenditure attributable to cerebral palsy.
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Affiliation(s)
- E Meehan
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
| | - G L Freed
- Health Systems and Workforce Unit, Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - S M Reid
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
| | - K Williams
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia.,Developmental Medicine, Royal Children's Hospital, Melbourne, Australia.,Deakin Child Study Centre, School of Psychology, Deakin University, Melbourne, Australia
| | - J R Sewell
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Australia.,Community Health Services Research, Population Health, Murdoch Childrens Research Institute, Melbourne, Australia
| | - B Rawicki
- Paediatric Rehabilitation, Monash Children's Hospital, Melbourne, Australia
| | - D S Reddihough
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia.,Developmental Medicine, Royal Children's Hospital, Melbourne, Australia
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31
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Meehan E, Reid SM, Williams K, Freed GL, Babl FE, Sewell JR, Rawicki B, Reddihough DS. Tertiary paediatric emergency department use in children and young people with cerebral palsy. J Paediatr Child Health 2015; 51:994-1000. [PMID: 25976361 DOI: 10.1111/jpc.12919] [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] [Accepted: 04/07/2015] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to describe the pattern of tertiary paediatric emergency department (ED) use in children and young people with cerebral palsy (CP). METHODS A retrospective analysis of ED data routinely collected at the two tertiary paediatric hospitals in Victoria, Australia, cross-matched with the Victorian Cerebral Palsy Register. Data pertaining to the ED presentations of 2183 registered individuals born 1993-2008 were obtained. RESULTS Between 2008 and 2012, 37% (n = 814) of the CP cohort had 3631 tertiary paediatric ED presentations. Overall, 40% (n = 332) of presenters were residing in inner metropolitan Melbourne; 44% (n = 356) in outer Melbourne; and 13% (n = 108) in regional Victoria. Presenters were more likely than non-presenters to be younger, non-ambulant and have epilepsy. In total, 71% of presentations were triaged as Australasian Triage Scale 1-3 (urgent), and 44% resulted in a hospital admission. Disorders of the respiratory, neurological and gastrointestinal systems, and medical device problems were responsible for 72% of presentations. CONCLUSION Many of the tertiary paediatric ED presentations in this group were appropriate based on the high admission rate and the large proportion triaged as urgent. However, there is evidence that some families are bypassing local services and travelling long distances to attend the tertiary paediatric ED, even for less urgent complaints that do not require hospital admission. Alternative pathways of care delivery, and strategies to promote the management of common problems experienced by children and young people with CP in non-paediatric EDs or primary care settings, may go some way towards reducing unnecessary tertiary paediatric ED use in this group.
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Affiliation(s)
- Elaine Meehan
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Susan M Reid
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gary L Freed
- Health Systems and Workforce Unit, Centre for Health Policy, School of Global and Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jillian R Sewell
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Policy, Equity and Translation Research, Population Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Barry Rawicki
- Paediatric Rehabilitation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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Teale MJ, Kahsai M, Singh SK, Edmondson SP, Gupta R, Shriver JW, Meehan E. Cloning, expression, crystallization and preliminary X-ray analysis of the DNA-binding protein Sso10a from Sulfolobus solfataricus. Acta Crystallogr D Biol Crystallogr 2003; 59:1320-2. [PMID: 12832799 DOI: 10.1107/s090744490301062x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2003] [Accepted: 05/13/2003] [Indexed: 11/10/2022]
Abstract
The gene for the DNA-binding protein Sso10a from the hyperthermophilic archaeon Sulfolobus solfataricus was cloned and overexpressed in Escherichia coli. Crystals of the purified protein have been grown that diffract to beyond 2.15 A resolution. The protein crystals belong to the orthorhombic space group P2(1)2(1)2(1), with unit-cell parameters a = 57.24, b = 60.16, c = 69.96 A. With one dimer per asymmetric unit, the crystal to volume per protein mass (V(M)) is 2.9 A(3) Da(-1) and the solvent content is approximately 57%. Complete X-ray diffraction native data were collected from a single crystal and processed to 2.15 A.
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Affiliation(s)
- M J Teale
- Chemistry Department, University of Alabama in Huntsville, Huntsville, AL 35899, USA.
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Abstract
Particle size and particle size distribution can have a fundamental effect on the physical properties of colloidal dispersions. For many systems the measurement of average particle size is not sufficient, the presence of different size populations will have a strong influence on properties and could be related to the production process. Hydrodynamic chromatography (HDC) provides a method for the separation of polymers in solution or particles in suspension based on their size. In a packed column, the separation takes place in the inter-particle channels and the elution order is from large to small, analogous to gel permeation chromatography. The dynamic range of packed column HDC is from molecular size up to particles of greater than 1 microm. New instrumentation which can be used to determine the particle size distribution of a range of colloidal dispersions by packed column HDC is described. Data to support accuracy and precision of average particle size determination is presented as well as a number of case studies to illustrate the applicability of the technique to samples with polydisperse or multi-modal particle size distributions.
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Affiliation(s)
- A Williams
- Polymer Laboratories, Essex Road, Church Stretton, SY6 6AX, Shropshire, UK
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Karpova EA, Meehan E, Pusey ML, Chen L. Crystallization and preliminary X-ray diffraction analysis of restriction endonuclease EcoRII. Acta Crystallogr D Biol Crystallogr 1999; 55:1604-5. [PMID: 10489460 DOI: 10.1107/s090744499900863x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Crystals of the restriction endonuclease EcoRII have been obtained by the vapor-diffusion technique in the presence of ammonium sulfate or polyethylene glycol. The best crystals were grown with ammonium sulfate as a precipitant. Crystals with dimensions of up to 0.6 x 0. 6 x 0.6 mm have been observed. The crystals diffract to about 4.0 A resolution at a cryo-temperature of 100 K using a rotating-anode X-ray source and a Rigaku R-AXIS IV imaging-plate detector. The space group has been determined to be either I23 or I2(1)3, with unit-cell parameters a = b = c = 160.3 A, alpha = beta = gamma = 90 degrees. The crystal asymmetric unit contains two protein molecules, and self-rotation function analysis shows a pseudo-twofold symmetry relating the two monomers. Attempts to improve the resolution of crystal diffraction and to search for heavy-atom derivatives are under way.
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Affiliation(s)
- E A Karpova
- NASA Marshall Space Flight Center, Huntsville, AL 35812, USA
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McClean S, Prosser E, Meehan E, O'Malley D, Clarke N, Ramtoola Z, Brayden D. Binding and uptake of biodegradable poly-DL-lactide micro- and nanoparticles in intestinal epithelia. Eur J Pharm Sci 1998; 6:153-63. [PMID: 9795038 DOI: 10.1016/s0928-0987(97)10007-0] [Citation(s) in RCA: 215] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The use of biodegradable particles as oral delivery vehicles for macromolecular drugs was investigated. We evaluated the binding, uptake and absorption of poly-dl-lactide (PLA) micro- and nanoparticles in Caco-2 monolayers and in ileal tissue and gut associated lymphoid tissue (GALT) of anaesthetised rats and rabbits. Using a range of experimental techniques, we found that approximately 10% of administered micro- and nanoparticles were adsorbed to the apical membranes of each of the five intestinal models. Nanoparticles were found to be absorbed better than microparticles. Overall, little discrimination in uptake patterns was evident between Peyer's patch (PP) and non-PP tissue while rat ileum showed a greater uptake capacity than rabbit. Our results show that uptake of PLA particles was low capacity, size-dependent and predominantly transcellular in all systems. A low proportion of the apically-bound particles was absorbed, with uptake exclusion evident for particles >4microm. The affinity of PLA particles for intestinal epithelia and GALT needs to be greatly enhanced in order to achieve improved oral bioavailability of macromolecules.
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Affiliation(s)
- S McClean
- Elan Pharmaceutical Technologies, Biotechnology Building, Trinity College, Dublin 2, Ireland
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Scully P, Meehan E, Kelly JG. High-performance liquid chromatographic assay for diltiazem in small-volume blood specimens and application to pharmacokinetic studies in rats. J Chromatogr A 1996; 729:297-300. [PMID: 9004953 DOI: 10.1016/0021-9673(95)01235-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A high-performance liquid chromatographic (HPLC) method was developed which involves the use of two 5-microns BDS silica gel columns (15 cm x 4.6 mm I.D.) in series for increased resolution and sensitivity, and an organic mobile phase for both extraction and elution of diltiazem. Plasma samples (400 microliters) were extracted using the organic mobile phase [n-hexane-methanol-dichloromethane-ammonia (370:35:30:0.3)] and the extracts were monitored at 240 nm. Desipramine (30 micrograms ml-1) was the internal standard. The limit of quantification in plasma was 20 ng ml-1 with a correlation coefficient of > or = 0.999 within the 20-800 ng ml-1 standard window. The inter- and intra-assay R.S.D.s were within 5%. The recovery of diltiazem varied from 101.1% at 20 ng ml-1 to 93.7% at 400 ng ml-1. The method was applied to the investigation of diltiazem absorption in a rat. Drug absorption was based on the intestinal single-pass perfusion model. The concentration of diltiazem in all test perfusion solutions was 1 mg ml-1 (2.4 mM) and the flow-rate through the system was 3.33.10(-3) ml s-1. A non-specific mucolytic absorption enhancer was also added to a diltiazem solution and studied in the in situ system. The pharmacokinetics of diltiazem hydrochloride were investigated in two study groups of Wistar rats (n = 4). A two-sample Student's t-test was employed to compare values of the area under the curve (AUC). The pharmacokinetic data indicated that the AUC in the group which received the enhancer [18.12 +/- 5.43 ng ml-1 h-1 (+/- S.D.)] was higher than that in the control group (11.49 +/- 3.67 ng h-1 ml-1), t-test; p = 0.0483. Hence it was shown that administration of an enhancer could increase the oral bioavailability of diltiazem.
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Affiliation(s)
- P Scully
- Elan Corporation Research Institute, Trinity College, Dublin, Ireland
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Brayden D, Creed E, Meehan E, O'Malley K. Passive transepithelial diltiazem absorption across intestinal tissue leading to tight junction openings. J Control Release 1996. [DOI: 10.1016/0168-3659(95)00120-4] [Citation(s) in RCA: 4] [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: 11/29/2022]
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Meehan E, Beaugé F, Choquart D, Leonard BE. Influence of an n-6 polyunsaturated fatty acid-enriched diet on the development of tolerance during chronic ethanol administration in rats. Alcohol Clin Exp Res 1995; 19:1441-6. [PMID: 8749808 DOI: 10.1111/j.1530-0277.1995.tb01005.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study investigates the effects of n-6 polyunsaturated fatty acids (PUFAs), in the form of dietary Evening Primrose Oil (EPO) and safflower oil, on the development of tolerance to ethanol. The degree of fluorescence polarization of the fluoroprobes DPH, PROP-DPH, and TMA-DPH in isolated cortical synaptosomal membranes was measured. In addition, the development of tolerance, as shown by changes in synaptosomal membrane fluidity after an acute in vitro ethanol challenge, was also determined after 20 weeks of ethanol administration, either alone or together with a PUFA-enriched diet. Although the administration of EPO-enriched diet did not significantly render the inner core of the cortical synaptosomal membrane tolerant to the acute ethanol challenge, concomitant administration of ethanol and EPO was found to increase further the rigidity and tolerance to the acute ethanol challenge in the inner core. Chronic administration of safflower oil, which lacks gamma-linolenic acid (18:3, n-6) but like EPO contains linoleic acid, either alone or together with chronic ethanol had no effect on synaptosomal membrane fluidity after an acute ethanol challenge. The results suggest that gamma-linolenic acid or its metabolites may have an important role to play in the development of tolerance to chronic ethanol.
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Affiliation(s)
- E Meehan
- Department of Pharmacology, University College, Galway, Ireland
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Meehan E, Warner FP, Reid SP, Patterson M, Dawkins JV. Characterization of Poly(Vinyl Alcohol) by Liquid Chromatographic Techniques. International Journal of Polymer Analysis and Characterization 1995. [DOI: 10.1080/10236669508233896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Meehan E, Lloyd LL, McConville JA, Warner FP, Gabbott NP, Dawkins JV. Rigid polymeric packings for aqueous size exclusion chromatography. J Appl Polym Sci 1991. [DOI: 10.1002/app.1991.070480002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Meehan E, MacRae K. Legal implications of premenstrual syndrome: a Canadian perspective. CMAJ 1986; 135:601-8. [PMID: 3756691 PMCID: PMC1491301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A summary of the symptoms, prevalence and history of premenstrual syndrome (PMS) is presented. The legal implications of PMS, particularly its use as a defence in criminal prosecutions and as an implicit factor in specific offences, are discussed by means of an analysis of Canadian legal cases, with reference to those in England and the United States. The authors offer suggestions on how physicians can make use of PMS in a courtroom more reliable. They conclude that PMS is unlikely to become a substantive criminal defence until the medical community more fully recognizes its significance. Although the role of PMS as a mitigating factor in sentencing may be illogical, the courts now recognize the syndrome in a legally and practically important manner.
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Meehan E. United team in Manchester. Nurs Mirror 1984; 159:28-9. [PMID: 6567159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Meehan E. Developments re pensions. World Ir Nurs 1978; 7:9. [PMID: 246637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Meehan E. A concept of professionalism; integrity and openness. World Ir Nurs 1975; 4:4-5. [PMID: 1048815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
Pairs of rats received grid shock in a conical enclosure. Each shock elicited the stereotyped fighting posture. An omnidirectional pole, which was always between the rats, was accidentally operated whenever the rats fought. The number of pole hits, and the number of observed fight bouts, increased with current intensity. The number of pole hits served as a reliable and objective measure of shock-induced fighting in rats.
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