1
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Bortoluzzi A, Fanouriakis A, Silvagni E, Appenzeller S, Carli L, Carrara G, Cauli A, Conti F, Costallat LTL, De Marchi G, Doria A, Fredi M, Franceschini F, Garaffoni C, Hanly JG, Mosca M, Murphy E, Piga M, Quartuccio L, Scirè CA, Tomietto P, Truglia S, Zanetti A, Zen M, Bertsias G, Govoni M. Therapeutic Strategies and Outcomes in Neuropsychiatric Systemic Lupus Erythematosus: An International Multicenter Retrospective Study. Rheumatology (Oxford) 2024:keae119. [PMID: 38402539 DOI: 10.1093/rheumatology/keae119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/20/2023] [Accepted: 02/07/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES The management of neuropsychiatric systemic lupus erythematosus (NPSLE) poses considerable challenges due to limited clinical trials. Therapeutic decisions are customized based on suspected pathogenic mechanisms and symptom severity. This study aimed to investigate therapeutic strategies and disease outcome for patients with NPSLE experiencing their first neuropsychiatric (NP) manifestation. METHODS This retrospective cohort study defined NP events according to the American College of Rheumatology case definition, categorizing them into three clusters: central/diffuse, central/focal and peripheral. Clinical judgment and a validated attribution algorithm were used for NP event attribution. Data included demographic variables, SLE disease activity index, cumulative organ damage, and NP manifestation treatments. The clinical outcome of all NP events was determined by a physician seven-point Likert scale. Predictors of clinical improvement/resolution were investigated in a multivariable logistic regression analysis. RESULTS The analysis included 350 events. Immunosuppressants and corticosteroids were more frequently initiated/escalated for SLE-attributed central diffuse or focal NP manifestations. At 12 months of follow-up, 64% of patients showed a clinical improvement in NP manifestations. Focal central events and SLE-attributed manifestations correlated with higher rates of clinical improvement. Patients with NP manifestations attributed to SLE according to clinical judgment and treated with immunosuppressants had a significantly higher probability of achieving clinical response (OR 2.55, 95%CI 1.06-6.41, p= 0.04). Age at diagnosis and focal central events emerged as additional response predictors. CONCLUSION NP manifestations attributed to SLE by clinical judgment and treated with immunosuppressants demonstrated improved 12-month outcomes. This underscores the importance of accurate attribution and timely diagnosis of NPSLE.
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Affiliation(s)
- Alessandra Bortoluzzi
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Cona, 44124, Italy
| | - Antonis Fanouriakis
- Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital and National Kapodistrian University of Athens Medical School, Athens, 12462, Greece
| | - Ettore Silvagni
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Cona, 44124, Italy
| | - Simone Appenzeller
- Rheumatology Unit, Department of Orthopedics, Rheumatology and Traumatology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, 13083-970, Brazil
| | - Linda Carli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 56124, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society of Rheumatology, Milan, 20121, Italy
| | - Alberto Cauli
- Rheumatology Unit, University Clinic, AOU Cagliari, 09124, Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, 09124, Italy
| | - Fabrizio Conti
- Rheumatology Unit, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, 33100, Udine, Italy
| | - Lilian Teresa Lavras Costallat
- Rheumatology Unit, Department of Orthopedics, Rheumatology and Traumatology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, 13083-970, Brazil
| | - Ginevra De Marchi
- Rheumatology Unit, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, 33100, Udine, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, 35128, Italy, Via Giustiniani, 2
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit and Clinical and Experimental Science Department ASST Spedali Civili, University of Brescia, Brescia, 25123, Italyand
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit and Clinical and Experimental Science Department ASST Spedali Civili, University of Brescia, Brescia, 25123, Italyand
| | - Carlo Garaffoni
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Cona, 44124, Italy
| | - John G Hanly
- Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Center, B3H 4K4, Canada, Halifax, Nova Scotia
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 56124, Italy
| | - Elana Murphy
- Division of Rheumatology, Departments of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Center, B3H 4K4, Canada, Halifax, Nova Scotia
| | - Matteo Piga
- Rheumatology Unit, University Clinic, AOU Cagliari, 09124, Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, 09124, Italy
| | - Luca Quartuccio
- Rheumatology Unit, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, 33100, Udine, Italy
| | - Carlo Alberto Scirè
- Epidemiology Unit, Italian Society of Rheumatology, Milan, 20121, Italy
- School of Medicine, University of Milano Bicocca, Milan, 20126, Italy
| | - Paola Tomietto
- Internal Medicine Department, Rheumatology Unit, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128, Trieste, Italy
| | - Simona Truglia
- Rheumatology Unit, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, 33100, Udine, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milan, 20121, Italy
| | - Margherita Zen
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, 35128, Italy, Via Giustiniani, 2
| | - George Bertsias
- Department of Rheumatology, Clinical Immunology, University of Crete Medical School and University Hospital of Heraklion, Heraklion, 71409, Greece
- Laboratory of Rheumatology, Autoimmunity and Inflammation, Infections & Immunity Division, Institute of Molecular Biology and Biotechnology (FORTH), Heraklion, 70013, Greece
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Cona, 44124, Italy
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2
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Bluett-Duncan M, Astill D, Charbak R, Clayton-Smith J, Cole S, Cook PA, Cozens J, Keely K, Morris J, Mukherjee R, Murphy E, Turnpenny P, Williams J, Wood AG, Yates LM, Bromley RL. Neurodevelopmental outcomes in children and adults with Fetal Valproate Spectrum Disorder: A contribution from the ConcePTION project. Neurotoxicol Teratol 2023; 100:107292. [PMID: 37666366 DOI: 10.1016/j.ntt.2023.107292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/17/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
AIM To describe the neurodevelopmental phenotype of older children and adults with a diagnosis of Fetal Valproate Spectrum Disorder (FVSD). METHODS In this cross-sectional study, 90 caregivers were recruited and completed a series of questionnaires regarding the neurodevelopmental outcomes of 146 individuals aged 7-37 years (M = 18.1), including individuals with a formal diagnosis of FVSD (n = 99), individuals exposed to Valproate but without an FVSD diagnosis (n = 24), and individuals not exposed to Valproate (N = 23). The mean dose of valproate exposure for individuals with an FVSD diagnosis was 1470 mg/day. RESULTS Individuals with a diagnosis of FVSD showed significantly higher levels of moderate (43.4%) and severe (14.4%) cognitive impairment than other groups (p = 0.003), high levels of required formal educational support (77.6%), and poorer academic competence than individuals not exposed to Valproate (p = 0.001). Overall psychosocial problems (p = 0.02), internalising problems (p = 0.05) and attention problems (p = 0.001), but not externalising problems, were elevated in individuals with a diagnosis of FVSD. Rates of neurodevelopmental disorders, particularly autistic spectrum disorders (62.9%) and sensory problems (80.6%) are particularly central to the FVSD phenotype. There was no evidence of a statistical dose-dependent effect, possibly due to the high mean dose of exposure having a uniformly negative impact across the sample. Individuals with FVSD had required a significant number of health and child development services. INTERPRETATION Children and young adults with a diagnosis of FVSD are at an increased risk of a range of altered neurodevelopmental outcomes, highlighting the need for a multidisciplinary approach to clinical management across the lifespan.
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Affiliation(s)
- M Bluett-Duncan
- Division of Neuroscience, School of Biological Sciences, The University of Manchester, UK.
| | - D Astill
- Foetal Anti-Convulsant Syndrome New Zealand, Aukland, New Zealand
| | - R Charbak
- Division of Neuroscience, School of Biological Sciences, The University of Manchester, UK
| | - J Clayton-Smith
- Division of Evolution, Systems and Genomics, University of Manchester, UK
| | - S Cole
- Pharma Consent, London, UK
| | - P A Cook
- School of Health and Society, University of Salford, UK
| | - J Cozens
- Organisation for Anti-Convulsant Syndrome, UK
| | - K Keely
- Organisation for Anti-Convulsant Syndrome, Ireland
| | - J Morris
- Foetal Anti-Convulsant Syndrome New Zealand, Aukland, New Zealand
| | - R Mukherjee
- Department of Health and Social Science, University of Salford, Allerton Building, Salford, England, UK
| | - E Murphy
- Independent Fetal Anti-Convulsant Trust, Preston, UK
| | - P Turnpenny
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - J Williams
- Independent Fetal Anti-Convulsant Trust, Preston, UK
| | - A G Wood
- Clinical Sciences, Murdoch Children's Research Institute, & School of Psychology, Deakin University, Melbourne, Australia; Institute of Health and Neurodevelopment, Aston University, UK
| | - L M Yates
- Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK; KRISP, University of KwaZulu-Natal, South Africa
| | - R L Bromley
- Division of Neuroscience, School of Biological Sciences, The University of Manchester, UK; Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Shiralkar S, Field E, Murphy E, Shelton C. The role of volatile capture technology in desflurane disposal from decommissioned vaporisers. Anaesthesia 2023; 78:1298-1300. [PMID: 37423619 DOI: 10.1111/anae.16044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 07/11/2023]
Affiliation(s)
- S Shiralkar
- North West School of Anaesthesia, Manchester, UK
| | - E Field
- Cardiff University, Cardiff, UK
| | - E Murphy
- Manchester University NHS Foundation Trust, Manchester, UK
| | - C Shelton
- Lancaster Medical School, Lancaster, UK
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4
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Saripalli A, Ross D, Murphy E, Gomez K, Thilges S, Harkenrider MM. Prevalence of Trauma History and Symptoms in Patients Who Have Received Vaginal Brachytherapy as Part of their Endometrial Cancer Treatment. Int J Radiat Oncol Biol Phys 2023; 117:e542. [PMID: 37785674 DOI: 10.1016/j.ijrobp.2023.06.1837] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Vaginal brachytherapy (VBT) is an essential component of curative intent treatment for many patients with endometrial cancer. The prevalence of trauma history in this population is unknown and is important to understand considering VBT requires patients to have an instrument vaginally inserted while in the vulnerable lithotomy position. We aim to retrospectively identify patients treated with VBT for early-stage endometrial cancer and collect survey data to assess the prevalence of trauma history, whether VBT re-induced trauma symptoms, and whether VBT was considered an independent traumatic event by patients. MATERIALS/METHODS We retrospectively identified patients with endometrial cancer treated with VBT at our institution from January 2017 to August 2022. Patients were mailed a cover letter and unique-identifier coded survey that included the Brief Trauma Questionnaire (BTQ) and Primary Care Post Traumatic Stress Disorder Screen for DSM-V (PC-PTSD-5), both validated instruments. Patients were instructed to fill out the surveys as it relates to their trauma history prior to VBT and again considering any trauma symptomatology related to VBT. BTQ was interpreted as positive if the patient responded yes to any question. PC-PTSD-5 was interpreted positive if the patient responded yes to at least 3 questions. Electronic medical record review was performed to identify clinical and pathologic features. Descriptive statistics and qualitative analysis were used to assess survey responses. RESULTS A total of 51 of 206 patients returned the survey at the time of interim analysis. 43 patients (84%) screened positive on the BTQ for having trauma history. Of those patients, 7 (16%) screened positive on the PC-PTSD-5 for a probable PTSD diagnosis. Additionally, 22 (51%)/18 (42%) patients answered yes to at least one/two symptoms on the PC-PTSD-5 respectively. Of the patients who answered yes to at least one question on the PC-PTSD-5, 18% (4 patients) responded that VBT triggered flashbacks of their past trauma. Regarding PC-PTSD-5 considering trauma symptomatology related to VBT, 20 patients (39%) answered yes to any question, though only 2 patients (4%) met the threshold to screen positive for probable PTSD. 20 patients (39%) indicated they would have accepted a referral to psychology before or during VBT. Suggested improvements made via free text responses included minimizing the time the cylinder was inserted and eliminating the need to transfer via hallway from the simulation room to the treatment room. CONCLUSION This study provides a baseline for understanding the prevalence of trauma history and trauma related to VBT in patients with endometrial cancer. This data can be used to guide patient centered discussions of endometrial cancer care, importantly including to counsel patients that a possible toxicity of VBT is trauma symptomatology, particularly for those with a history of trauma.
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Affiliation(s)
- A Saripalli
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - D Ross
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - E Murphy
- Department of Psychiatry and Behavioral Neurosciences, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - K Gomez
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - S Thilges
- Department of Psychiatry and Behavioral Neurosciences, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - M M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
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5
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Palmer S, Coad J, Gamble J, Jones C, Lees-Deutsch L, McWilliams D, Murphy E, Kneafsey R. Nursing, midwifery, and allied health professions research capacities and cultures: a survey of staff within a university and acute healthcare organisation. BMC Health Serv Res 2023; 23:647. [PMID: 37328877 DOI: 10.1186/s12913-023-09612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/28/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND There is an increasing focus on the development of research capacity and culture in Nursing, Midwifery and Allied Health Professions (NMAHP). However, better understanding of the existing research success and skills, motivators, barriers, and development needs of NMAHP professionals is required to inform this development. This study sought to identify such factors within a university and an acute healthcare organisation. METHODS An online survey, incorporating the Research Capacity and Culture tool, was administered to NMAHP professionals and students at a university and an acute healthcare organisation in the United Kingdom. Ratings of success/skill levels of teams and individuals were compared between professional groups using Mann-Whitney U tests. Motivators, barriers, and development needs were reported using descriptive statistics. Descriptive thematic analysis was used for open-ended text responses. RESULTS A total of 416 responses were received (N&M n = 223, AHP n = 133, Other n = 60). N&M respondents were more positive than their AHP counterparts about the success/skill levels of their teams. There were no significant differences between N&M and AHP in their ratings of individual successes/skills. Finding and critically reviewing relevant literature were identified as specific individual strengths; with weaknesses in securing research funding, submitting ethics applications, writing for publication, and advising less experienced researchers. The main motivators for research were to develop skills, increased job satisfaction, and career advancement; whilst barriers included lack of time for research and other work roles taking priority. Key support needs identified included mentorship (for teams and individuals) and in-service training. Open-ended questions generated main themes of 'Employment & staffing', 'Professional services support', 'Clinical & academic management', 'Training & development', 'Partnerships' and 'Operating principles'. Two cross-cutting themes described issues common to multiple main themes: 'Adequate working time for research' and 'Participating in research as an individual learning journey'. CONCLUSIONS Rich information was generated to inform the development of strategies to enhance research capacity and culture in NMAHP. Much of this can be generic but some nuances may be required to address some specific differences between professional groups, particularly related to perceived team success/skills and priorities identified for support and development.
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Affiliation(s)
- S Palmer
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - J Coad
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
- School of Health Sciences, Nottingham University Queen's Medical Centre, Nottingham, UK
| | - J Gamble
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - C Jones
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - L Lees-Deutsch
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - D McWilliams
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - E Murphy
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - R Kneafsey
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK.
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Chen J, Rees A, Coughlan CH, Goodison W, Murphy E, Chandratheva A. Ischaemic stroke with multi-focal venous and arterial thrombosis due to hyperhomocysteinemia: anabolic androgenic steroid use and MTHFR c.667 C > T variant - a case report. BMC Neurol 2023; 23:167. [PMID: 37101129 PMCID: PMC10131300 DOI: 10.1186/s12883-023-03197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Severely elevated serum homocysteine is a rare cause of ischaemic stroke and extra-cranial arterial and venous thrombosis. Several factors can lead to mild elevation of homocysteine including dietary folate and B12 deficiency, and genetic variants of the methylenetetrahydrofolate reductase (MTHFR) enzyme. The use of Anabolic androgenic steroid (AAS) is under-reported, but increasingly linked to ischaemic stroke and can raise homocysteine levels. CASE REPORT We present a case of a man in his 40s with a large left middle cerebral artery (MCA) territory ischaemic stroke and combined multifocal, extracranial venous, and arterial thrombosis. His past medical history was significant for Crohn's disease and covert use of AAS. A young stroke screen was negative except for a severely elevated total homocysteine concentration, folate and B12 deficiencies. Further tests revealed he was homozygous for the methylenetetrahydrofolate reductase enzyme thermolabile variant (MTHFR c.667 C > T). The etiology of this stroke was a hypercoagulable state induced by raised plasma homocysteine. Raised homocysteine in this case was likely multifactorial and related to chronic AAS use in combination with the homozygous MTHFR c.677 C > T thermolabile variant, folate deficiency and, vitamin B12 deficiency. CONCLUSION In summary, hyperhomocysteinemia is an important potential cause of ischaemic stroke and may result from genetic, dietary, and social factors. Anabolic androgenic steroid use is an important risk factor for clinicians to consider, particularly in cases of young stroke with elevated serum homocysteine. Testing for MFTHR variants in stroke patients with raised homocysteine may be useful to guide secondary stroke prevention through adequate vitamin supplementation. Further studies looking into primary and secondary stroke prevention in the high-risk MTHFR variant cohort are necessary.
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Affiliation(s)
- Jpk Chen
- National Hospital for Neurology and Neurosurgery, London, UK.
| | - A Rees
- National Hospital for Neurology and Neurosurgery, London, UK
| | - C H Coughlan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - W Goodison
- National Hospital for Neurology and Neurosurgery, London, UK
| | - E Murphy
- University College London Hospitals NHS Foundation Trust, London, UK
| | - A Chandratheva
- University College London Hospitals NHS Foundation Trust, London, UK
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O’Connor M, Stapleton A, O'Reilly G, Murphy E, Connaughton L, Hoctor E, McHugh L. The efficacy of mindfulness-based interventions in promoting resilience: A systematic review and meta-analysis of randomised controlled trials. Journal of Contextual Behavioral Science 2023. [DOI: 10.1016/j.jcbs.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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LIEBERMAN K, Paredes A, Srivastava T, Komers R, Murphy E, Trachtman H. WCN23-1184 LONG-TERM EFFICACY AND SAFETY OF SPARSENTAN IN YOUNG PATIENTS WITH FSGS: 240-WEEK ANALYSIS OF THE DUET OPEN-LABEL EXTENSION (OLE). Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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9
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Murphy E, Lopez M, Fallon A. 104 SPONTANEOUS ILIOPSOAS TENDON RUPTURE AND PSOAS HAEMATOMA ON ASPIRIN MONOTHERAPY: A CASE REPORT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Spontaneous Iliopsoas Tendon (IPT) rupture is a rare condition, with a prevalence of 0.66%, occurring most commonly in athletes. Risk factors for non-athletic IPT rupture include age, female gender and steroid use. Psoas haematomas are associated with surgery, anticoagulation and coagulopathies. Only a handful of case reports have associated psoas haematoma with single antiplatelet use. We present the case of a patient who developed psoas tendon rupture and psoas haematoma.
Methods
A 77-year-old female presented with a four week history of declining mobility and left hip pain, without history of trauma. Past medical history included chronic lymphoedema and an NSTEMI, for which she was taking aspirin monotherapy. On examination, she had reduced power on left hip flexion and a tender anterior thigh, with normal sensation. CT showed asymmetric thickening of the left iliacus muscle and surrounding fat stranding. MRI demonstrated partial IPT tear with oedema extending into the iliacus muscle.
Results
After several weeks of rehabilitation, her mobility deteriorated again. A second CT was performed, which showed new expansion and fat stranding of the right iliopsoas muscle and tendon compatible with acute haemorrhage. Aspirin was held for four weeks, and she was discharged after completing rehabilitation. Her baseline mobility had disimproved and she required assistance and a frame on discharge.
Conclusion
IPT rupture and psoas haematoma are atypical causes of atraumatic hip pain in older adults. Nevertheless, they can cause significant disability. MRI is recommended as the gold standard for diagnosis. Treatment is commonly conservative, focused on physiotherapy and pain control to maintain mobility. While aspirin is not commonly associated with tendon rupture or haemorrhage, it is widely used in primary prevention of cardiovascular disease and due consideration should be given to stopping it following the occurrence of haemorrhage.
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Affiliation(s)
- E Murphy
- Tallaght University Hospital , Dublin, Ireland
| | - M Lopez
- Tallaght University Hospital , Dublin, Ireland
| | - A Fallon
- Tallaght University Hospital , Dublin, Ireland
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10
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Cosgrave E, Blake M, Murphy E, Sheridan A, Doyle F, Kavanagh P. Is Ireland ready for tobacco endgame? A national survey of knowledge and attitudes to tobacco endgame. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In 2013 ‘Tobacco-Free Ireland’ (TFI) shifted Irish national policy from tobacco control to “tobacco endgame”: policies, plans and interventions seeking to end the tobacco epidemic completely. Recent trends suggest the current 2025 TFI goal will not be achieved. This cross-sectional study is a timely assessment of public knowledge and attitude to re-focus Irish “tobacco endgame” planning.
Methods
A literature-informed, pre-tested survey instrument was telephone-administered to a representative sample of 1000 members of the Irish public aged ≥15 years recruited via random digit dialling in February 2022. Prevalence of “tobacco endgame” views was measured; logistic regression determined factors associated with key responses.
Results
Response rate was 30% (n = 1,000, post-hoc weighting applied). While TFI goal awareness was low (34%), support was high (75%), albeit most (61%) recognised postponement beyond 2025 was required for achievability. There was majority support for 18/22 endgame measures assessed. Product-focused tactics were popular, while views on targeting users were mixed: e.g. 86% supported a reduction in tobacco-product nicotine content; 40% supported introduction of a tobacco-user license. Phasing-out tobacco sales was highly-supported (83%); however, this was contingent on special supports for those currently addicted. Support for the TFI goal was higher among non-tobacco users (aOR 2.66, 95%CI 1.89-3.76), females (aOR 1.57, 95%CI 1.17-2.11) and those of higher social class (aOR 1.72, 95%CI 1.25-2.35).
Conclusions
While achievement by 2025 is increasingly unrealistic, findings strongly affirm Irish public opinion is ready for “tobacco endgame”. Recognition of the needs of currently addicted tobacco users and focusing on subgroups with lower support levels should be integral to equitable “tobacco endgame” planning and communication. This study should mobilise renewed Irish political commitment to bold actions aimed at ending smoking-related harm.
Key messages
• There is strong support for tobacco endgame measures among the Irish population, which is a supportive factor for bold political leadership to make these radical ideas a reality.
• Public preference for product and non-user-focused measures aligns with tobacco endgame discourse and should aid policy reframing to tackle structures and dynamics sustaining the tobacco epidemic.
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Affiliation(s)
- E Cosgrave
- Department of Public Health HSE South East, Health Service Executive , Kilkenny, Ireland
| | - M Blake
- HSE Tobacco Free Ireland Programme, Health Service Executive , Dublin, Ireland
| | - E Murphy
- HSE Tobacco Free Ireland Programme, Health Service Executive , Dublin, Ireland
| | - A Sheridan
- HSE Tobacco Free Ireland Programme, Health Service Executive , Dublin, Ireland
| | - F Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland , Dublin, Ireland
| | - P Kavanagh
- HSE Tobacco Free Ireland Programme, Health Service Executive , Dublin, Ireland
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Murphy E, Jessopp M, Darby J. Light to intermediate oil sheens increase Manx shearwater feather permeability. R Soc Open Sci 2022; 9:220488. [PMID: 36249329 PMCID: PMC9533009 DOI: 10.1098/rsos.220488] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Oil pollution has profound negative impacts on the marine environment, with seabirds particularly vulnerable to oiling, due to the amount of time spent on the sea surface foraging or resting. Exposure to oil can affect feather structure and influence waterproofing, buoyancy and thermoregulation. We investigated the effects of surface crude oil on the feather structure of Manx shearwaters (Puffinus puffinus), a seabird species that spends a high proportion of time on the water surface. Sampled body contour feathers were exposed to varying thicknesses of surface crude oil before assessing their resistance to water permeation, increase in mass and clumping of feather barbules. Surface oil as thin as 0.1 µm was enough to increase feather permeability, while greatest impacts on permeability were caused by exposure to dark colour surface sheens 3 µm in thickness. Increases in feather mass of up to 1000% were noted in heavy oiling scenarios due to contact with thicker oil slicks, which may significantly affect wing loading and energetic expenditure.
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Affiliation(s)
- E. Murphy
- School of Biological, Earth & Environmental Sciences, University College Cork, Cork, Ireland
| | - M. Jessopp
- School of Biological, Earth & Environmental Sciences, University College Cork, Cork, Ireland
- MaREI Centre, Environmental Research Institute, University College Cork, Cork, Ireland
| | - J. Darby
- School of Biological, Earth & Environmental Sciences, University College Cork, Cork, Ireland
- MaREI Centre, Environmental Research Institute, University College Cork, Cork, Ireland
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Nally DM, Lonergan PE, O’Connell EP, McNamara DA, Elwahab SA, Bass G, Burke E, Cagney D, Canas A, Cronin C, Cullinane C, Devane L, Fearon N, Fowler A, Fullard A, Hechtl D, Kelly M, Lenihan J, Murphy E, Neary C, O'Connell R, O'Neill M, Ramkaran C, Troy A, Tully R, White C, Yadav H. Increasing the use of perioperative risk scoring in emergency laparotomy: nationwide quality improvement programme. BJS Open 2022; 6:6649489. [PMID: 35876188 PMCID: PMC9309802 DOI: 10.1093/bjsopen/zrac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Emergency laparotomy is associated with high morbidity and mortality. The early identification of high-risk patients allows for timely perioperative care and appropriate resource allocation. The aim of this study was to develop a nationwide surgical trainee-led quality improvement (QI) programme to increase the use of perioperative risk scoring in emergency laparotomy. Methods The programme was structured using the active implementation framework in 15 state-funded Irish hospitals to guide the staged implementation of perioperative risk scoring. The primary outcome was a recorded preoperative risk score for patients undergoing an emergency laparotomy at each site. Results The rate of patients undergoing emergency laparotomy receiving a perioperative risk score increased from 0–11 per cent during the exploratory phase to 35–100 per cent during the full implementation phase. Crucial factors for implementing changes included an experienced central team providing implementation support, collaborator engagement, and effective communication and social relationships. Conclusions A trainee-led QI programme increased the use of perioperative risk assessment in patients undergoing emergency laparotomy, with the potential to improve patient outcomes and care delivery.
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Affiliation(s)
- Deirdre M Nally
- Department of Surgical Affairs, Royal College of Surgeons in Ireland , Dublin , Ireland
- Department of Surgery, Mater Misericordiae University Hospital , Dublin , Ireland
| | - Peter E Lonergan
- National Clinical Programme in Surgery, Royal College of Surgeons in Ireland , Dublin , Ireland
- Department of Urology, St. James’s Hospital , Dublin , Ireland
- Department of Surgery, Trinity College , Dublin , Ireland
| | | | - Deborah A McNamara
- National Clinical Programme in Surgery, Royal College of Surgeons in Ireland , Dublin , Ireland
- Department of Surgery, Beaumont Hospital , Dublin , Ireland
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Rehman A, Tariq S, Kumar J, Martin L, Bannon C, Duffy T, Murphy E, Stack J, Barry M, Murphy CL. POS0661 MAJOR COST SAVINGS ASSOCIATED WITH BIOLOGIC DOSE REDUCTION IN PATIENTS WITH INFLAMMATORY ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAnti-TNF drugs have dramatically improved the management of inflammatory arthritis (IA).Although the introduction of biosimilars have reduced the cost, chronic use of biologic agentshas a high impact on healthcare expenditure. This study evaluated the cost effectiveness of adose reduction strategy for the most commonly used anti- TNF drugs over a period of 10 yearsin patients with IA in remission.ObjectivesThe purpose of this study was to explore whether patients with Inflammatory Arthritis (IA) (Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS) would remain in remission after 10 year period, following a reduction in biologic dosing frequency and to calculate the cost savings associated with dose reduction.MethodsThis prospective, non-blinded, non-randomised study was commenced in 2010. Patientswith IA, Rheumatoid arthritis (RA),ankylosing spondylitis (AS) and Psoriatic arthritis (PsA)who were in remission as defined by disease activity indices (DAS28<2.6, BASDAI<4), andwere offered Anti TNF dose reduction. Patients on etanercept were reduced from 50mgweekly to fortnightly, adalimumab 40mg once monthly instead of fortnightly. Patients wereassessed for disease activity at 1, 4 and 10 years following reduction in dosingfrequency.Cost saving was calculated by deducting the total annual cost of the biologicagent used over 10 years compared with the cost if the dosing interval had not changed.ResultsSeventy nine patients with inflammatory arthritis in remission were recruited. 57% had rheumatoid arthritis (n=45), 13% psoriatic arthritis (n=10) and 30% ankylosing spondylitis (n=24). 57% (n=45) were taking etanercept and 43% (n=34) adalimumab. The percentage of patients who maintained dose reduction at 10 years was 9% (n=7). Of the total 48 patients who were successfully dose reduced at year 1 (n=42), (69%, n=29) were able to maintain the dose reduction up to 4 years and 9% (n=7) maintained this dose reduction up to year 10. The estimated cost saving was €4,928 per patient per year. Estimated cost savings for 7 patients on reduced dose was €344,952.88 over 10 years.ConclusionAnti TNF dose reduction strategy in patients with IA results in substantial cost savings. Implementation of a dose reduction strategy while monitoring of disease activity reduces the financial impact of the use of biologic therapies. Further studies should be done to identify which patients are more likely to remain in remission while on dose reduction.References[1]Bonafede MM, Gandra SR, Watson C, Princic N, Fox KM. Cost per treated patient for etanercept, adalimumab, and infliximab across adult indications: a claims analysis. Adv Ther. 2012 Mar;29(3):234-48. doi: 10.1007/s12325-012-0007-y. Epub 2012 Mar 9. PMID: 22411424.[2]Joaquín Borrás-Blasco, Antonio Gracia-Pérez, J Dolores Rosique-Robles, MD Elvira Casterá & F Javier Abad (2014) Clinical and economic impact of the use of etanercept 25 mg once weekly in rheumatoid arthritis, psoriatic arthropathy and ankylosing spondylitis patients, Expert Opinion on Biological Therapy, 14:2, 145-150, DOI: 10.1517/14712598.2014.868433[3]Carter CT, Changolkar AK, Scott McKenzie R. Adalimumab, etanercept, and infliximab utilization patterns and drug costs among rheumatoid arthritis patients. J Med Econ. 2012;15(2):332-9. doi: 10.3111/13696998.2011.649325. Epub 2012 Jan 6. PMID: 22168788.Disclosure of InterestsNone declared
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Thanamayooran A, Tennankore K, Geldenhuys L, Murphy E, More K. Q-uestioning the Diagnosis: An Educational Case Report. Can J Kidney Health Dis 2022; 9:20543581221097749. [PMID: 35528726 PMCID: PMC9069601 DOI: 10.1177/20543581221097749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/24/2022] [Indexed: 11/30/2022] Open
Abstract
Rationale: Q fever is a zoonotic infection that may lead to acute or long-term renal injury. Given its rare incidence, Q fever is not often considered on the initial differential diagnosis for glomerular disease which can lead to delays in treatment. This case highlights the importance of avoiding early diagnostic closure and revisiting the differential diagnosis in the setting of an atypical clinical presentation or response to treatment. Presenting Concerns: A 52-year-old female was referred for assessment of possible glomerulonephritis. She described a 3-month history of bilateral lower extremity rash, intermittent knee pain with swelling, and a 2-year history of subjective fevers. Urinalysis showed persistent microscopic hematuria, and her creatinine was elevated at 94 umol/L (baseline 59 umol/L). Her initial investigations included an elevated C-reactive protein (CRP) and rheumatoid factor with a weakly positive anti nuclear antibody (ANA). Diagnoses: Kidney biopsy was consistent with an immune complex mesangial proliferative glomerulonephritis. Light microscopy showed diffuse global mesangial hypercellularity. Immunofluorescence was positive for trace mesangial IgG and kappa, 1+ IgM, lambda and C1q, and 2+ C3. Electron microscopy showed mesangial electron dense deposits. These findings were felt to be most in keeping with mesangial proliferative lupus nephritis; however, it was acknowledged that clinical and laboratory findings supporting this diagnosis were lacking. Interventions: Following treatment with oral prednisone her symptoms resolved, and renal function improved. However, she was unable to taper off prednisone completely without her symptoms returning. Additional immunosuppressive therapies were trialed, but she remained steroid dependent with disease flares related to prednisone tapers. Her atypical response to treatment led to consideration of alternative diagnoses, and further investigation revealed positive Q fever serology (phase-I IgG 1:1892, phase II IgG 1:8192, phase-I and -II IgM < 1:16). She was diagnosed with long-term Q fever and was treated with doxycycline and hydroxychloroquine. Outcomes: She remained on treatment for 2 years. During this time, her symptoms resolved, hematuria disappeared, and her creatinine returned to baseline. Following cessation of therapy, her Q fever IgM titres rose, and she was restarted on doxycycline and hydroxychloroquine indefinitely. Teaching Points: (1) Keeping a broad differential diagnosis in the setting of atypical clinical features or unexpected response to therapy is important for ensuring accurate diagnosis and appropriate treatment. (2) Clinical improvement in relation to immunosuppressive therapy does not preclude an infectious cause of glomerular disease.
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Affiliation(s)
| | - Karthik Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Laurette Geldenhuys
- Division of Anatomical Pathology, Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Elana Murphy
- Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Keigan More
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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Severson P, Kellner W, Franovic A, Miller N, Murphy E, Martin E, Williams R. 40P Real-world clinical genomic analysis of patients with BRAF mutated cancers identifies BRAF class II and III as a population of unmet medical need. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Murphy E, Burke E, O'Donoghue J, Xidous D, Grey T, Kennelly S, O'Neill D. 212 BUILT ENVIRONMENT OF NURSING HOMES AND INFECTION CONTROL AND PANDEMIC PREPAREDNESS. Age Ageing 2021. [PMCID: PMC8690060 DOI: 10.1093/ageing/afab219.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The disproportionately high death rate of nursing home (NH) residents from COVID-19 in many countries, including Ireland, has focussed attention on infection prevention and control, including the built environment, in nursing homes. This has been a poorly researched topic to date, and we undertook a systematic review of evidence for architectural design measures which support infection control and pandemic preparedness. Methods Databases were screened for keywords related to NHs, built environment, infection prevention and control, and COVID-19; relevant papers were uploaded onto Covidence and screened for relevance. Data extracted from included articles was tabulated under 8 specific aspects of the built environment. Results Of 17 papers included in the final analysis, four studies found that larger nursing homes carried an increased risk of COVID-19 infection. Crowding in NHs was also a risk factor for infection, with a high crowding index associated with COVID-19 infection in five studies. Green House care homes, which are based on small clusters of domestic dwellings, fared better than traditional NHs. Two papers found an association between the location of NHs and the risk of COVID-19 infection, with urban NHs and those in areas of high prevalence being more at risk. Two papers identified internal fittings as a target for infection prevention and control. Seven papers highlighted the role of adequate ventilation in NHs in the prevention of spread of COVID-19. Only one paper described easy access to the outdoors as beneficial to infection control. Conclusion Residents of NHs are amongst the most vulnerable to COVID-19 infection. When designing and building NHs, the role of the built environment in controlling the spread of the virus should not be underestimated. This research supported by Science Foundation Ireland.
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Affiliation(s)
- E Murphy
- Centre for Aging, Neuroscience and the Humanities, Trinity College Dublin, Dublin, Ireland
| | - E Burke
- TrinityHaus, Trinity College Dublin, Dublin, Ireland
| | - J O'Donoghue
- TrinityHaus, Trinity College Dublin, Dublin, Ireland
| | - D Xidous
- TrinityHaus, Trinity College Dublin, Dublin, Ireland
| | - T Grey
- TrinityHaus, Trinity College Dublin, Dublin, Ireland
| | - S Kennelly
- Centre for Aging, Neuroscience and the Humanities, Trinity College Dublin, Dublin, Ireland
| | - D O'Neill
- Centre for Aging, Neuroscience and the Humanities, Trinity College Dublin, Dublin, Ireland
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Abstract
BACKGROUND Sleepiness associated with night shift working (NSW) is known to adversely affect workers' health and well-being. It has been associated with adverse safety outcomes and is a recognized workplace hazard among healthcare workers. AIMS This study was aimed to assess the prevalence of self-reported sleepiness in NSW nurses and midwives. This study also explored the consequences of sleepiness on safety at work and driving. METHODS A cross-sectional study of NSW nurses and midwives was conducted at an National Health Service (NHS) hospital trust from 16 March 2020 to 1 June 2020. Data were collected by online questionnaire and included information on demographics, shift work and safety aspects. Sleepiness was assessed with the Epworth Sleepiness Scale (ESS). RESULTS Data collection coincided with the first coronavirus pandemic peak in England. Out of 1985 eligible NSW nurses and midwives, 229 participated in the study, with a response rate of 12%. The prevalence of sleepiness was 28%. Following a night shift, 49% of nurses reported nodding off at the wheel and 44% reported a near-miss car accident in past 12 months. An abnormal ESS score was significantly associated with near-miss car accidents (odds ratio [OR] 2.75, 95% confidence interval [CI] 1.31-5.77) and with low confidence in undertaking complex tasks at night (OR 2.64, 95% CI 1.20-5.84). CONCLUSIONS More than a quarter of NSW nurses and midwives reported excessive daytime sleepiness although, due to the low response rate, this may not be representative. Adverse driving events were common. Elevated ESS scores correlated well with safety issues relating to work and driving.
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Affiliation(s)
- A Westwell
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - P Cocco
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - M Van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - E Murphy
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
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McCausland D, Luus R, McCallion P, Murphy E, McCarron M. The impact of COVID-19 on the social inclusion of older adults with an intellectual disability during the first wave of the pandemic in Ireland. J Intellect Disabil Res 2021; 65:879-889. [PMID: 34165228 PMCID: PMC8447302 DOI: 10.1111/jir.12862] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Social restrictions and service closures from COVID-19 have negatively impacted social inclusion and well-being for some people with intellectual disabilities (IDs). METHODS The fourth wave of a national longitudinal study on ageing in people with ID in Ireland was interrupted during the COVID-19 outbreak. Social inclusion data for pre-existing participants interviewed before COVID-19 (n = 444) were compared with data for pre-existing participants interviewed during/after lockdown (n = 62). RESULTS More people interviewed after lockdown reported frequent family contact. Significantly greater numbers in the post-lockdown group reported access to and use of technology than the pre-lockdown group. Technology use was higher among those living in grouped residences supported by services compared with individuals living independently or with family. CONCLUSIONS During the early stages of the COVID-19 pandemic in Ireland, many older adults with ID stayed connected with family and reported rates of contact higher than were reported by others before COVID-19. This connection may have been supported by a significant increase in technology use during the pandemic. However, uneven use of technology may disadvantage some including individuals living with family or independently. Given that COVID-19 restrictions are likely to continue to restrict social opportunities, increased digital support may assist more people with ID to use technology to maintain their social connections.
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Affiliation(s)
- D. McCausland
- Trinity Centre for Ageing and Intellectual Disability, School of Nursing and MidwiferyTrinity College DublinDublinIreland
| | - R. Luus
- Trinity Centre for Ageing and Intellectual Disability, School of Nursing and MidwiferyTrinity College DublinDublinIreland
| | | | - E. Murphy
- Trinity Centre for Ageing and Intellectual Disability, School of Nursing and MidwiferyTrinity College DublinDublinIreland
| | - M. McCarron
- Trinity Centre for Ageing and Intellectual Disability, School of Nursing and MidwiferyTrinity College DublinDublinIreland
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Porter G, Murphy E, Adamu F, Dayil PB, De Lannoy A, Han S, Mansour H, Dungey C, Ahmad H, Maskiti B, S C, Van der Weidje K. Women's mobility and transport in the peripheries of three African cities: Reflecting on early impacts of COVID-19. Transp Policy (Oxf) 2021; 110:181-190. [PMID: 35721253 PMCID: PMC9188408 DOI: 10.1016/j.tranpol.2021.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 05/04/2023]
Abstract
This paper reflects on the mobility experiences of women in African cities in COVID-19, based on research conducted both prior to and following entry into the COVID-19 'moment'. It draws on material collected during an ongoing action research study aimed at addressing the everyday transport and mobility challenges faced by young women living in poor peripheral communities of three African cities - Abuja, Cape Town and Tunis. The project has the specific objective of supporting young women's improved access to employment opportunities through trialling various mobility/transport-related skills interventions (based on prior in-depth analysis of mobility constraints). With the onset of COVID-19 some readjustments to the research focus and planned interventions became necessary. The research teams, together with an NGO partner, are now working to chart how young women's everyday experiences of mobility and transport - both as transport users and as transport sector workers - are changing as processes of lockdown and their relaxation evolve. The paper covers the period from early 2019 through to March 2021, and offers reflections regarding 'lived experiences' of mobility practice pre-pandemic, during the pandemic, and the potential longer-term mobility-related impacts for women resident in low-income neighbourhoods in a post-COVID-19 era. This leads to consideration of key policy lessons. There is potential for prioritisation of Non-Motorised Transport interventions towards a green restart that would benefit women (for instance through promoting women's cycling), and for growing women's participation as transport operators, even perhaps the usage of drones to aid women's safer pedestrian travel. But such interventions will require far greater representation of women in COVID-19 and wider transport decision-making entities than has hitherto been the case.
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Affiliation(s)
| | | | - F Adamu
- Usmanu Danfodiyo University, Sokoto, Nigeria
| | | | | | | | | | | | - H Ahmad
- University of Abuja, Nigeria
| | - B Maskiti
- University of Cape Town, South Africa
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Pyrke B, Abdalla B, Cartwright G, Figg K, Murphy E, Tuck A, White H. 140 Lessons From the Front Line: Communication is Key. Age Ageing 2021. [PMCID: PMC7989613 DOI: 10.1093/ageing/afab030.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction As junior doctors, we very rarely receive formal teaching on communication after medical school, with telephone encounters and difficult conversations over technology being a vital yet missing part of our education. The COVID-19 pandemic has required us to adapt how we communicate with patients’ families due to hospital visiting restrictions. In an era where tragically deterioration and death have been much more commonplace, we looked to identify areas where junior doctors felt their communication skills could be improved, and implemented a teaching programme to deliver this. Methods Pre-teaching questionnaires were distributed to a range of grades of junior doctors working in University Hospital of Llandough, Cardiff. The questionnaires were distributed at the beginning of June 2020, after 3 months of working in pandemic conditions. A teaching session on telephone and video communication skills was delivered by a local palliative care consultant. Post-teaching, a repeat questionnaire was undertaken to assess response and identify key learning points. Results Pre-teaching, 100% of the 22 respondents had had to participate in difficult conversations over the phone, 82% had had no formal phone based communication skills training and 81.82% felt some form of formal teaching would be helpful. Post-teaching, 12 junior doctors provided feedback with an average 37% increase in confidence to undertake difficult conversations. Key learning points from the session highlighted the importance of preparation, regularly updating the family to build trust and rapport, and integrating family updates via tele-communication into daily ward life. Conclusions Education around telephone communication skills is critical to enable us to adapt our skills in accordance with the demands of the pandemic, to continue to support relatives and to engage with technology with confidence. Increased preparation is required to navigate difficult conversations via technology, and successful communication requires clinicians to take responsibility for initiating regular family updates.
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Affiliation(s)
- B Pyrke
- University Hospital of Llandough, Cardiff, Wales
| | - B Abdalla
- University Hospital of Llandough, Cardiff, Wales
| | - G Cartwright
- University Hospital of Llandough, Cardiff, Wales
| | - K Figg
- University Hospital of Llandough, Cardiff, Wales
| | - E Murphy
- University Hospital of Llandough, Cardiff, Wales
| | - A Tuck
- University Hospital of Llandough, Cardiff, Wales
| | - H White
- University Hospital of Llandough, Cardiff, Wales
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White H, Tuck A, Pyrke B, Murphy E, Figg K, Cartwright G, Abdalla B. 141 Face Time’ for the First Time: Patients, Families and Junior Doctors. Age Ageing 2021. [PMCID: PMC7989593 DOI: 10.1093/ageing/afab030.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Over the course of the COVID-19 pandemic, supporting effective communication between patients and their families has been a recognised challenge in the healthcare environment. Virtual communication via telecommunication and video-calling is more important than ever, but with minimal clinician education, preparation and relevant technological infrastructure available in the context of a global pandemic, we have recognised communication as an area for improvement as junior doctors working on a COVID-19 ward. Methods We interviewed via telephone 22 nominated next of kin relatives of patients admitted to a COVID-19 ward in the University Hospital of Llandough during May 2020 using a pre-prepared survey. We then provided relatives with the opportunity to engage with video-call updates from a doctor (with the patient’s permission). In appropriate scenarios, we used video calling to break bad news and to facilitate difficult communications with family members. These video calls were provided via Accurx, an NHS approved video communication system. Results Initial survey results showed an average understanding score of their relative’s current clinical plan of 5.5/10, with 63% of respondents saying they did not feel well informed. Nearly a quarter of respondents (22%) had received difficult news over the phone during the COVID-19 pandemic, and 86% said they would find video communication useful. Post-intervention survey results suggested a unanimous improvement in relative satisfaction, with relatives reporting an increased understanding around the admission, reassurance around the quality of care being given and less isolation from the patient. Conclusions The COVID-19 pandemic has provided novel communication challenges to physicians, promoting flexibility and adaptation to some of the core inter-personal skills we develop throughout training. Technology plays a huge role in this, and the use of video calling in particular can preserve non-verbal communication within the doctor-relative relationship and improve emotional connection between patients and their loved ones.
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Affiliation(s)
- H White
- University Hospital of Llandough, Wales
| | - A Tuck
- University Hospital of Llandough, Wales
| | - B Pyrke
- University Hospital of Llandough, Wales
| | - E Murphy
- University Hospital of Llandough, Wales
| | - K Figg
- University Hospital of Llandough, Wales
| | | | - B Abdalla
- University Hospital of Llandough, Wales
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Murphy E, Glass A, McCall P, Shelley B. Myocardial inflammation after major non-cardiac thoracic surgery. Br J Anaesth 2021. [DOI: 10.1016/j.bja.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Lyndon D, Davagnanam I, Wilson D, Jichi F, Merwick A, Bolsover F, Jager HR, Cipolotti L, Wheeler-Kingshott C, Hughes D, Murphy E, Lachmann R, Werring DJ. MRI-visible perivascular spaces as an imaging biomarker in Fabry disease. J Neurol 2020; 268:872-878. [PMID: 33078310 PMCID: PMC7914182 DOI: 10.1007/s00415-020-10209-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/02/2022]
Abstract
Introduction Fabry disease (FD) is an X-linked lysosomal storage disorder resulting in vascular glycosphingolipid accumulation and increased stroke risk. MRI findings associated with FD include white matter hyperintensities (WMH) and cerebral microbleeds (CMBs), suggesting the presence of cerebral small vessel disease. MRI-visible perivascular spaces (PVS) are another promising marker of small vessel disease associated with impaired interstitial fluid drainage. We investigated the association of PVS severity and anatomical distribution with FD.
Patients and methods We compared patients with genetically proven FD to healthy controls. PVS, WMH, lacunes and CMBs were rated on standardised sequences using validated criteria and scales, blinded to diagnosis. A trained observer (using a validated rating scale), quantified the total severity of PVS. We used logistic regression to investigate the association of severe PVS with FD. Results We included 33 FD patients (median age 44, 44.1% male) and 20 healthy controls (median age 33.5, 50% male). Adjusting for age and sex, FD was associated with more severe basal ganglia PVS (odds ratio (OR) 5.80, 95% CI 1.03–32.7) and higher total PVS score (OR 4.03, 95% CI 1.36–11.89). Compared with controls, participants with FD had: higher WMH volume (median 495.03 mm3 vs 0, p = 0.0008), more CMBs (21.21% vs none, p = 0.04), and a higher prevalence of lacunes (21.21% vs. 5%, p = 0.23). Conclusions PVS scores are more severe in FD than control subjects. Our findings have potential relevance for FD diagnosis and suggest that impaired interstitial fluid drainage might be a mechanism of white matter injury in FD.
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Affiliation(s)
- D Lyndon
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK
| | - I Davagnanam
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK.
| | - D Wilson
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - F Jichi
- Department of Biostatistics, University College of London, London, UK
| | - A Merwick
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK
| | - F Bolsover
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - H R Jager
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK
| | - L Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - C Wheeler-Kingshott
- Department of Neuroinflammation Queen Square MS Centre, UCL Institute of Neurology, London, UK
| | - D Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital, Rowland Hill Street, London, UK
| | - E Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - R Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - D J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK
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Abstract
Background During the COVID-19 pandemic, it has been essential for occupational health services (OHS) providers to react rapidly to increased demand and to utilize resources in novel ways. The impact of the COVID-19 pandemic on the psychological well-being of staff is already identified as an area of high risk; therefore, providing timely access to psychological support may be vital, although limited evidence is available on how these risks are best managed. Aims To describe implementation and analysis of a psychology-led COVID-19 telephone support line in a National Health Service OHS. Methods Data from calls made to the support line were collected over the first 4 weeks of service implementation. Numerical data including frequency of calls and average waiting time were first considered. A content analysis was then conducted on call notes to identify prevalence of themes. Results Six hundred and fifty-five calls were received, and 362 notes included sufficient information for use within the content analysis. Frequency of calls peaked within the first week followed by a reduction in the number of calls received per day over time. Most calls included discussion around clarification of guidance (68%) with a smaller subset of calls offering support around anxiety (29%). Prevalence of themes did not appear to change over time. Conclusions Clear and timely information is vital to support the well-being of healthcare staff. A psychologically informed telephone support line was a good use of occupational health service resources in the interim while more tailored advice and services could be established.
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Affiliation(s)
- J Matthewson
- Occupational Health Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Regent Point, Gosforth, Newcastle upon Tyne, UK
| | - A Tiplady
- Occupational Health Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Regent Point, Gosforth, Newcastle upon Tyne, UK
| | - F Gerakios
- Occupational Health Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Regent Point, Gosforth, Newcastle upon Tyne, UK
| | - A Foley
- Occupational Health Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Regent Point, Gosforth, Newcastle upon Tyne, UK
| | - E Murphy
- Occupational Health Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Regent Point, Gosforth, Newcastle upon Tyne, UK
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MacDonald CJ, Hellmuth R, Priba L, Murphy E, Gandy S, Matthew S, Ross R, Houston JG. Experimental Assessment of Two Non-Contrast MRI Sequences Used for Computational Fluid Dynamics: Investigation of Consistency Between Techniques. Cardiovasc Eng Technol 2020; 11:416-430. [PMID: 32613600 PMCID: PMC7385008 DOI: 10.1007/s13239-020-00473-z] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/20/2020] [Indexed: 11/05/2022]
Abstract
Purpose Recent studies have noted a degree of variance between the geometries segmented by different groups from 3D medical images that are used in computational fluid dynamics (CFD) simulations of patient-specific cardiovascular systems. The aim of this study was to determine if the applied sequence of magnetic resonance imaging (MRI) also introduced observable variance in CFD results. Methods Using a series of phantoms MR images of vessels of known diameter were assessed for the time-of-flight and multi-echo data image combination sequences. Following this, patient images of arterio-venous fistulas were acquired using the same sequences. Comparisons of geometry were made using the phantom and patient images, and of wall shear stress quantities using the CFD results from the patient images. Results Phantom images showed deviations in diameter between 0 and 15% between the sequences, depending on vessel diameter. Patient images showed different geometrical features such as narrowings that were not present on both sequences. Distributions of wall shear stress (WSS) quantities differed from simulations between the geometries obtained from the sequences. Conclusion In conclusion, choosing different MRI sequences resulted in slightly different geometries of the same anatomy, which led to compounded errors in WSS quantities from CFD simulation. Electronic supplementary material The online version of this article (10.1007/s13239-020-00473-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C J MacDonald
- Imaging and Technology, University of Dundee, Dundee, UK
| | - R Hellmuth
- Vascular Flow Technologies LTD, Dundee, UK
| | - L Priba
- Medical Physics, NHS Tayside, Dundee, UK
| | - E Murphy
- Imaging and Technology, University of Dundee, Dundee, UK
| | - S Gandy
- Medical Physics, NHS Tayside, Dundee, UK
| | - S Matthew
- Imaging and Technology, University of Dundee, Dundee, UK
| | - R Ross
- Vascular Laboratory, NHS Tayside, Dundee, UK
| | - J G Houston
- Imaging and Technology, University of Dundee, Dundee, UK. .,Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK.
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Kiss A, Wei C, Aligabi Z, Barlas M, Murphy E, Glass F, Friedman A, Efimova T. 693 p38 signaling regulates human cutaneous metastatic melanoma (MM) invasion and MM-dependent disruption of keratinocyte differentiation. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Philippou Y, Sjoberg H, Murphy E, Alyacoubi S, Jones K, Gordon-Weeks A, Lamb A, McKenna W, Gileadi U, Cerundolo V, Mills I, Hamdy F, Muschel R, Bryant R. Investigating tumour immune microenvironment effects of hypofractionated radiotherapy +/- immune checkpoint blockade in immunocompetent pre-clinical prostate cancer models. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bergstra SA, Vega-Morales D, Murphy E, De Buck M, Solomon-Escoto K, Huizinga T, Allaart C. SAT0099 BMI AND TREATMENT SURVIVAL IN RA PATIENTS STARTING TREATMENT WITH TNFΑ-INHIBITORS: LONG TERM FOLLOW-UP IN THE REAL LIFE METEOR REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:BMI appears to be associated with treatment response on TNFi(nhibitors) in rheumatoid arthritis (RA), but large heterogeneity between studies exists. More extreme BMI categories are rarely studied and it is unclear if differences exist between various TNFi.1Table 1Characteristics of RA patientsFemale, n (%)935 (79.8)Age, years*51.0 ±13.7Current smokers, n (%)256 (23.2)RF Positivity, n (%)404 (55.6)Anti-CCP Positivity, n (%)430 (58.2)X-ray Erosion, n (%)317 (61.9)ESR, mm/h*31.2±21.9CRP, mg/L*17.2±3.9DAS 28-CRP*3.8±1.6VAS global*46.6±28.6HAQ*0.9±0.7First TNFi Etanercept, n (%)525 (38.7) Adalimumab, n (%)379 (27.9) Infliximab, n (%)118 (8.7) Certolizumab, n (%)188 (13.8) Golimumab, n (%)147 (10.9)* mean ±S.DRF, Rheumatoid factor; Anti-CCP, Anti- cyclic citrullinated peptid; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; DAS28–CRP, Disease Activity Score using 28 joints–CRP; VAS, Visual analog scale; HAQ, Health Assessment QuestionnaireObjectives:To study whether there is an association between BMI category and drug survival in RA patients starting treatment with various TNFi in a real life longitudinal international registry.Methods:Data from 5230 RA patients starting a TNFi were included from the METEOR registry. Timing of follow-up visits was daily practice based. Follow-up was censored at 5000 days (±13.5 years). Patients were divided into 6 BMI categories (WHO definition): underweight BMI <18.5, normal weight BMI 18.5-25, pre-obesity BMI 25-30, obesity class I BMI 30-35, class II BMI 35-40, and class III BMI >40. Missing data were imputed using chained equations. The association between BMI category and time on treatment was investigated using Kaplan-Meier (KM) curves and Cox regression analyses, for time on first TNFi and for the first prescribed course of adalimumab (ADA), etanercept (ETA) and infliximab (IFX) separately. All analyses were adjusted for the potential confounders age, gender, smoking, baseline DAS28, concomitant glucocorticoid use and country. Potential effect modification by reported pain was tested by adding an interaction term between BMI category and baseline pain category (VAS pain 0-25, 25-50, 50-75 and 75-100).Results:Most patients had a normal weight (46%) or pre-obesity (32%). 4% of patients were underweight, 10% had obesity class I, 3% obesity class II and 1% obesity class III. N=2936 patients ever started ETA, n=2069 ADA, n=1390 IFX, n=263 certolizumab and n=84 golimumab. The KM curve in fig 1A shows TNFi survival in patient starting their first TNFi per BMI category. Patients with normal weight and pre-obesity had longest drug survival and patients with obesity class II and especially patients with obesity class III had shortest drug survival. The adjusted Cox regression support these findings, with statistically significantly shorter drug survival for patients with obesity class III [HR (95% CI) 1.67 (1.29; 2.18)] and class II [1.28 (1.06; 1.54)], but also for underweight patients [1.3 (1.07; 1.58)], compared to normal weight patients. KM curves for individual TNFi showed shorter drug survival on ADA for patients with obesity class II and III (fig 1B), on ETA for patients with obesity, especially in class III (fig 1C) and on IFX, for patients with obesity class II and III and underweight patients (fig 1D). After adjustment in Cox regression, statistical significant BMI-drug survival associations remained for patients with pre-obesity starting ADA [HR (95% CI) 0.86 (0.75; 0.99)], for patients starting ETA with obesity class II [HR (95% CI) 1.27 (0.98; 1.65) or class III [1.79 (1.25; 2.55)] and for patients on IFX who were underweight [HR (95% CI) 1.82 (1.20; 2.76)] or in obesity class II [1.49 (0.98; 2.26)]. No effect modification was found for reported pain.Conclusion:Both underweight (as identified in IFX treated patients) and overweight patients (in ADA, ETA and IFX treated patients) discontinued a first TNFi treatment earlier than normal weight patients. Reported pain was not the main determinant. It remains uncertain what determines TNFi survival in individual patients.References:[1] Singh, et al.PloS One2018; 13:e0195123Disclosure of Interests:Sytske Anne Bergstra: None declared, David Vega-Morales: None declared, Elizabeth Murphy: None declared, Marieke de Buck: None declared, Karen Solomon-Escoto: None declared, Thomas Huizinga Grant/research support from: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Consultant of: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Cornelia Allaart: None declared
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Kelly ME, Murphy E, Bolger JC, Cahill RA. COVID-19 and the treatment of acute appendicitis in Ireland: a new era or short-term pivot? Colorectal Dis 2020; 22:648-649. [PMID: 32403188 PMCID: PMC7272949 DOI: 10.1111/codi.15141] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- M. E. Kelly
- Department of SurgeryMater Misericordiae University HospitalDublinIreland
| | - E. Murphy
- Department of SurgeryMater Misericordiae University HospitalDublinIreland
| | - J. C. Bolger
- Department of SurgeryMater Misericordiae University HospitalDublinIreland
| | - R. A. Cahill
- Department of SurgeryMater Misericordiae University HospitalDublinIreland
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Khan MF, Murphy E, Cahill RA. Training pathway for a novel smart surgical system (FlexDex™) - a video vignette. Colorectal Dis 2020; 22:469-470. [PMID: 31782877 DOI: 10.1111/codi.14920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/20/2019] [Indexed: 01/24/2023]
Affiliation(s)
- M F Khan
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.,Centre for Precision Surgery, Section of Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | - E Murphy
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - R A Cahill
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.,Centre for Precision Surgery, Section of Surgery, School of Medicine, University College Dublin, Dublin, Ireland
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Devane LA, Khan F, Murphy E, McCaul C, Cahill RA. Laparoscopic guided transversus abdominis plane block for abdominal surgery - a video vignette. Colorectal Dis 2020; 22:221-222. [PMID: 31487430 DOI: 10.1111/codi.14848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/27/2019] [Indexed: 02/08/2023]
Affiliation(s)
- L A Devane
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - F Khan
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - E Murphy
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C McCaul
- Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
| | - R A Cahill
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.,Section of Surgery and Surgical Specialties, School of Medicine, University College Dublin, Dublin, Ireland
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Murphy E, Whitla L, Nadeem M. Herpes Simplex Virus Meningoencephalitis: Is It Nice to Continue. Ir Med J 2020; 113:13. [PMID: 32298559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- E Murphy
- Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
| | - L Whitla
- Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
| | - M Nadeem
- Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
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Murphy E, Van Den Berg K, Vermeulen M, Bakkour S, Busch M. Rapid ART in blood donors with acute and recent HIV clade C infection in South Africa. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Poole E, Huang CJZ, Forbester J, Shnayder M, Nachshon A, Kweider B, Basaj A, Smith D, Jackson SE, Liu B, Shih J, Kiskin FN, Roche K, Murphy E, Wills MR, Morrell NW, Dougan G, Stern-Ginossar N, Rana AA, Sinclair J. An iPSC-Derived Myeloid Lineage Model of Herpes Virus Latency and Reactivation. Front Microbiol 2019; 10:2233. [PMID: 31649625 PMCID: PMC6795026 DOI: 10.3389/fmicb.2019.02233] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/11/2019] [Indexed: 02/02/2023] Open
Abstract
Herpesviruses undergo life-long latent infection which can be life-threatening in the immunocompromised. Models of latency and reactivation of human cytomegalovirus (HCMV) include primary myeloid cells, cells known to be important for HCMV latent carriage and reactivation in vivo. However, primary cells are limited in availability, and difficult to culture and to genetically modify; all of which have hampered our ability to fully understand virus/host interactions of this persistent human pathogen. We have now used iPSCs to develop a model cell system to study HCMV latency and reactivation in different cell types after their differentiation down the myeloid lineage. Our results show that iPSCs can effectively mimic HCMV latency/reactivation in primary myeloid cells, allowing molecular interrogations of the viral latent/lytic switch. This model may also be suitable for analysis of other viruses, such as HIV and Zika, which also infect cells of the myeloid lineage.
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Affiliation(s)
- Emma Poole
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Jessica Forbester
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Miri Shnayder
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Aharon Nachshon
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Baraa Kweider
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Anna Basaj
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Daniel Smith
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Bin Liu
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Joy Shih
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Fedir N. Kiskin
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - K. Roche
- Cleveland Clinic, Lerner Research Institute, Cleveland, OH, United States
| | - E. Murphy
- Cleveland Clinic, Lerner Research Institute, Cleveland, OH, United States
| | - Mark R. Wills
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Gordon Dougan
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Noam Stern-Ginossar
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Amer A. Rana
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - John Sinclair
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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Arranz E, Corrochano A, Shanahan C, Villalva M, Jaime L, Santoyo S, Callanan M, Murphy E, Giblin L. Antioxidant activity and characterization of whey protein-based beverages: Effect of shelf life and gastrointestinal transit on bioactivity. INNOV FOOD SCI EMERG 2019. [DOI: 10.1016/j.ifset.2019.102209] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tesar V, Trachtman H, Murphy E, Ferguson B, Komers R. SUN-037 NO IMPACT OF NEWLY INITIATED IMMUNOSUPPRESSIVE THERAPY OBSERVED ON LONG-TERM ANTIPROTEINURIC EFFECT OF SPARSENTAN IN FOCAL SEGMENTAL GLOMERULOSCLEROSIS: INTERIM 84-WEEK ANALYSIS OF THE DUET TRIAL. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Affiliation(s)
- E. Murphy
- Golden Jubilee National Hospital, Glasgow, UK
- Academic Unit of Anaesthesia Critical Care and Pain Medicine, Glasgow University, Glasgow, UK
| | - B. Shelley
- Golden Jubilee National Hospital, Glasgow, UK
- Academic Unit of Anaesthesia Critical Care and Pain Medicine, Glasgow University, Glasgow, UK
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Milando R, Kiss A, Sall M, Murphy E, Friedman A, Efimova T. 152 Suppression of p38α promotes fibroblast-led human squamous cell carcinoma (SCC) invasion through p38δ-dependent mechanism. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rubio-Gozalbo ME, Haskovic M, Bosch AM, Burnyte B, Coelho AI, Cassiman D, Couce ML, Dawson C, Demirbas D, Derks T, Eyskens F, Forga MT, Grunewald S, Häberle J, Hochuli M, Hubert A, Huidekoper HH, Janeiro P, Kotzka J, Knerr I, Labrune P, Landau YE, Langendonk JG, Möslinger D, Müller-Wieland D, Murphy E, Õunap K, Ramadza D, Rivera IA, Scholl-Buergi S, Stepien KM, Thijs A, Tran C, Vara R, Visser G, Vos R, de Vries M, Waisbren SE, Welsink-Karssies MM, Wortmann SB, Gautschi M, Treacy EP, Berry GT. The natural history of classic galactosemia: lessons from the GalNet registry. Orphanet J Rare Dis 2019; 14:86. [PMID: 31029175 PMCID: PMC6486996 DOI: 10.1186/s13023-019-1047-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/12/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Classic galactosemia is a rare inborn error of carbohydrate metabolism, caused by a severe deficiency of the enzyme galactose-1-phosphate uridylyltransferase (GALT). A galactose-restricted diet has proven to be very effective to treat the neonatal life-threatening manifestations and has been the cornerstone of treatment for this severe disease. However, burdensome complications occur despite a lifelong diet. For rare diseases, a patient disease specific registry is fundamental to monitor the lifespan pathology and to evaluate the safety and efficacy of potential therapies. In 2014, the international Galactosemias Network (GalNet) developed a web-based patient registry for this disease, the GalNet Registry. The aim was to delineate the natural history of classic galactosemia based on a large dataset of patients. METHODS Observational data derived from 15 countries and 32 centers including 509 patients were acquired between December 2014 and July 2018. RESULTS Most affected patients experienced neonatal manifestations (79.8%) and despite following a diet developed brain impairments (85.0%), primary ovarian insufficiency (79.7%) and a diminished bone mineral density (26.5%). Newborn screening, age at onset of dietary treatment, strictness of the galactose-restricted diet, p.Gln188Arg mutation and GALT enzyme activity influenced the clinical picture. Detection by newborn screening and commencement of diet in the first week of life were associated with a more favorable outcome. A homozygous p.Gln188Arg mutation, GALT enzyme activity of ≤ 1% and strict galactose restriction were associated with a less favorable outcome. CONCLUSION This study describes the natural history of classic galactosemia based on the hitherto largest data set.
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Affiliation(s)
- M E Rubio-Gozalbo
- Department of Pediatrics and Clinical Genetics, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - M Haskovic
- Department of Pediatrics and Clinical Genetics, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - A M Bosch
- Amsterdam UMC, University of Amsterdam, Pediatric Metabolic Diseases, Emma Children's Hospital, Amsterdam, Netherlands
| | - B Burnyte
- Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - A I Coelho
- Department of Pediatrics and Clinical Genetics, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - D Cassiman
- Metabolic Center, Department of Gastroenterology-Hepatology, Leuven University Hospitals and KU Leuven, Leuven, Belgium
| | - M L Couce
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, S. Neonatology, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, CIBERER, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - C Dawson
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, London, UK
| | - D Demirbas
- Manton Center for Orphan Disease Research, Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - T Derks
- Section of Metabolic Diseases, Beatrix Children's Hospital, and Groningen University Institute for Drug Exploration (GUIDE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F Eyskens
- Antwerp University Hospital, Antwerp, Belgium
| | - M T Forga
- Hospital Clinic Barcelona, Barcelona, Spain
| | - S Grunewald
- Metabolic Medicine Department, Great Ormond Street Hospital, Institute for Child Health UCL, London, UK
| | - J Häberle
- Division of Metabolism and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - M Hochuli
- Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - A Hubert
- APHP, HUPS, Hôpital Antoine Béclère, Centre de Référence Maladies Héréditaires Hépatiques, Clamart, France.,Université Paris Sud-Paris Saclay, and INSERM U 1195, Paris, France
| | - H H Huidekoper
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - P Janeiro
- Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - J Kotzka
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - I Knerr
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Temple Street, Dublin, Ireland
| | - P Labrune
- APHP, HUPS, Hôpital Antoine Béclère, Centre de Référence Maladies Héréditaires Hépatiques, Clamart, France.,Université Paris Sud-Paris Saclay, and INSERM U 1195, Paris, France
| | - Y E Landau
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J G Langendonk
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Möslinger
- Department for Pediatrics and Adolescent Medicine, Inborn Errors of Metabolism, Medical University of Vienna, Vienna, Austria
| | - D Müller-Wieland
- Clinical Research Center, Department of Medicine I, University Hospital RWTH Aachen, Aachen, Germany
| | - E Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - K Õunap
- Department of Clinical Genetics, United Laboratories and Institute of Clinical Medicine, Tartu University Hospital, Tartu, Estonia
| | - D Ramadza
- Department of Pediatrics, University Hospital Centre, Zagreb, Croatia
| | - I A Rivera
- Research Institute for Medicines (iMed.ULisboa), and Department of Biochemistry and Human Biology, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - S Scholl-Buergi
- Universitätsklink für Pädiatrie, Tirol Kliniken GmbH, Innsbruck, Austria
| | - K M Stepien
- Mark Holland Metabolic Unit, Adult Inherited Metabolic Disorders Department, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
| | - A Thijs
- Vrije Universiteit Amsterdam, Internal Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - C Tran
- Center for Molecular Diseases, Division of Genetic Medicine, University Hospital Lausanne, Lausanne, Switzerland
| | - R Vara
- Department of Paediatric Inherited Metabolic Disease, Evelina London Children's Hospital, London, UK
| | - G Visser
- Department of Pediatrics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R Vos
- Department of Methodology and Statistics, CAPHRI School for Primary Care and Public Health, Faculty Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - M de Vries
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S E Waisbren
- Department of Pediatrics, Division of Genomics and Genetics, Harvard Medical School and Boston Children's Hospital, Boston, USA
| | - M M Welsink-Karssies
- Amsterdam UMC, University of Amsterdam, Pediatric Metabolic Diseases, Emma Children's Hospital, Amsterdam, Netherlands
| | - S B Wortmann
- University Children's Hospital, Parcelsus Medical University (PMU), Salzburg, Austria
| | - M Gautschi
- Department of Pediatrics and Institute of Clinical Chemistry, Inselspital, University Hospital Bern, Bern, Switzerland
| | - E P Treacy
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Centre for Inherited Metabolic Disorders, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - G T Berry
- Manton Center for Orphan Disease Research, Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Whilta L, Veitch V, O’Halloran K, O’Riordan F, Murphy E, Coghlan D, Elnazir B, Nadeem M. Influenza in Children: Is there a link with Medical Complications or Inflammatory Markers? Ir Med J 2019; 112:925. [PMID: 31245975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- L Whilta
- Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
| | - V Veitch
- Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
| | - K O’Halloran
- Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
| | - F O’Riordan
- Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
| | - E Murphy
- Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
| | - D Coghlan
- Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
- Trinity College Dublin
| | - B Elnazir
- Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
- Trinity College Dublin
| | - M Nadeem
- Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
- Trinity College Dublin
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Dunne L, Murphy E, Rutledge R. “Semenly” Harmless Back Pain: An Unusual Presentation of a Subcutaneous Abscess. Ir Med J 2019; 112:857. [PMID: 30719898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aims We report, with review of the literature, the case of a patient who developed a subcutaneous abscess after intravenously injecting his own semen in an attempt to treat longstanding back pain. He had devised this “cure” independent of medical advice. Methods A review of EMBASE, PubMed, google scholar and the wider internet was conducted with an emphasis on parenteral semen for the treatment of back pain and for other medical and non-medical uses. Results There were no other reported cases of intravenous semen injection found across the medical literature. A broader search of internet sites and forums found no documentation of semen injection for back pain treatment or otherwise. Conclusion While suicide attempt by intravenous injection of harmful substances is well described, this unique case demonstrates risks involved with innovative treatments prior to clinical research in the form of phased trials inclusive of safety and efficacy assessments.
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Affiliation(s)
- L Dunne
- Tallaght University Hospital, Tallaght, Dublin 24
| | - E Murphy
- Tallaght University Hospital, Tallaght, Dublin 24
| | - R Rutledge
- Tallaght University Hospital, Tallaght, Dublin 24
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Mulcahy S, Prendergast J, Foley G, O Hare A, Murphy E, Guinan EM, Hussey J. Exercise Rehabilitation Services Provided by Physiotherapy Departments in Cancer Care in Ireland. Ir Med J 2018; 111:818. [PMID: 30556666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aims This study aimed to identify the physiotherapy exercise rehabilitation services available to patients with cancer in Ireland and to identify barriers to the provision of services. Methods Physiotherapy department managers in specialised cancer centres, public and private hospitals and palliative care settings were surveyed to establish the availability of exercise rehabilitation services for patients with cancer. Results Of 40 managers contacted, 24 responded providing information about 26 services. Ten services employed a dedicated oncology physiotherapist. Exercise classes were offered to patients with cancer by five services, primarily within the palliative care setting. In the 17 hospitals which provided surgery, ten provided oncology specific post-operative exercise rehabilitation and one offered a prehabilitation programme. Limited human and physical resources and absence of established physiotherapy pathways were cited barriers to service provision. Conclusion Exercise rehabilitation is not an element of standard care for patients with cancer in Ireland.
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Affiliation(s)
- S Mulcahy
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin
| | - J Prendergast
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin
| | - G Foley
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin
| | - A O Hare
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin
| | - E Murphy
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin
| | - E M Guinan
- School of Medicine, Trinity College Dublin
| | - J Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin
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Bousquet J, Devillier P, Arnavielhe S, Bedbrook A, Alexis-Alexandre G, van Eerd M, Murray R, Canonica GW, Illario M, Menditto E, Passalacqua G, Stellato C, Triggiani M, Carreiro-Martins P, Fonseca J, Morais Almeida M, Nogueira-Silva L, Pereira AM, Todo Bom A, Bosse I, Caimmi D, Demoly P, Fontaine JF, Just J, Onorato GL, Kowalski ML, Kuna P, Samolinski B, Anto JM, Mullol J, Valero A, Tomazic PV, Bergmann KC, Keil T, Klimek L, Mösges R, Shamai S, Zuberbier T, Murphy E, McDowall P, Price D, Ryan D, Sheikh A, Chavannes NH, Fokkens WJ, Kvedariene V, Valiulis A, Bachert C, Hellings PW, Kull I, Melen E, Wickman M, Bindslev-Jensen C, Eller E, Haahtela T, Papadopoulos NG, Annesi-Maesano I, Bewick M, Bosnic-Anticevich S, Cruz AA, De Vries G, Gemicioglu B, Larenas-Linnemann D, Laune D, Mathieu-Dupas E, O'Hehir RE, Pfaar O, Portejoie F, Siroux V, Spranger O, Valovirta E, VandenPlas O, Yorgancioglu A. Treatment of allergic rhinitis using mobile technology with real-world data: The MASK observational pilot study. Allergy 2018; 73:1763-1774. [PMID: 29336067 DOI: 10.1111/all.13406] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Large observational implementation studies are needed to triangulate the findings from randomized control trials as they reflect "real-world" everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real-life treatment of allergic rhinitis (AR) using mobile technology. METHODS A mobile phone app (Allergy Diary, freely available in Google Play and Apple App stores) collects the data of daily visual analog scales (VAS) for (i) overall allergic symptoms, (ii) nasal, ocular, and asthma symptoms, (iii) work, as well as (iv) medication use using a treatment scroll list including all medications (prescribed and over the counter (OTC)) for rhinitis customized for 15 countries. RESULTS A total of 2871 users filled in 17 091 days of VAS in 2015 and 2016. Medications were reported for 9634 days. The assessment of days appeared to be more informative than the course of the treatment as, in real life, patients do not necessarily use treatment on a daily basis; rather, they appear to increase treatment use with the loss of symptom control. The Allergy Diary allowed differentiation between treatments within or between classes (intranasal corticosteroid use containing medications and oral H1-antihistamines). The control of days differed between no [best control], single, or multiple treatments (worst control). CONCLUSIONS This study confirms the usefulness of the Allergy Diary in accessing and assessing everyday use and practice in AR. This pilot observational study uses a very simple assessment (VAS) on a mobile phone, shows novel findings, and generates new hypotheses.
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Affiliation(s)
- J. Bousquet
- Contre les MAladies Chroniques Pour un VIeillissement Actif en France; European Innovation Partnership on Active and Healthy Ageing Reference Site; MACVIA-France; Montpellier France
- INSERM U 1168; VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches; Université Versailles St-Quentin-en-Yvelines, UMR-S168; Villejuif, Montigny le Bretonneux France
- Euforea; Brussels Belgium
| | - P. Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220; Pôle des Maladies Respiratoires; Hôpital Foch; Suresnes - Université Versailles Saint-Quentin; Versailles France
| | | | - A. Bedbrook
- Contre les MAladies Chroniques Pour un VIeillissement Actif en France; European Innovation Partnership on Active and Healthy Ageing Reference Site; MACVIA-France; Montpellier France
| | | | | | - R. Murray
- Medical Communications Consultant; MedScript Ltd; Dundalk Ireland
| | - G. W. Canonica
- Allergy and Respiratory Diseases; Department of Internal Medicine; IRCCS San Martino-IST-University of Genoa; Genoa Italy
| | - M. Illario
- Division for Health Innovation; Campania Region and Federico II University Hospital Naples (R&D and DISMET); Naples Italy
| | - E. Menditto
- Center of Pharmacoeconomics; CIRFF; University of Naples Federico II; Naples Italy
| | - G. Passalacqua
- Allergy and Respiratory Diseases; Department of Internal Medicine; IRCCS San Martino-IST-University of Genoa; Genoa Italy
| | - C. Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”; University of Salerno; Salerno Italy
| | - M. Triggiani
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”; University of Salerno; Salerno Italy
| | - P. Carreiro-Martins
- Servicio de Imunoalergologia; EPE - Nova Medical School; Respiratory Research Group; CEDOC; Centro Hospitalar de Lisboa Central; Lisbon Portugal
| | - J. Fonseca
- Faculdade de Medicina; Center for Health Technology and Services Research-CINTESIS; Universidade do Porto; Porto Portugal
- Allergy Unit; CUF Porto Instituto & Hospital; Porto Portugal
| | - M. Morais Almeida
- Rhinology Unit & Smell Clinic; ENT Department; Hospital Clinic; Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES; University of Barcelona; Barcelona Spain
| | - L. Nogueira-Silva
- Department of Internal Medicine; Center for Health Technology and Services Research-CINTESIS; Centro Hospitalar Sao Joao; Porto Portugal
| | - A. M. Pereira
- Allergy Unit; CUF Porto Instituto & Hospital; Porto Portugal
- Immunoallergy Department; CUF-Descobertas Hospital; Lisbon Portugal
- Health Information and Decision Sciences Department; Faculty of Medicine of the University of Porto; Porto Portugal
| | - A. Todo Bom
- Imunoalergologia; Centro Hospitalar Universitario de Coimbra; Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | | | - D. Caimmi
- CHU de Montpellier; UPMC, Paris 06; UMR-S 1136, IPLESP, Equipe EPAR; Sorbonne Universités; Paris France
| | - P. Demoly
- CHU de Montpellier; UPMC, Paris 06; UMR-S 1136, IPLESP, Equipe EPAR; Sorbonne Universités; Paris France
| | | | - J. Just
- Allergology Department; Centre de l'Asthme et des Allergies; Hôpital d'Enfants Armand-Trousseau - INSERM; UMRS 1136, UPMC Univ Paris 06 - Institut Pierre Louis d'Epidémiologie et de Santé Publique; Equipe EPAR; Sorbonne Universités; Paris France
| | - G. L. Onorato
- Contre les MAladies Chroniques Pour un VIeillissement Actif en France; European Innovation Partnership on Active and Healthy Ageing Reference Site; MACVIA-France; Montpellier France
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz Poland
- HARC; Lodz Poland
| | - P. Kuna
- Division of Internal Medicine; Asthma and Allergy; Barlicki University Hospital; Medical University of Lodz; Lodz Poland
| | - B. Samolinski
- Department of Prevention of Environmental Hazards and Allergology; Medical University of Warsaw; Warsaw Poland
| | - J. M. Anto
- ISGLoBAL; Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- IMIM (Hospital del Mar Research Institute); Barcelona Spain
- CIBER Epidemiologıa y Salud Publica (CIBERESP); Barcelona Spain
- Universitat Pompeu Fabra (UPF); Barcelona Spain
| | - J. Mullol
- Rhinology Unit & Smell Clinic; ENT Department; Hospital Clinic; Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES; University of Barcelona; Barcelona Spain
| | - A. Valero
- Pneumology and Allergy Department Hospital Clınic; Clinical & Experimental Respiratory Immunoallergy; IDIBAPS, CIBERES; University of Barcelona; Barcelona Spain
| | - P. V. Tomazic
- Department of ENT; Medical University of Graz; Graz Austria
| | - K. C. Bergmann
- Comprehensive Allergy-Centre-Charité; Department of Dermatology and Allergy; Global Allergy and Asthma European Network (GA LEN); Charité Universitatsmedizin Berlin; Berlin Germany
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics; Charité-Universitatsmedizin; Berlin Germany
- Institute for Clinical Epidemiology and Biometry; University of Wuerzburg; Wuerzburg Germany
| | - L. Klimek
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - R. Mösges
- Institute of Medical Statistics and Computational Biology; Medical Faculty; University of Cologne; Cologne Germany
- CRI-Clinical Research International-Ltd; Hamburg Germany
| | - S. Shamai
- Institute of Medical Statistics and Computational Biology; Medical Faculty; University of Cologne; Cologne Germany
- CRI-Clinical Research International-Ltd; Hamburg Germany
| | - T. Zuberbier
- Comprehensive Allergy-Centre-Charité; Department of Dermatology and Allergy; Global Allergy and Asthma European Network (GA LEN); Charité Universitatsmedizin Berlin; Berlin Germany
| | - E. Murphy
- Newcastle OHS; The Newcastle upon Tyne NHS Foundation Hospitals Trust; Newcastle upon Tyne UK
| | - P. McDowall
- Newcastle OHS; The Newcastle upon Tyne NHS Foundation Hospitals Trust; Newcastle upon Tyne UK
| | - D. Price
- Observational and Pragmatic Research Institute; Singapore City Singapore
- Optimum Patient Care; Cambridge UK
- Academic Centre of Primary Care; University of Aberdeen; Aberdeen UK
| | - D. Ryan
- Allergy and Respiratory Research Group; Usher Institute of Population Health Sciences and Informatics; University of Edinburgh; Edinburgh UK
| | - A. Sheikh
- Asthma UK Centre for Applied Research; Centre of Medical Informatics; Usher Institute of Population Health Sciences and Informatics; The University of Edinburgh; Edinburgh UK
| | - N. H. Chavannes
- Department of Public Health and Primary Care; Leiden University Medical Center; Leiden The Netherlands
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
| | - V. Kvedariene
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology; Vilnius University; Vilnius Lithuania
| | - A. Valiulis
- Vilnius University Clinic of Children's Diseases and Public Health Institute; Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS-SP); Brussels Belgium
| | - C. Bachert
- ENT Department; Upper Airways Research Laboratory; Ghent University Hospital; Ghent Belgium
| | - P. W. Hellings
- Euforea; Brussels Belgium
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
- Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - I. Kull
- Department of Clinical Science and Education; Sodersjukhuset; Karolinska Institutet; Stockholm Sweden
| | - E. Melen
- Department of Clinical Science and Education; Sodersjukhuset; Karolinska Institutet; Stockholm Sweden
| | - M. Wickman
- Sodersjukhuset; Sachs' Children and Youth Hospital; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense Research Center for Anaphylaxis (ORCA); Odense University Hospital; Odense Denmark
| | - E. Eller
- Department of Dermatology and Allergy Centre; Odense Research Center for Anaphylaxis (ORCA); Odense University Hospital; Odense Denmark
| | - T. Haahtela
- Skin and Allergy Hospital; Helsinki University Hospital; Helsinki Finland
| | - N. G. Papadopoulos
- Center for Pediatrics and Child Health; Institute of Human Development; Royal Manchester Children's Hospital; University of Manchester; Manchester UK
- Allergy Department; 2nd Pediatric Clinic; Athens General Children's Hospital “P&A Kyriakou”; University of Athens; Athens Greece
| | - I. Annesi-Maesano
- EPAR U707 INSERM; Paris France
- EPAR UMR-S UPMC; Paris VI; Paris France
| | | | - S. Bosnic-Anticevich
- Woolcock Institute of Medical Research; University of Sydney; Sydney NSW Australia
- Sydney Local Health District; Glebe NSW Australia
| | - A. A. Cruz
- ProAR-Nucleo de Excelencia em Asma; Federal University of Bahia; Salvador Brazil
- GARD Executive Committee; Salvador Brazil
| | | | - B. Gemicioglu
- Department of Pulmonary Diseases; Cerrahpasa Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - D. Larenas-Linnemann
- Center of Excellence in Asthma and Allergy; Hospital Médica Sur; Mexico City Mexico
| | | | | | - R. E. O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine; Alfred Hospital and Central Clinical School; Monash University; Melbourne Vic. Australia
- Department of Immunology; Monash University; Melbourne Vic. Australia
| | - O. Pfaar
- Center for Rhinology and Allergology; Wiesbaden Germany
- Departent of Otorhinolaryngology, Head and Neck Surgery; Universitätsmedizin Mannhein; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - F. Portejoie
- Contre les MAladies Chroniques Pour un VIeillissement Actif en France; European Innovation Partnership on Active and Healthy Ageing Reference Site; MACVIA-France; Montpellier France
| | - V. Siroux
- INSERM; Universite Grenoble Alpes; IAB; U 1209; Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health; Université Joseph Fourier; Grenoble France
| | - O. Spranger
- Global Allergy and Asthma Platform GAAPP; Vienna Austria
| | - E. Valovirta
- Department of Lung Diseases and Clinical Allergology; Terveystalo; Allergy Clinic; University of Turku; Turku Finland
| | - O. VandenPlas
- Department of Chest Medicine; Centre Hospitalier Universitaire UCL Namur; Université Catholique de Louvain; Yvoir Belgium
| | - A. Yorgancioglu
- Department of Pulmonology; Celal Bayar University; Manisa Turkey
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Murphy E, Glass A, McCall P, Kinsella J, Shelley B. Cardiac-magnetic-resonance-derived strain rate: a novel technique for assessing right ventricular diastolic function post-lung resection. Br J Anaesth 2018. [DOI: 10.1016/j.bja.2018.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Murphy E, Shelley B. The right ventricle-structural and functional importance for anaesthesia and intensive care. BJA Educ 2018; 18:239-245. [PMID: 33456839 DOI: 10.1016/j.bjae.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- E Murphy
- Academic Unit of Anaesthesia, Pain and Critical Care Medicine, University of Glasgow, Golden Jubilee National Hospital, Glasgow, UK
| | - B Shelley
- Academic Unit of Anaesthesia, Pain and Critical Care Medicine, University of Glasgow, Golden Jubilee National Hospital, Glasgow, UK
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Curtin M, Murphy E, Bryan C, Moroney P. Scarf osteotomy without internal fixation for correction of hallux valgus: A clinical and radiographic review of 148 cases. Foot Ankle Surg 2018; 24:252-258. [PMID: 29409250 DOI: 10.1016/j.fas.2017.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/05/2017] [Accepted: 02/21/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus is a common condition with in excess of 120 procedures described in the literature for its correction. Traditionally, distal metatarsal osteotomies have been employed in the treatment of mild deformities, with proximal osteotomies being reserved for more severe presentations. The Scarf osteotomy without internal fixation allows large translations which can successfully correct severe hallux valgus deformities, without limitations related to screw placement. METHODS This is a retrospective single surgeon case series performed over a three year period. One hundred and forty-eight cases were identified, with an average follow up time of 16.5 months. Visual analogue scales were used to obtain preoperative and postoperative pain and cosmetic scores, with the Foot and Ankle Disability Index (FADI) index used to assess functional status. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were assessed on preoperative and postoperative AP weight-bearing foot X-rays. RESULTS The mean pain score improved from 7.04/10 preoperatively to 0.29/10 postoperatively. The mean cosmetic score improved from 2.1/10 to 9.1/10 postoperatively. The mean preoperative HVA and IMA were 35.04° and 15.04°, respectively. The mean postoperative HVA and IMA were 11.54° and 4.83°, respectively. The mean postoperative FADI score was 103.4/104. We report a loss of correction in two cases. One revision surgery was performed. CONCLUSIONS We report a large series of cases of the modified Scarf osteotomy as described by Maestro-a versatile, cost-effective, safe and reliable technique with the potential for three dimensional correction. Whilst this is a technically demanding procedure, we recommend the use of the modified Scarf osteotomy in the treatment of a wide range of hallux valgus deformities.
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Affiliation(s)
- M Curtin
- Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
| | - E Murphy
- Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
| | - C Bryan
- Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
| | - P Moroney
- Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
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Mapson R, Murphy E, Read D. Impact of dietitian led enteral nutrition service development at Western Sussex Hospitals NHS Foundation Trust. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Scalco R, Manole A, Chatfield S, Booth S, Wigley R, Pattni J, Michalak Z, Desikan M, Godfrey R, Houlden H, Murphy E, Quinlivan R. Exercise profile in patients with SLC2A9 homozygous mutation and a history of exercise induced kidney failure. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Murphy E, Mandigo M, Anderson J. Opportunities to prevent unintended pregnancy among women with HIV. Contraception 2017. [DOI: 10.1016/j.contraception.2017.07.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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