1
|
Chan B, Buckley T, Hansen P, Shaw E, Tofler GH. Circadian variation in acute myocardial infarction and modification by coronary artery disease: a prospective observational study. Eur Heart J Open 2023; 3:oead068. [PMID: 37465259 PMCID: PMC10351570 DOI: 10.1093/ehjopen/oead068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Bernard Chan
- Cardiology Department, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
- Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia
| | - Thomas Buckley
- Cardiology Department, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
- Sydney Nursing School, University of Sydney, Camperdown, NSW 2006, Australia
| | - Peter Hansen
- Cardiology Department, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
- Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia
| | - Elizabeth Shaw
- Cardiology Department, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
- Cardiology Department, Hornsby Ku-ring-gai Hospital, Palmerston Road, Hornsby, NSW 2077, Australia
| | | |
Collapse
|
2
|
Latham K, Subhi H, Shaw E. Further Validation of Comfortable Print Size as a Parameter for Clinical Low-Vision Assessment. Transl Vis Sci Technol 2023; 12:18. [PMID: 37358493 DOI: 10.1167/tvst.12.6.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Abstract
Purpose Comfortable print size (CfPS) has been proposed as a clinical alternative to deriving critical print size (CPS) in the assessment of reading function of vision-impaired patients. This study aimed to assess the repeatability of CfPS and to compare assessment duration and values to CPS measures and acuity reserves. Methods Thirty-four adults with vision impairment had their reading function assessed. Two assessments of CfPS were made by asking, "What is the smallest print size that you would find comfortable using?" Reading parameters including CPS were determined using the MNREAD card chart and MNREAD app. Results CfPS was quicker to assess (mean ± SD, 144 ± 77 seconds) than the MNREAD card (231 ± 177 seconds) or app (285 ± 43 seconds). Within-session repeatability of CfPS showed no significant bias or variation across the functional range and limits of agreement (LoA) of ±0.09 logMAR. CfPS values were 0.10 logMAR larger than card CPS values, but no different from app CPS values, with LoA of ±0.43 to 0.45 logMAR. Acuity reserve (comparing CfPS to card reading acuity) was 1.9:1 on average, with a maximum of 5.0:1. Conclusions CfPS offers a quick, repeatable, and individualized clinical measure of the print size required for sustained reading that reflects CPS values obtained by more traditional measures. Translational Relevance CfPS is an appropriate clinical measure of reading function to use in determining the magnification requirements of vision impaired patients for sustained reading tasks.
Collapse
Affiliation(s)
- Keziah Latham
- Vision & Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Hikmat Subhi
- Vision & Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Elizabeth Shaw
- Vision & Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| |
Collapse
|
3
|
Christodoulou J, Vincent E, Shaw E, Jones ASK, Rotheram-Borus MJ. Not as Clear Online? Active Visualization of How PrEP Works in the Body Improves Knowledge But Doesn't Change Behavior. AIDS Behav 2023; 27:1116-1122. [PMID: 36112258 PMCID: PMC9483425 DOI: 10.1007/s10461-022-03848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
Abstract
Active visualization, the use of dynamic representation of internal processes, is associated with increased knowledge and adherence to ART among people living with HIV. The current pilot intervention study tested the effectiveness of an online visualization for HIV prevention among 146 at-risk youth. Youth were randomized to a standard PrEP briefing or an online visualization. PrEP knowledge, attitudes, and uptake were self-reported at baseline and 3-months. Knowledge of PrEP increased, but there were no changes in preferences or uptake. Active visualization delivered online may be a useful educational tool for PrEP but not for shifting youth's uptake.
Collapse
Affiliation(s)
| | - Eleanor Vincent
- Department of Psychology, Palo Alto University, Palo Alto, CA USA
| | - Elizabeth Shaw
- Department of Psychology, Palo Alto University, Palo Alto, CA USA
| | - Annie S. K. Jones
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024 USA
| |
Collapse
|
4
|
Lau D, Shaw E, McMullen S, Cowling T, Witges K, Amitay E, STEUBL D, Girard L. WCN23-0604 ACUTE AND CHRONIC COMPLICATION PROFILES AMONG PATIENTS IDENTIFIED WITH CHRONIC KIDNEY DISEASE IN ALBERTA, CANADA. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.391] [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
|
5
|
Burgess S, Cader FA, Shaw E, Banerjee S, Stehli J, Krishnamorthy R, Khor L, Forotan H, Bastiany A, Rao S, Chandrasekhar J, Zaman S, Alasnag M, Chieffo A, Coylewright M. Under-representation of Women as Proceduralists and Patients in TAVR and TMVr Procedures: Data, Implications and Proposed Solutions. Eur Cardiol 2022; 17:e27. [PMID: 36845217 PMCID: PMC9947929 DOI: 10.15420/ecr.2022.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 12/23/2022] Open
Abstract
Women are under-represented among transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVr) operators. This review assesses the representation of women as patients and as proceduralists and trial authors in major structural interventions. Women are under-represented as proceduralists in structural interventions: only 2% of TAVR operators and 1% of TMVr operators are women. Only 1.5% of authors in landmark clinical TAVR and TMVr trials are interventional cardiologists who are women (4/260). Significant under-representation and under-enrolment of women in landmark TAVR trials is evident: the calculated participation-to-prevalence ratio (PPR) is 0.73, and in TMVr trials, the PPR is 0.69. Under-representation of women is also evident in registry data (PPR = 0.84 for TAVR registries and for TMVr registries). In structural interventional cardiology, women are under-represented as proceduralists, trial participants and patients. This under-representation has the potential to affect the recruitment of women to randomised trials, subsequent guideline recommendations, selection for treatment, patient outcomes and sex-specific data analysis.
Collapse
Affiliation(s)
- Sonya Burgess
- Department of Medicine, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Nepean HospitalSydney, New South Wales, Australia
| | - F. Aaysha Cader
- Department of Cardiology, Ibrahim Cardiac Hospital & Research InstituteDhaka, Bangladesh,Department of Population Health, University of OxfordOxford, UK
| | - Elizabeth Shaw
- Department of Medicine, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Hornsby Ku-ring-gai Hospital,Sydney, New South Wales, Australia,Department of Cardiology, Sydney Adventist Hospital, WahroongaSydney, New South Wales, Australia
| | - Shrilla Banerjee
- Department of Cardiology, Surrey and Sussex Healthcare NHS TrustRedhill, UK
| | - Julia Stehli
- Department of Cardiology, University Hospital ZurichZurich, Switzerland
| | | | - Lynn Khor
- Department of Cardiology, Nepean HospitalSydney, New South Wales, Australia
| | - Homa Forotan
- Department of Cardiology, Princess Alexandra HospitalBrisbane, Queensland, Australia
| | - Alexandra Bastiany
- Thunder Bay Regional Health Sciences Centre and Northern Ontario School of MedicineThunder Bay, Ontario, Canada
| | - Sarita Rao
- Department of Cardiology, Apollo HospitalIndore, India
| | - Jaya Chandrasekhar
- Department of Cardiology, Eastern HealthMelbourne, Victoria, Australia,Eastern Health Clinical School, Monash UniversityMelbourne, Victoria, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Westmead HospitalSydney, New South Wales, Australia
| | - Mirvat Alasnag
- Department of Cardiology, King Fahd Armed Forces HospitalJeddah, Saudi Arabia
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific InstituteMilan, Italy
| | - Megan Coylewright
- Section of Cardiovascular Medicine, Erlanger Heart and Lung InstituteChattanooga, Tennessee, US
| |
Collapse
|
6
|
Fahim C, Wiebe N, Nisenbaum R, Hamid JS, Ewusie JE, Tonelli M, Brauer P, Shaw E, Bell N, Stacey D, Holmes NM, Straus SE. Changes in mammography screening in Ontario and Alberta following national guideline dissemination: an interrupted time series analysis. F1000Res 2022; 10:1044. [PMID: 36544564 PMCID: PMC9745205 DOI: 10.12688/f1000research.55004.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background: In November 2011, the Canadian Task Force on Preventive Health Care released guidelines for screening women at average breast cancer risk. Weak recommendations (framed using GRADE methodology) were made for screening women aged 50 to 74 years every two to three years, and for not screening women aged 40 to 49 years. Methods: We conducted an interrupted time series analysis using administrative data to examine bilateral mammography use before and after a release of a national breast screening guideline. Women aged 40 to 74 years living in Ontario or Alberta from 30th November 2008 to 30th November 2014 were included. Strata included age, region of residence, neighbourhood income quintile, immigration status, and education level. Results: In both provinces, mammography use rates were lower in the post-intervention period (527 vs. 556 and 428 vs. 465/1000 women in Ontario and Alberta, respectively). In Ontario, mammography trends decreased following guideline release to align with recommendations for women aged 40 to 74 (decrease of 2.21/1000 women, SE 0.26/1000, p<0.0001). In Alberta, mammography trends decreased for women aged 40 to 49 years (3/1000 women, SE 0.32, p<0.001) and 50 to 69 (2.9/1000 women, SE 0.79, p<0.001), but did not change for women aged 70 to 74 (0.7/1000 women, SE 1.23, p=0.553). In both provinces, trends in mammography use rates were sustained for up to three years after guideline release. Conclusions: We observed a decrease in screening for women aged 40-49. Additional research to explore whether shared decision making was used to optimize guideline-concordant screening for women aged 50-74 is needed.
Collapse
Affiliation(s)
- Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1T8, Canada,
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Ontario, M5B 1T8, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada
| | - Jemila S. Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada
| | - Joycelyne E. Ewusie
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, Hamilton, Ontario, L8N 4A6, Canada
| | - Marcello Tonelli
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 1N4, Canada
| | - Paula Brauer
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - Elizabeth Shaw
- Department of Family Medicine, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
| | - Neil Bell
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, T6G 2R3, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada,Ottawa Hospital Research Institute, Ottawa, Ontario, K1H 8L6, Canada
| | | | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1T8, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
| |
Collapse
|
7
|
Taniere P, Nicholson A, Gosney J, Joseph L, Shaw E, Lanctot A, Bains R, Ryan J. PATHways UK survey: Pathology perceptions on current biomarker testing and pathways for breast cancer in England. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
8
|
Allan GM, Aubrey-Bassler K, Cauchon M, Ivers NM, Kirkwood J, Kuling PJ, Moore S, Scrimshaw C, Shaw E. Response. Can Fam Physician 2021; 67:882. [PMID: 34906928 PMCID: PMC8670643 DOI: 10.46747/cfp.6712882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
|
9
|
Burgess S, Shaw E, Ellenberger KA, Segan L, Castles AV, Biswas S, Thomas L, Zaman S. Gender equity within medical specialties of Australia and New Zealand: cardiology's outlier status. Intern Med J 2021; 50:412-419. [PMID: 31211491 DOI: 10.1111/imj.14406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/03/2019] [Accepted: 06/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gender disparity remains a prominent medical workforce issue, extending beyond surgical specialties with low proportions of female doctors. AIMS To examine female representation within Australia and New Zealand (NZ) among physician specialties and certain comparator surgical specialties with a focus on cardiology as an outlier of workforce gender equality. METHODS Data of practising medical specialists, new consultants and trainees were sought from the Australian Health Practitioner Regulation Agency, the Medical Council of NZ and the Royal Australasian College of Surgeons (2015-2017). The stratified data pertaining to interventional cardiologists were obtained through direct contact with individual hospitals (from 2017 to 2018) and derived from state-based cardiac registries. RESULTS In Australia and NZ, there were fewer female practising adult medicine physician consultants (n = 8956, 32%, P < 0.001), with gender disparities seen across most physician specialties. Cardiology (15%) was the only physician specialty with <20% representation; gastroenterology (23%), neurology (27%) and respiratory medicine (29%) had <30% female representation at the consultant level. The rates of cardiology (15%) and interventional cardiology (5%) were similar to general surgery (15%) and orthopaedics (4%). Although more than half of physician trainees are female, and most physician specialties are approaching or have equal gender ratios at the trainee level, cardiology (23%) and interventional cardiology (9%) remain significantly underrepresented. CONCLUSIONS Cardiology is the only physician specialty with <20% female consultants, and this disparity is reflected throughout every stage of the cardiology training programme. Increased awareness and proactive strategies are needed to improve gender disparity within this underrepresented medical specialty.
Collapse
Affiliation(s)
- Sonya Burgess
- Department of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Cardiology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Shaw
- Department of Medicine, The University of Sydney, Sydney, New South Wales, Australia.,Cardiology Department, Macquarie University Hospital, Sydney, New South Wales, Australia.,Department of Cardiology, Hornsby Ku-ring-gai Hospital, Sydney, New South Wales, Australia
| | | | - Louise Segan
- Department of Cardiology, Barwon Health, Geelong, Victoria, Australia.,Clinical Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Anastasia V Castles
- Department of Cardiology, The Northern Hospital, Melbourne, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Liza Thomas
- Department of Medicine, The University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sarah Zaman
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia.,Monash Heart, Monash Medical Centre, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Sutton E, Bion J, Mannion R, Willars J, Shaw E, Tarrant C. A qualitative study of organisational response to national quality standards for 7-day services in English hospitals. BMC Health Serv Res 2021; 21:205. [PMID: 33676507 PMCID: PMC7937294 DOI: 10.1186/s12913-021-06213-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/24/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND National standards are commonly used as an improvement strategy in healthcare, but organisations may respond in diverse and sometimes negative ways to external quality demands. This paper describes how a sample of NHS hospital trusts in England responded to the introduction of national standards for 7-day services (7DS), from an organisational behaviour perspective. METHODS We conducted 43 semi-structured interviews with executive/director level and clinical staff, in eight NHS trusts that varied in size, location, and levels of specialist staffing at weekends. We explored approaches to implementing standards locally, and the impact of organisational culture and local context on organisational response. RESULTS Senior staff in the majority of trusts described a focus on hitting targets and achieving compliance with the standards. Compliance-based responses were associated with a hierarchical organisational culture and focus on external performance. In a minority of trusts senior staff described mobilising commitment-based strategies. In these trusts senior staff reframed the external standards in terms of organisational values, and used co-operative strategies for achieving change. Trusts that took a commitment-based approach tended to be described as having a developmental organisational culture and a history of higher performance across the board. Audit data on 7DS showed improvement against standards for most trusts, but commitment-focused trusts were less likely to demonstrate improvements on the 7DS audit. The ability of trusts to respond to external standards was limited when they were under pressure due to a history of overall poor performance or resource limitations. CONCLUSIONS National standards and audit for service-level improvement generate different types of response in different local settings. Approaches to driving improvement nationally need to be accompanied by resources and tailored support for improvement, taking into account local context and organisational culture.
Collapse
Affiliation(s)
- Elizabeth Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Julian Bion
- Intensive Care Medicine, University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK.
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Elizabeth Shaw
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
11
|
Shaw E. Neurodoping in Chess to Enhance Mental Stamina. NEUROETHICS-NETH 2021. [DOI: 10.1007/s12152-020-09456-2] [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]
|
12
|
Lennox R, Patel T, Marmel A, Shaw E. Prenatal Care Outcomes in Women with Substance Use Disorders: A Retrospective Cohort Study. J Obstet Gynaecol Can 2020; 43:850-855. [PMID: 33301956 DOI: 10.1016/j.jogc.2020.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study sought to examine and compare the characteristics and prenatal care and pregnancy outcomes of women with and without substance use disorder (SUD). It also examined whether there were differences in prenatal care and pregnancy outcomes within the population of substance-using women based on the stability of their SUD during pregnancy. METHODS This retrospective cohort study involved pregnant women with and without SUD who accessed care through the Maternity Centre of Hamilton between 2015 and 2017. Cases and controls were matched 1:1 for gravidity, parity, ethnicity, smoking status, and postal code. RESULTS Fifty-five pregnant women with SUD were identified and matched to 55 pregnant women without SUD. When analyzed by stability of substance use, women with stable SUD had similar outcomes to those of women without SUD. Women with unstable SUD received the poorest prenatal care and were more likely to have their infants removed from their care. There was significant movement towards stability of maternal substance use over the course of pregnancy in our integrated prenatal and addiction care model. CONCLUSION Women with unstable SUD had poorer prenatal care and higher rates of custody loss than those with stable substance use disorders or those without substance use disorders. The disparate outcomes among women with unstable SUD may indicate a need to identify patients requiring greater support at entry into prenatal care and to target services accordingly. This integrated prenatal and addiction care model was effective in reducing maternal substance use in pregnancy.
Collapse
Affiliation(s)
- Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, ON; Maternity Centre of Hamilton, Hamilton, ON.
| | - Tejal Patel
- Department of Family Medicine, McMaster University, Hamilton, ON; Maternity Centre of Hamilton, Hamilton, ON
| | - Allison Marmel
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Elizabeth Shaw
- Department of Family Medicine, McMaster University, Hamilton, ON; Maternity Centre of Hamilton, Hamilton, ON
| |
Collapse
|
13
|
Hofman P, Ilié M, Chamorey E, Brest P, Schiappa R, Nakache V, Antoine M, Barberis M, Begueret H, Bibeau F, Bonnetaud C, Boström P, Brousset P, Bubendorf L, Carvalho L, Cathomas G, Cazes A, Chalabreysse L, Chenard MP, Copin MC, Côté JF, Damotte D, de Leval L, Delongova P, Thomas de Montpreville V, de Muret A, Dema A, Dietmaier W, Evert M, Fabre A, Forest F, Foulet A, Garcia S, Garcia-Martos M, Gibault L, Gorkiewicz G, Jonigk D, Gosney J, Hofman A, Kern I, Kerr K, Kossai M, Kriegsmann M, Lassalle S, Long-Mira E, Lupo A, Mamilos A, Matěj R, Meilleroux J, Ortiz-Villalón C, Panico L, Panizo A, Papotti M, Pauwels P, Pelosi G, Penault-Llorca F, Pop O, Poté N, Cajal SRY, Sabourin JC, Salmon I, Sajin M, Savic-Prince S, Schildhaus HU, Schirmacher P, Serre I, Shaw E, Sizaret D, Stenzinger A, Stojsic J, Thunnissen E, Timens W, Troncone G, Werlein C, Wolff H, Berthet JP, Benzaquen J, Marquette CH, Hofman V, Calabrese F. Clinical and molecular practice of European thoracic pathology laboratories during the COVID-19 pandemic. The past and the near future. ESMO Open 2020; 6:100024. [PMID: 33399086 PMCID: PMC7780004 DOI: 10.1016/j.esmoop.2020.100024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022] Open
Abstract
Background This study evaluated the consequences in Europe of the COVID-19 outbreak on pathology laboratories orientated toward the diagnosis of thoracic diseases. Materials and methods A survey was sent to 71 pathology laboratories from 21 European countries. The questionnaire requested information concerning the organization of biosafety, the clinical and molecular pathology, the biobanking, the workload, the associated research into COVID-19, and the organization of education and training during the COVID-19 crisis, from 15 March to 31 May 2020, compared with the same period in 2019. Results Questionnaires were returned from 53/71 (75%) laboratories from 18 European countries. The biosafety procedures were heterogeneous. The workload in clinical and molecular pathology decreased dramatically by 31% (range, 3%-55%) and 26% (range, 7%-62%), respectively. According to the professional category, between 28% and 41% of the staff members were not present in the laboratories but did teleworking. A total of 70% of the laboratories developed virtual meetings for the training of residents and junior pathologists. During the period of study, none of the staff members with confirmed COVID-19 became infected as a result of handling samples. Conclusions The COVID-19 pandemic has had a strong impact on most of the European pathology laboratories included in this study. Urgent implementation of several changes to the organization of most of these laboratories, notably to better harmonize biosafety procedures, was noted at the onset of the pandemic and maintained in the event of a new wave of infection occurring in Europe. Biosafety measures used in the first wave of the COVID-19 crisis were heterogeneous in 53 European pathology laboratories. A dramatic decrease of the workload in pathology laboratories was noted. No case of healthcare workers contaminated with SARS-CoV-2 associated with samples handling was identified.
Collapse
Affiliation(s)
- P Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France.
| | - M Ilié
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - E Chamorey
- Epidemiology and Biostatistics Unit, Centre Antoine-Lacassagne, Université Côte d'Azur, Nice, France
| | - P Brest
- Team 4, IRCAN, INSERM, CNRS, Centre Antoine-Lacassagne, Université Côte d'Azur, Nice, France
| | - R Schiappa
- Epidemiology and Biostatistics Unit, Centre Antoine-Lacassagne, Université Côte d'Azur, Nice, France
| | - V Nakache
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - M Antoine
- Department of Pathology, Hôpital Tenon, AP-HP, Paris, France
| | - M Barberis
- Unit of Histopathology and Molecular Diagnostics, Division of Pathology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - H Begueret
- Department of Pathology, University Hospital of Bordeaux, Bordeaux, France
| | - F Bibeau
- Department of Pathology, CHU de Caen, Université de Caen Normandie, Caen, France
| | - C Bonnetaud
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - P Boström
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - P Brousset
- Department of Pathology, IUC-T-Oncopole, Inserm U1037 CRCT, Université de Toulouse, Toulouse, France
| | - L Bubendorf
- Institute of Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - L Carvalho
- Institute of Anatomical and Molecular Pathology and University Hospital, University of Coimbra, Coimbra, Portugal
| | - G Cathomas
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - A Cazes
- Department of Pathology, Bichat Hospital, AP-HP, Inserm UMR 1152, Université de Paris, Paris, France
| | - L Chalabreysse
- Department of Pathology, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - M-P Chenard
- Department of Pathology, University Hospital of Strasbourg, Strasbourg, France
| | - M-C Copin
- Institut de Pathologie, CHU Lille, Université de Lille, Lille, France
| | - J-F Côté
- Department of Pathology, Institut Mutualiste Montsouris, Paris, France
| | - D Damotte
- Department of Pathology, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Inserm U1138, Université de Paris, Paris, France
| | - L de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - P Delongova
- Institute of Pathology, University Hospital Ostrava, Ostrava, Czech Republic
| | | | - A de Muret
- Department of Pathology, University Hospital of Tours, Tours, France
| | - A Dema
- Department of Pathology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - W Dietmaier
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - M Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - A Fabre
- Department of Histopathology, St Vincent's University Hospital, University College Dublin School of Medicine, Dublin, Ireland
| | - F Forest
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - A Foulet
- Department of Pathology, Centre Hospitalier, Le Mans, France
| | - S Garcia
- Department of Pathology, Hôpital Nord, AP-HM, Aix Marseille University, Marseille, France
| | - M Garcia-Martos
- Pulmonary Pathology Department, Gregorio Marañon University Hospital, Madrid, Spain
| | - L Gibault
- Department of Pathology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | - G Gorkiewicz
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - D Jonigk
- Institute of Pathology, German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Hannover Medical School, Hannover, Germany
| | - J Gosney
- Liverpool University Hospitals, Royal Liverpool University Hospital, Liverpool, UK
| | - A Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - I Kern
- Department of Pathology, University Clinic Golnik, Golnik, Slovenia
| | - K Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - M Kossai
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France
| | - M Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, and German Center for Lung Research (DZL), Germany
| | - S Lassalle
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - E Long-Mira
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - A Lupo
- Department of Pathology, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Inserm U1138, Université de Paris, Paris, France
| | - A Mamilos
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - R Matěj
- Department of Pathology and Molecular Medicine, Third Faculty of Medicine, Charles University, Thomayer Hospital and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - J Meilleroux
- Department of Pathology, IUC-T-Oncopole, Inserm U1037 CRCT, Université de Toulouse, Toulouse, France
| | - C Ortiz-Villalón
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - L Panico
- Unit of Pathology, Azienda Ospedaliera dei Colli, Monaldi-Cotugno-CTO, Naples, Italy
| | - A Panizo
- Department of Pathology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M Papotti
- Department of Oncology, University of Torino, Torino, Italy
| | - P Pauwels
- Centre for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | - G Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, and IRCCS MultiMedica, Milan, Italy
| | - F Penault-Llorca
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France
| | - O Pop
- Department of Pathology, University of Oradea, Oradea, Romania
| | - N Poté
- Department of Pathology, Bichat Hospital, AP-HP, Inserm UMR 1152, Université de Paris, Paris, France
| | - S R Y Cajal
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J-C Sabourin
- Department of Pathology, Inserm 1245, Rouen University Hospital Normandy University, Rouen, France
| | - I Salmon
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - M Sajin
- Department of Pathology, Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - S Savic-Prince
- Institute of Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - H-U Schildhaus
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - P Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, and German Center for Lung Research (DZL), Germany
| | - I Serre
- Department of Biopathology, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - E Shaw
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Sizaret
- Department of Pathology, University Hospital of Tours, Tours, France
| | - A Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, and German Center for Lung Research (DZL), Germany
| | - J Stojsic
- Department of Thoracic Pathology, Service of Pathology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - E Thunnissen
- Department of Pathology, Amsterdam University Medical Centres, Location VUmc, Amsterdam, The Netherlands
| | - W Timens
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G Troncone
- Department of Public Health, University of Naples Frederico II, Naples, Italy
| | - C Werlein
- Institute of Pathology, German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Hannover Medical School, Hannover, Germany
| | - H Wolff
- Laboratory of Pathology, Finnish Institute of Occupational Health, Helsinki, Finland
| | - J-P Berthet
- Department of Thoracic Surgery, FHU OnoAge, Louis Pasteur Hospital, University Côte d'Azur, Nice, France
| | - J Benzaquen
- Department of Pneumology, FHU OncoAge, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - C-H Marquette
- Department of Pneumology, FHU OncoAge, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - V Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - F Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Pathological Anatomy Section, University of Padova Medical School, Padova, Italy
| |
Collapse
|
14
|
Ridge CA, Desai SR, Jeyin N, Mahon C, Lother DL, Mirsadraee S, Semple T, Price S, Bleakley C, Arachchillage DJ, Shaw E, Patel BV, Padley SPG, Devaraj A. Dual-Energy CT Pulmonary Angiography (DECTPA) Quantifies Vasculopathy in Severe COVID-19 Pneumonia. Radiol Cardiothorac Imaging 2020; 2:e200428. [PMID: 33778632 PMCID: PMC7605077 DOI: 10.1148/ryct.2020200428] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND The role of dual energy computed tomographic pulmonary angiography (DECTPA) in revealing vasculopathy in coronavirus disease 2019 (COVID-19) has not been fully explored. PURPOSE To evaluate the relationship between DECTPA and disease duration, right ventricular dysfunction (RVD), lung compliance, D-dimer and obstruction index in COVID-19 pneumonia. MATERIALS AND METHODS This institutional review board approved this retrospective study, and waived the informed consent requirement. Between March-May 2020, 27 consecutive ventilated patients with severe COVID-19 pneumonia underwent DECTPA to diagnose pulmonary thrombus (PT); 11 underwent surveillance DECTPA 14 ±11.6 days later. Qualitative and quantitative analysis of perfused blood volume (PBV) maps recorded: i) perfusion defect 'pattern' (wedge-shaped, mottled or amorphous), ii) presence of PT and CT obstruction index (CTOI) and iii) PBV relative to pulmonary artery enhancement (PBV/PAenh); PBV/PAenh was also compared with seven healthy volunteers and correlated with D-Dimer and CTOI. RESULTS Amorphous (n=21), mottled (n=4), and wedge-shaped (n=2) perfusion defects were observed (M=20; mean age=56 ±8.7 years). Mean extent of perfusion defects=36.1%±17.2. Acute PT was present in 11/27(40.7%) patients. Only wedge-shaped defects corresponded with PT (2/27, 7.4%). Mean CTOI was 2.6±5.4 out of 40. PBV/PAenh (18.2 ±4.2%) was lower than in healthy volunteers (27 ±13.9%, p = 0.002). PBV/PAenh correlated with disease duration (β = 0.13, p = 0.04), and inversely correlated with RVD (β = -7.2, p = 0.001), persisting after controlling for confounders. There were no linkages between PBV/PAenh and D-dimer or CTOI. CONCLUSION Perfusion defects and decreased PBV/PAenh are prevalent in severe COVID-19 pneumonia. PBV/PAenh correlates with disease duration and inversely correlates with RVD. PBV/PAenh may be an important marker of vasculopathy in severe COVID-19 pneumonia even in the absence of arterial thrombus.
Collapse
Affiliation(s)
| | | | - Nidhish Jeyin
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| | - Ciara Mahon
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| | - Dione L Lother
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| | - Saeed Mirsadraee
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| | - Tom Semple
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| | - Susanna Price
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| | - Caroline Bleakley
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| | - Deepa J Arachchillage
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| | - Elizabeth Shaw
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| | - Brijesh V Patel
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| | - Simon PG Padley
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| | - Anand Devaraj
- From the Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A)
| |
Collapse
|
15
|
Walker E, Shaw E, Nunns M, Moore D, Thompson Coon J. No evidence synthesis about me without me: Involving young people in the conduct and dissemination of a complex evidence synthesis. Health Expect 2020; 24 Suppl 1:122-133. [PMID: 32510790 PMCID: PMC8137485 DOI: 10.1111/hex.13078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 05/02/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023] Open
Abstract
Objectives To describe and reflect on the methods and influence of involvement of young people with lived experience within a complex evidence synthesis. Study design and setting Linked syntheses of quantitative and qualitative systematic reviews of evidence about interventions to improve the mental health of children and young people (CYP) with long‐term physical conditions (LTCs). Methods Involvement was led by an experienced patient and public involvement in research lead. Young people with long‐term physical conditions and mental health issues were invited to join a study‐specific Children and Young People's Advisory Group (CYPAG). The CYPAG met face to face on four occasions during the project with individuals continuing to contribute to dissemination following report submission. Results Eight young people joined the CYPAG. Their views and experiences informed (a) a systematic review evaluating the effectiveness of interventions intended to improve the mental health of CYP with LTCs, (b) a systematic review exploring the experiences of interventions intended to improve the mental well‐being of CYP with LTCs and (c) an overarching synthesis. The CYPAG greatly contributed to the team's understanding and appreciation of the wider context of the research. The young people found the experience of involvement empowering and felt they would use the knowledge they had gained about the research process in the future. Conclusion Creating an environment that enabled meaningful engagement between the research team and the CYPAG had a beneficial influence on the young people themselves, as well as on the review process and the interpretation, presentation and dissemination of findings.
Collapse
Affiliation(s)
- Erin Walker
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Elizabeth Shaw
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Michael Nunns
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Darren Moore
- Graduate School of Education, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- University of Exeter Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
16
|
Shaw E, Majid M, Hope J, Savory S, Perkins T, White J, Boulger A, Halst S, Agrawal S, Bennett J, Tufail M. A patients’ satisfaction survey on speed of the Leicester optimal lung cancer pathway. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30081-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
17
|
Armson H, Perrier L, Roder S, Shommu NS, Wakefield J, Shaw E, Zahorka S, Elmslie T, Lofft M. Assessing Unperceived Learning Needs in Continuing Medical Education for Primary Care Physicians: A Scoping Review. J Contin Educ Health Prof 2020; 40:257-267. [PMID: 33284177 DOI: 10.1097/ceh.0000000000000300] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Assessing needs before developing continuing medical education/continuing professional development (CME/CPD) programs is a crucial step in the education process. A previous systematic literature review described a lack of objective evaluation for learning needs assessments in primary care physicians. This scoping review updates the literature on uses of objective evaluations to assess physicians' unperceived learning needs in CME/CPD. Identifying and understanding these approaches can inform the development of educational programs that are relevant to clinical practice and patient care. The study objectives were to (1) scope the literature since the last systematic review published in 1999; (2) conduct a comprehensive search for studies and reports that explore innovative tools and approaches to identify physicians' unperceived learning needs; (3) summarize, compare, and classify the identified approaches; and (4) map any gaps in the literature to identify future areas of research. METHODS A scoping review was used to "map" the literature on current knowledge regarding approaches to unperceived needs assessment using conceptual frameworks for planning and assessing CME/CPD activities. RESULTS Two prominent gaps were identified: (1) performance-based assessment strategies are highly recommended in nonresearch articles yet have low levels of implementation in published studies and (2) analysis of secondary data through patient input or environmental scanning is emphasized in grey literature implementation strategies more so than in peer-reviewed theoretical and research articles. DISCUSSION Future evaluations should continue to incorporate multiple strategies and focus on making unperceived needs assessments actionable by describing strategies for resource management.
Collapse
Affiliation(s)
- Heather Armson
- Dr. Armson: Assistant Dean, Continuing Medical Education and Professional Development and Professor, Department of Family Medicine, University of Calgary; Research Director, The Foundation for Medical Practice Education, McMaster University. Dr. Perrier: Research Data Management Librarian, University of Toronto Libraries, University of Toronto. Dr. Roder: Research Program Coordinator, The Foundation for Medical Practice Education, McMaster University. Dr. Shommu: Research Coordinator, Department of Medicine, Cumming School of Medicine, University of Calgary. Dr. Wakefield: Professor Emeritus, Department of Family Medicine, McMaster University; Senior Editor, Module Development, The Foundation for Medical Practice Education, McMaster University. Dr. Shaw: Professor; Associate Chair of Education, Department of Family Medicine; Director, Module Development, The Foundation for Medical Practice Education, McMaster University. Ms. Zahorka: Education Coordinator, The Foundation for Medical Practice Education, McMaster University. Dr. Elmslie: Professor Emeritus, Department of Family Medicine, University of Ottawa; Executive Director, The Foundation for Medical Practice Education, McMaster University. Ms. Lofft: Research Assistant, The Foundation for Medical Practice Education, McMaster University
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Ziser K, Dutkiewicz C, Byun M, Robertson G, Duke S, Sindone A, Shaw E, Tofler G. 169 Sodium-glucose Co-transporter-2 (SGLT2) Inhibitor Usage in Heart Failure Patients With Type Two Diabetes. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.176] [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: 10/23/2022]
|
19
|
Affiliation(s)
- Sonya Burgess
- University of New South Wales, Sydney, Australia (S.B.)
| | | | - Sarah Zaman
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia (S.Z.)
| |
Collapse
|
20
|
Buckley T, Soo Hoo SY, Shaw E, Hansen PS, Fethney J, Tofler GH. Triggering of Acute Coronary Occlusion by Episodes of Vigorous Physical Exertion. Heart Lung Circ 2019; 28:1773-1779. [DOI: 10.1016/j.hlc.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/21/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022]
|
21
|
Shaw E. Counterproductive criminal rehabilitation: Dealing with the double-edged sword of moral bioenhancement via cognitive enhancement. Int J Law Psychiatry 2019; 65:101378. [PMID: 30206004 DOI: 10.1016/j.ijlp.2018.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/23/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
|
22
|
Sullivan L, Shaw E, Snell G, Brooks A, Westall G. A Longitudinal Study of γδ T Cell Subsets Post Lung Transplant: Potential Players in CMV Immunity. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
23
|
Shaw E, Blakey R. Determinism, Moral Responsibility and Retribution. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09403-w] [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]
|
24
|
Crowhurst JA, Whitby M, Savage M, Murdoch D, Robinson B, Shaw E, Gaikwad N, Saireddy R, Hay K, Walters DL. Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography. J Med Radiat Sci 2019; 66:20-29. [PMID: 30488575 PMCID: PMC6399189 DOI: 10.1002/jmrs.315] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/27/2018] [Accepted: 10/31/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Diagnostic coronary angiography (CA) uses ionising radiation with relatively high doses, which impact on both patients and staff. This study sought to identify which patient and procedural factors impact patient and operator dose the most during CA. METHODS Patient and procedure related variables impacting on Kerma area product (PKA ) and operator dose (OD) were collected for 16 months. Procedures were separated into 10 different procedure categories. PKA was used for patient dose and OD was measured with an instantly downloadable dosimeter (IDD) - downloaded at the end of each procedure. High and low radiation dose was defined by binary variables based on the 75th percentile of the continuous measures. Univariate and multivariate regression were used to identify predictors. RESULTS Of 3860 patients included, the IDD was worn for 2591 (61.7%). Obesity (BMI > 30 compared to BMI < 25) was the strongest predictor for both a PKA (odds ratio (OR) = 19.1 (95% CI 13.5-26.9) P < 0.001) and OD (OR = 3.3 (2.4-4.4) P < 0.001) above the 75th percentile. Male gender, biplane imaging, the X-ray unit used, operator experience and procedure type also predicted a high PKA . Radial access, male gender, biplane imaging and procedure type also predicted a high OD. CONCLUSION Radiation dose during CA is multifactorial and is dependent on patient and procedure related variables. Many factors impact on both PKA and OD but obesity is the strongest predictor for both patients and operators to receive a high radiation dose.
Collapse
Affiliation(s)
- James A. Crowhurst
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
- Medical Imaging DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Mark Whitby
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
- Bio‐Medical Technical ServicesThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Michael Savage
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
| | - Dale Murdoch
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
| | - Brendan Robinson
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- Medical Imaging DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Elizabeth Shaw
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Niranjan Gaikwad
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Ramkrishna Saireddy
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- Cairns Base HospitalCairnsQueenslandAustralia
| | - Karen Hay
- QIMR Berghofer Medical Research InstituteHerstonQueenslandAustralia
| | - Darren L. Walters
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
| |
Collapse
|
25
|
Gomila A, Carratalà J, Eliakim-Raz N, Shaw E, Wiegand I, Vallejo-Torres L, Gorostiza A, Vigo JM, Morris S, Stoddart M, Grier S, Vank C, Cuperus N, Van den Heuvel L, Vuong C, MacGowan A, Leibovici L, Addy I, Pujol M. Risk factors and prognosis of complicated urinary tract infections caused by Pseudomonas aeruginosa in hospitalized patients: a retrospective multicenter cohort study. Infect Drug Resist 2018; 11:2571-2581. [PMID: 30588040 PMCID: PMC6302800 DOI: 10.2147/idr.s185753] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose Complicated urinary tract infections (cUTIs) are among the most frequent health-care-associated infections. In patients with cUTI, Pseudomonas aeruginosa deserves special attention, since it can affect patients with serious underlying conditions. Our aim was to gain insight into the risk factors and prognosis of P. aeruginosa cUTIs in a scenario of increasing multidrug resistance (MDR). Methods This was a multinational, retrospective, observational study at 20 hospitals in south and southeastern Europe, Turkey, and Israel including consecutive patients with cUTI hospitalized between January 2013 and December 2014. A mixed-effect logistic regression model was performed to assess risk factors for P. aeruginosa and MDR P. aeruginosa cUTI. Results Of 1,007 episodes of cUTI, 97 (9.6%) were due to P. aeruginosa. Resistance rates of P. aeruginosa were: antipseudomonal cephalosporins 35 of 97 (36.1%), aminoglycosides 30 of 97 (30.9%), piperacillin-tazobactam 21 of 97 (21.6%), fluoroquinolones 43 of 97 (44.3%), and carbapenems 28 of 97 (28.8%). The MDR rate was 28 of 97 (28.8%). Independent risk factors for P. aeruginosa cUTI were male sex (OR 2.61, 95% CI 1.60-4.27), steroid therapy (OR 2.40, 95% CI 1.10-5.27), bedridden functional status (OR 1.79, 95% CI 0.99-3.25), antibiotic treatment within the previous 30 days (OR 2.34, 95% CI 1.38-3.94), indwelling urinary catheter (OR 2.41, 95% CI 1.43-4.08), and procedures that anatomically modified the urinary tract (OR 2.01, 95% CI 1.04-3.87). Independent risk factors for MDR P. aeruginosa cUTI were age (OR 0.96, 95% CI 0.93-0.99) and anatomical urinary tract modification (OR 4.75, 95% CI 1.06-21.26). Readmission was higher in P. aeruginosa cUTI patients than in other etiologies (23 of 97 [23.7%] vs 144 of 910 [15.8%], P=0.04), while 30-day mortality was not significantly different (seven of 97 [7.2%] vs 77 of 910 [8.5%], P=0.6). Conclusion Patients with P. aeruginosa cUTI had characteristically a serious baseline condition and manipulation of the urinary tract, although their mortality was not higher than that of patients with cUTI caused by other etiologies.
Collapse
Affiliation(s)
- Aina Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain, .,Infectious Diseases Department, University of Barcelona, Barcelona, Spain
| | - N Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - E Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
| | - I Wiegand
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - L Vallejo-Torres
- UCL Department of Applied Health Research, University College London, London, UK
| | - A Gorostiza
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
| | - J M Vigo
- Informatics Unit, Fundació Institut Català de Farmacologia, Barcelona, Spain
| | - S Morris
- UCL Department of Applied Health Research, University College London, London, UK
| | - M Stoddart
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - S Grier
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - C Vank
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - N Cuperus
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Van den Heuvel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C Vuong
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - A MacGowan
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - L Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - I Addy
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
| | | |
Collapse
|
26
|
Burgess SN, Shaw E, Zaman SJ. Role Models, Allies, and Diversity-Global Issues for Female Cardiology Trainees. JAMA Cardiol 2018; 3:1251-1252. [PMID: 30419109 DOI: 10.1001/jamacardio.2018.3559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sonya N Burgess
- Department of Cardiology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Shaw
- Department of Cardiology, Hornsby Ku-ring-gai Hospital, Sydney, New South Wales, Australia
| | - Sarah J Zaman
- Monash Medical Centre, Monash Heart, Melbourne, Victoria, Australia
| |
Collapse
|
27
|
|
28
|
Mangin D, Lawson J, Cuppage J, Shaw E, Ivanyi K, Davis A, Risdon C. Legacy Drug-Prescribing Patterns in Primary Care. Ann Fam Med 2018; 16:515-520. [PMID: 30420366 PMCID: PMC6231929 DOI: 10.1370/afm.2315] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/27/2018] [Accepted: 09/10/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Polypharmacy is a key clinical challenge for primary care. Drugs that should be prescribed for an intermediate term (longer than 3 months, but not indefinitely) that are not appropriately discontinued could contribute to polypharmacy. We named this type of prescribing legacy prescribing. Commonly prescribed drugs with legacy prescribing potential include antidepressants, bisphosphonates, and proton pump inhibitors (PPIs). We evaluated the proportion of legacy prescribing within these drug classes. METHODS We conducted a population-based retrospective cohort study using prospectively collected data from the McMaster University Sentinel and Information Collaboration (MUSIC) Primary Care Practice Based Research Network, located in Hamilton, Ontario. All adult patients (aged 18 or older) in the MUSIC data set during 2010-2016 were included (N = 50,813). We calculated rates of legacy prescribing of antidepressants (prescription longer than 15 months), bisphosphonates (longer than 5.5 years), and PPIs (longer than 15 months). RESULTS The proportion of patients having a legacy prescription at some time during the study period was 46% (3,766 of 8,119) for antidepressants, 14% (228 of 1,592) for bisphosphonates, and 45% (2,885 of 6,414) for PPIs. Many of these patients held current prescriptions. The mean duration of prescribing for all legacy prescriptions was significantly longer than that for non-legacy prescriptions (P <.001). Concurrent legacy prescriptions for both antidepressants and PPIs was common, signaling a potential prescribing cascade. CONCLUSIONS The phenomenon of legacy prescribing appears prevalent. These data demonstrate the potential of legacy prescribing to contribute to unnecessary polypharmacy, providing an opportunity for system-level intervention in primary care with enormous potential benefit for patients.
Collapse
Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada .,University of Otago, Christchurch, New Zealand
| | - Jennifer Lawson
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Elizabeth Shaw
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Katalin Ivanyi
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Stonechurch Family Health Centre, Hamilton, Ontario, Canada
| | - Amie Davis
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Halton McMaster Family Health Centre, Burlington, Ontario, Canada
| | - Cathy Risdon
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
29
|
Gomila A, Carratalà J, Badia JM, Camprubí D, Piriz M, Shaw E, Diaz-Brito V, Espejo E, Nicolás C, Brugués M, Perez R, Lérida A, Castro A, Biondo S, Fraccalvieri D, Limón E, Gudiol F, Pujol M. Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: a multicenter prospective cohort study. BMC Infect Dis 2018; 18:507. [PMID: 30290773 PMCID: PMC6173907 DOI: 10.1186/s12879-018-3413-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 09/25/2018] [Indexed: 12/15/2022] Open
Abstract
Background Healthcare-associated infections caused by Pseudomonas aeruginosa are associated with poor outcomes. However, the role of P. aeruginosa in surgical site infections after colorectal surgery has not been evaluated. The aim of this study was to determine the predictive factors and outcomes of surgical site infections caused by P. aeruginosa after colorectal surgery, with special emphasis on the role of preoperative oral antibiotic prophylaxis. Methods We conducted an observational, multicenter, prospective cohort study of all patients undergoing elective colorectal surgery at 10 Spanish hospitals (2011–2014). A logistic regression model was used to identify predictive factors for P. aeruginosa surgical site infections. Results Out of 3701 patients, 669 (18.1%) developed surgical site infections, and 62 (9.3%) of these were due to P. aeruginosa. The following factors were found to differentiate between P. aeruginosa surgical site infections and those caused by other microorganisms: American Society of Anesthesiologists’ score III–IV (67.7% vs 45.5%, p = 0.001, odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.44–4.39), National Nosocomial Infections Surveillance risk index 1–2 (74.2% vs 44.2%, p < 0.001, OR 3.6, 95% CI 2.01–6.56), duration of surgery ≥75thpercentile (61.3% vs 41.4%, p = 0.003, OR 2.2, 95% CI 1.31–3.83) and oral antibiotic prophylaxis (17.7% vs 33.6%, p = 0.01, OR 0.4, 95% CI 0.21–0.83). Patients with P. aeruginosa surgical site infections were administered antibiotic treatment for a longer duration (median 17 days [interquartile range (IQR) 10–24] vs 13d [IQR 8–20], p = 0.015, OR 1.1, 95% CI 1.00–1.12), had a higher treatment failure rate (30.6% vs 20.8%, p = 0.07, OR 1.7, 95% CI 0.96–2.99), and longer hospitalization (median 22 days [IQR 15–42] vs 19d [IQR 12–28], p = 0.02, OR 1.1, 95% CI 1.00–1.17) than those with surgical site infections due to other microorganisms. Independent predictive factors associated with P. aeruginosa surgical site infections were the National Nosocomial Infections Surveillance risk index 1–2 (OR 2.3, 95% CI 1.03–5.40) and the use of oral antibiotic prophylaxis (OR 0.4, 95% CI 0.23–0.90). Conclusions We observed that surgical site infections due to P. aeruginosa are associated with a higher National Nosocomial Infections Surveillance risk index, poor outcomes, and lack of preoperative oral antibiotic prophylaxis. These findings can aid in establishing specific preventive measures and appropriate empirical antibiotic treatment.
Collapse
Affiliation(s)
- A Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,VINCat Program, Barcelona, Spain.
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,VINCat Program, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - J M Badia
- VINCat Program, Barcelona, Spain.,Department of General Surgery, Hospital General de Granollers, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - D Camprubí
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,VINCat Program, Barcelona, Spain
| | - M Piriz
- VINCat Program, Barcelona, Spain.,Department of Infectious Diseases, Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - E Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,VINCat Program, Barcelona, Spain
| | - V Diaz-Brito
- VINCat Program, Barcelona, Spain.,Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - E Espejo
- VINCat Program, Barcelona, Spain.,Department of Infectious Diseases, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - C Nicolás
- VINCat Program, Barcelona, Spain.,Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - M Brugués
- VINCat Program, Barcelona, Spain.,Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain
| | - R Perez
- VINCat Program, Barcelona, Spain.,Department of Internal Medicine, Fundació Althaia, Barcelona, Spain
| | - A Lérida
- VINCat Program, Barcelona, Spain.,Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain
| | - A Castro
- VINCat Program, Barcelona, Spain.,Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - S Biondo
- VINCat Program, Barcelona, Spain.,Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - D Fraccalvieri
- VINCat Program, Barcelona, Spain.,Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - E Limón
- VINCat Program, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - F Gudiol
- VINCat Program, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,VINCat Program, Barcelona, Spain
| | | |
Collapse
|
30
|
Heuvelings CC, Greve PF, de Vries SG, Visser B, Bélard S, Janssen S, Cremers AL, Spijker R, Shaw E, Hill RA, Zumla A, Sandgren A, van der Werf MJ, Grobusch MP. Effectiveness of service models and organisational structures supporting tuberculosis identification and management in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review. BMJ Open 2018; 8:e019642. [PMID: 30196265 PMCID: PMC6129047 DOI: 10.1136/bmjopen-2017-019642] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine which service models and organisational structures are effective and cost-effective for delivering tuberculosis (TB) services to hard-to-reach populations. DESIGN Embase and MEDLINE (1990-2017) were searched in order to update and extend the 2011 systematic review commissioned by National Institute for Health and Care Excellence (NICE), discussing interventions targeting service models and organisational structures for the identification and management of TB in hard-to-reach populations. The NICE and Cochrane Collaboration standards were followed. SETTING European Union, European Economic Area, European Union candidate countries and Organisation for Economic Co-operation and Development countries. PARTICIPANTS Hard-to-reach populations, including migrants, homeless people, drug users, prisoners, sex workers, people living with HIV and children within vulnerable and hard-to-reach populations. PRIMARY AND SECONDARY OUTCOME MEASURES Effectiveness and cost-effectiveness of the interventions. RESULTS From the 19 720 citations found, five new studies were identified, in addition to the six discussed in the NICE review. Community health workers from the same migrant community, street teams and peers improved TB screening uptake by providing health education, promoting TB screening and organising contact tracing. Mobile TB clinics, specialised TB clinics and improved cooperation between healthcare services can be effective at identifying and treating active TB cases and are likely to be cost-effective. No difference in treatment outcome was detected when directly observed therapy was delivered at a health clinic or at a convenient location in the community. CONCLUSIONS Although evidence is limited due to the lack of high-quality studies, interventions using peers and community health workers, mobile TB services, specialised TB clinics and improved cooperation between health services can be effective to control TB in hard-to-reach populations. Future studies should evaluate the (cost-)effectiveness of interventions on TB identification and management in hard-to-reach populations and countries should be urged to publish the outcomes of their TB control systems. PROSPERO REGISTRATION NUMBER CRD42015017865.
Collapse
Affiliation(s)
- Charlotte C Heuvelings
- Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick F Greve
- Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophia G de Vries
- Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Benjamin Visser
- Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Sabine Bélard
- Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia Janssen
- Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne L Cremers
- Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - René Spijker
- Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Elizabeth Shaw
- National Institute for Health and Care Excellence, Manchester, UK
| | - Ruaraidh A Hill
- Liverpool Reviews and Implementation Group, Health Services Research, University of Liverpool, Liverpool, UK
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre at UCL Hospitals, London, UK
| | - Andreas Sandgren
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Martin Peter Grobusch
- Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
31
|
Shaw E, Gavalda L. Response to Aho Glele et al. J Hosp Infect 2018; 100:68-69. [DOI: 10.1016/j.jhin.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 11/24/2022]
|
32
|
Affiliation(s)
- S N Burgess
- University of New South Wales, & Nepean Hospital, Cardiology department, Sydney, Australia
| | - E Shaw
- University of Sydney, Macquarie University Hospital & Hornsby Ku-ring-gai Hospital, Sydney, Australia
| | | | - S J Zaman
- Monash University, Cardiovascular Research Centre & Monash Heart, Monash Medical Centre, Melbourne, Australia
| | | |
Collapse
|
33
|
Shaw E, Gomila A, Piriz M, Perez R, Cuquet J, Vazquez A, Badia JM, Lérida A, Fraccalvieri D, Marron A, Freixas N, Castro A, Cruz A, Limón E, Gudiol F, Biondo S, Carratalà J, Pujol M. Multistate modelling to estimate excess length of stay and risk of death associated with organ/space infection after elective colorectal surgery. J Hosp Infect 2018; 100:400-405. [PMID: 30125586 DOI: 10.1016/j.jhin.2018.08.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/10/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Accounting for time-dependency and competing events are strongly recommended to estimate excess length of stay (LOS) and risk of death associated with healthcare-associated infections. AIM To assess the effect of organ/space (OS) surgical site infection (SSI) on excess LOS and in-hospital mortality in patients undergoing elective colorectal surgery (ECS). METHODS A multicentre prospective adult cohort undergoing ECS, January 2012 to December 2014, at 10 Spanish hospitals was used. SSI was considered the time-varying exposure and defined as incisional (superficial and deep) or OS. Discharge alive and death were the study endpoints. The mean excess LOS was estimated using a multistate model which provided a weighted average based on the states patients passed through. Multivariate Cox regression models were used to assess the effect of OS-SSI on risk of discharge alive or in-hospital mortality. FINDINGS Of 2778 patients, 343 (12.3%) developed SSI: 194 (7%) OS-SSI and 149 (5.3%) incisional SSI. Compared to incisional SSI or no infection, OS-SSI prolonged LOS by 4.2 days (95% confidence interval (CI): 4.1-4.3) and 9 days (8.9-9.1), respectively, reduced the risk of discharge alive (adjusted hazard ratio (aHR): 0.36 (95% CI: 0.28-0.47) and aHR: 0.17 (0.14-0.21), respectively), and increased the risk of in-hospital mortality (aHR: 8.02 (1.03-62.9) and aHR: 10.7 (3.7-30.9), respectively). CONCLUSION OS-SSI substantially extended LOS and increased risk of death in patients undergoing ECS. These results reinforce OS-SSI as the SSI with the highest health burden in ECS.
Collapse
Affiliation(s)
- E Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain.
| | - A Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain
| | - M Piriz
- VINCat Programme, Barcelona, Spain; Infection Control, Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - R Perez
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Fundació Althaia de Manresa, Barcelona, Spain
| | - J Cuquet
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital General de Granollers, Barcelona, Spain
| | - A Vazquez
- Servei d'Estadística Aplicada, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M Badia
- VINCat Programme, Barcelona, Spain; Department of General Surgery, Hospital General de Granollers, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain
| | - A Lérida
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain
| | - D Fraccalvieri
- VINCat Programme, Barcelona, Spain; Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Marron
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain
| | - N Freixas
- VINCat Programme, Barcelona, Spain; Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - A Castro
- VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - A Cruz
- VINCat Programme, Barcelona, Spain; Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain
| | - E Limón
- VINCat Programme, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - F Gudiol
- VINCat Programme, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - S Biondo
- VINCat Programme, Barcelona, Spain; Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain
| |
Collapse
|
34
|
Saliba P, Hornero A, Cuervo G, Grau I, Jimenez E, Berbel D, Martos P, Verge JM, Tebe C, Martínez-Sánchez JM, Shaw E, Gavaldà L, Carratalà J, Pujol M. Interventions to decrease short-term peripheral venous catheter-related bloodstream infections: impact on incidence and mortality. J Hosp Infect 2018; 100:e178-e186. [PMID: 29928942 DOI: 10.1016/j.jhin.2018.06.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/11/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Short-term peripheral venous catheters are a significant source of healthcare-acquired bloodstream infections and a preventable cause of death. AIM To assess the effectiveness of interventions applied to reduce the incidence and mortality associated with short-term peripheral venous catheter-related bloodstream infections (PVCR-BSIs). METHODS The intervention included continuous PVCR-BSI surveillance, implementation of preventive measures related to catheter insertion and maintenance in accordance with evidence-based recommendations and the hospital's own data, front-line staff educational campaigns, and assessment of adherence to hospital guidelines by ward rounds. A Poisson regression model was used to estimate the trend of rate per year. FINDINGS From January 2003 to December 2016, 227 episodes of PVCR-BSI were identified among hospitalized patients at a university hospital. The mean age of patients was 67 years (standard deviation 14 years), 69% were male and the median Charlson score was 3 (interquartile range 2-5). Staphylococcus aureus caused 115 (50.7%) episodes. Thirty-day mortality was 13.2%. After implementation of the intervention, the incidence of PVCR-BSIs decreased significantly from 30 episodes in 2003 (1.17 episodes/10,000 patient-days) to eight episodes in 2016 (0.36/10,000 patient-days). The number of episodes caused by S. aureus decreased from 18 episodes in 2003 (0.70/10,000 patient-days) to three episodes in 2016 (0.14/10,000 patient-day), and mortality decreased from seven cases in 2003 (0.27/10,000 patient-days) to zero cases in 2016 (0.00/10,000 patient-days). CONCLUSIONS Surveillance, implementation of a multi-modal strategy and periodical assessment of healthcare workers' adherence to hospital guidelines led to a sustained reduction in PVCR-BSIs. This reduction had a major impact on S. aureus BSI rates and associated mortality.
Collapse
Affiliation(s)
- P Saliba
- Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - A Hornero
- Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - G Cuervo
- Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - I Grau
- Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - E Jimenez
- Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - D Berbel
- Department of Microbiology, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - P Martos
- Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain
| | - J M Verge
- Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain
| | - C Tebe
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | | | - E Shaw
- Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - L Gavaldà
- Department of Preventive Medicine-Hospital Hygiene, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - M Pujol
- Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| |
Collapse
|
35
|
Biringer A, Forte M, Tobin A, Shaw E, Tannenbaum D. What influences success in family medicine maternity care education programs? Qualitative exploration. Can Fam Physician 2018; 64:e242-e248. [PMID: 29760273 PMCID: PMC5951668] [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: 06/08/2023]
Abstract
OBJECTIVE To ascertain how program leaders in family medicine characterize success in family medicine maternity care education and determine which factors influence the success of training programs. DESIGN Qualitative research using semistructured telephone interviews. SETTING Purposive sample of 6 family medicine programs from 5 Canadian provinces. PARTICIPANTS Eighteen departmental leaders and program directors. METHODS Semistructured telephone interviews were conducted with program leaders in family medicine maternity care. Departmental leaders identified maternity care programs deemed to be "successful." Interviews were audiorecorded and transcribed verbatim. Team members conducted thematic analysis. MAIN FINDINGS Participants considered their education programs to be successful in family medicine maternity care if residents achieved competency in intrapartum care, if graduates planned to include intrapartum care in their practices, and if their education programs were able to recruit and retain family medicine maternity care faculty. Five key factors were deemed to be critical to a program's success in family medicine maternity care: adequate clinical exposure, the presence of strong family medicine role models, a family medicine-friendly hospital environment, support for the education program from multiple sources, and a dedicated and supportive community of family medicine maternity care providers. CONCLUSION Training programs wishing to achieve greater success in family medicine maternity care education should employ a multifaceted strategy that considers all 5 of the interdependent factors uncovered in our research. By paying particular attention to the informal processes that connect these factors, program leaders can preserve the possibility that family medicine residents will graduate with the competence and confidence to practise full-scope maternity care.
Collapse
Affiliation(s)
- Anne Biringer
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario, and the Ada Slaight and Slaight Family Director of Maternity Care at the Granovsky Gluskin Family Medicine Centre at the Sinai Health System in Toronto.
| | - Milena Forte
- Assistant Professor and Maternity Care Lead in the Department of Family and Community Medicine at the University of Toronto, and is a staff physician at the Granovsky Gluskin Family Medicine Centre at the Sinai Health System
| | - Anastasia Tobin
- Doctoral candidate at the University of Toronto and a fellow at the Wilson Centre in Toronto
| | - Elizabeth Shaw
- Professor of Family Medicine at McMaster University in Hamilton, Ont
| | - David Tannenbaum
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto and Family Physician-in-Chief at the Sinai Health System
| |
Collapse
|
36
|
Ruane L, Buckley T, Hoo SYS, Hansen PS, McCormack C, Shaw E, Fethney J, Tofler GH. Triggering of acute myocardial infarction by respiratory infection. Intern Med J 2018; 47:522-529. [PMID: 28105763 DOI: 10.1111/imj.13377] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/27/2016] [Accepted: 01/11/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Respiratory infection has been associated with an increased short-term risk of myocardial infarction (MI). However, previous studies have predominantly been conducted without angiographic confirmation of MI. The possibility can therefore not be excluded that raised troponin levels or electrocardiogram abnormalities that may be seen with respiratory infections are due to non-ischaemic causes. AIMS To investigate the association between respiratory infection and angiographically confirmed MI. METHODS Interviews were conducted within 4 days of hospitalisation in 578 patients with angiographically confirmed MI, to assess for recent exposure to respiratory infection symptoms and the usual annual frequency of these symptoms. Using case-crossover methodology, exposure to respiratory infection prior to the onset of MI was compared against the usual frequency of exposure in the past year. RESULTS Symptoms of respiratory infection were reported by 100 (17%) and 123 (21%) within 7 and 35 days, respectively, prior to MI. The relative risk (RR) for MI occurring within 1-7 days after respiratory infection symptoms was 17.0 (95% confidence interval (CI) 13.2-21.8), and declined with subsequent time periods. In a subgroup analysis, the RR tended to be lower in groups taking regular cardiac medications. For those who reported milder, upper respiratory tract infection symptoms, the RR for the 1-7-day time period was 13.5 (95% CI 10.2-17.7). CONCLUSION These findings confirm that respiratory infection can trigger MI. Further study is indicated to identify treatment strategies to decrease this risk, particularly in individuals who may have increased susceptibility.
Collapse
Affiliation(s)
- Lorcan Ruane
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Buckley
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia.,Cardiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Soon Y S Hoo
- Cardiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Peter S Hansen
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Cardiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Catherine McCormack
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Shaw
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Cardiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Judith Fethney
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Geoffrey H Tofler
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Cardiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
37
|
Gabbay MB, Ring A, Byng R, Anderson P, Taylor RS, Matthews C, Harris T, Berry V, Byrne P, Carter E, Clarke P, Cocking L, Edwards S, Emsley R, Fornasiero M, Frith L, Harris S, Huxley P, Jones S, Kinderman P, King M, Kosnes L, Marshall D, Mercer D, May C, Nolan D, Phillips C, Rawcliffe T, Sardani AV, Shaw E, Thompson S, Vickery J, Wainman B, Warner M. Debt Counselling for Depression in Primary Care: an adaptive randomised controlled pilot trial (DeCoDer study). Health Technol Assess 2018. [PMID: 28648148 DOI: 10.3310/hta21350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression and debt are common in the UK. Debt Counselling for Depression in Primary Care: an adaptive randomised controlled pilot trial (DeCoDer) aimed to assess the clinical effectiveness and cost-effectiveness of the addition of a primary care debt counselling advice service to usual care for patients with depression and debt. However, the study was terminated early during the internal pilot trial phase because of recruitment delays. This report describes the rationale, methods and findings of the pilot study, and implications for future research. OBJECTIVES The overarching aim of the internal pilot was to identify and resolve problems, thereby assessing the feasibility of the main trial. The specific objectives were to confirm methods for practice recruitment and the ability to recruit patients via the proposed approaches; to determine the acceptability of the study interventions and outcome measures; to assess contamination; to confirm the randomisation method for main trial and the level of participant attrition; and to check the robustness of data collection systems. DESIGN An adaptive, parallel, two-group multicentre randomised controlled pilot trial with a nested mixed-methods process and economic evaluation. Both individual- and cluster (general practice)-level were was used in the pilot phase to assign participants to intervention or control groups. SETTING General practices in England and Wales. PARTICIPANTS Individuals were included who were aged ≥ 18 years, scored ≥ 14 on the Beck Depression Inventory II and self-identified as having debt worries. The main exclusion criteria were being actively suicidal or psychotic and/or severely depressed and unresponsive to treatment; having a severe addiction to alcohol/illicit drugs; being unable/unwilling to give written informed consent; currently participating in other research including follow-up phases; having received Citizens Advice Bureau (CAB) debt advice in the past year; and not wanting debt advice via a general practice. INTERVENTIONS The participants in the intervention group were given debt advice provided by the CAB and shared biopsychosocial assessment, in addition to treatment as usual (TAU) and two debt advice leaflets. The participants in the control group were given advice leaflets provided by the general practitioner and TAU only. MAIN OUTCOME MEASURES (1) Outcomes of the pilot trial - the proportion of eligible patients who consented, the number of participants recruited compared with target, assessment of contamination, and assessment of patient satisfaction with intervention and outcome measures. (2) Participant outcomes - primary - Beck Depression Inventory II; secondary - psychological well-being, health and social care utilisation, service satisfaction, substance misuse, record of priority/non-priority debts, life events and difficulties, and explanatory measures. Outcomes were assessed at baseline (pre-randomisation) and at 4 months post randomisation. Other data sources - qualitative interviews were conducted with participants, clinicians and CAB advisors. RESULTS Of the 238 expressions of interest screened, 61 participants (26%) were recruited and randomised (32 in the intervention group and 29 in the control group). All participants provided baseline outcomes and 52 provided the primary outcome at 4 months' follow-up (14.7% dropout). Seventeen participants allocated to the intervention saw a CAB advisor. Descriptive statistics are reported for participants with complete outcomes at baseline and 4 months' follow-up. Our qualitative findings suggest that the relationship between debt and depression is complex, and the impact of each on the other is compounded by other psychological, social and contextual influences. CONCLUSIONS As a result of low recruitment, this trial was terminated at the internal pilot phase and was too small for inferential statistical analysis. We recommend ways to reduce this risk when conducting complex trials among vulnerable populations recruited in community settings. These cover trial design, the design and delivery of interventions, recruitment strategies and support for sites. TRIAL REGISTRATION Current Controlled Trials ISRCTN79705874. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 35. See the NIHR Journals Library website for further project information. Mark Gabbay and Adele Ring are part-funded by NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) North West Coast and Richard Byng and Rod S Taylor, Vashti Berry and Elizabeth Shaw part-funded by NIHR CLAHRC South West Peninsula.
Collapse
Affiliation(s)
- Mark B Gabbay
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Adele Ring
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Richard Byng
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Pippa Anderson
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | | | - Tirril Harris
- Department of Health Service and Population Research, King's College London, London, UK
| | - Vashti Berry
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Paula Byrne
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Elliot Carter
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Pam Clarke
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Laura Cocking
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Suzanne Edwards
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Richard Emsley
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mauro Fornasiero
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Lucy Frith
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Shaun Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Peter Huxley
- Centre for Mental Health and Society, School of Social Sciences, Bangor University, Bangor, UK
| | - Siw Jones
- Citizens Advice Bureau, Liverpool, UK
| | - Peter Kinderman
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Liv Kosnes
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Daniel Marshall
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Dave Mercer
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Carl May
- Faculty of Life Sciences, University of Southampton, Southampton, UK
| | | | - Ceri Phillips
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Tim Rawcliffe
- Lancashire Care NHS Foundation Trust, Lancashire, UK
| | | | - Elizabeth Shaw
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Sam Thompson
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Jane Vickery
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Brian Wainman
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Mark Warner
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| |
Collapse
|
38
|
Gopal K, Markham R, Shaw E, Gaikwad N, Dautov R, Walters D. Zero Contrast Complex Percutaneous Coronary Intervention Via ‘Roadmap’. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1010] [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]
|
39
|
Lindsay C, Shaw E, Popat S, Blyth K, Walker I, Chaturvedi A, Dick C, Rassl D, Taniere P, Johnson P, Wallace W, Blackhall F, Nicholson A. KRAS Subtypes in non-small cell lung cancer (NSCLC) within Phase I of the Cancer Research UK Stratified Medicine Programme (SMP1). Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30039-4] [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: 11/16/2022]
|
40
|
Gomila A, Carratalà J, Biondo S, Badia JM, Fraccalvieri D, Shaw E, Diaz-Brito V, Pagespetit L, Freixas N, Brugués M, Mora L, Perez R, Sanz C, Arroyo N, Iftimie S, Limón E, Gudiol F, Pujol M. Predictive factors for early- and late-onset surgical site infections in patients undergoing elective colorectal surgery. A multicentre, prospective, cohort study. J Hosp Infect 2017; 99:24-30. [PMID: 29288776 DOI: 10.1016/j.jhin.2017.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 11/13/2017] [Accepted: 12/20/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are the leading cause of healthcare-associated infections in acute care hospitals in Europe. However, the risk factors for the development of early-onset (EO) and late-onset (LO) SSI have not been elucidated. AIM This study investigated the predictive factors for EO-SSI and LO-SSI in a large cohort of patients undergoing colorectal surgery. METHODS We prospectively followed-up adult patients undergoing elective colorectal surgery in 10 hospitals (2011-2014). Patients were divided into three groups: EO-SSI, LO-SSI, or no infection (no-SSI). The cut-off defining EO-SSI and LO-SSI was seven days (median time to SSI development). Different predictive factors for EO-SSI and LO-SSI were analysed, comparing each group with the no-SSI patients. FINDINGS Of 3701 patients, 320 (8.6%) and 349 (9.4%) developed EO-SSI and LO-SSI, respectively. The rest had no-SSI. Patients with EO-SSI were mostly males, had colon surgery and developed organ-space SSI whereas LO-SSI patients frequently received chemotherapy or radiotherapy and had incisional SSI. Male sex (odds ratio (OR): 1.92; P < 0.001), American Society of Anesthesiologists' physical status >2 (OR: 1.51; P = 0.01), administration of mechanical bowel preparation (OR: 0.7; P = 0.03) and stoma creation (OR: 1.95; P < 0.001) predicted EO-SSI whereas rectal surgery (OR: 1.43; P = 0.03), prolonged surgery (OR: 1.4; P = 0.03) and previous chemotherapy (OR: 1.8; P = 0.03) predicted LO-SSI. CONCLUSION We found distinctive predictive factors for the development of SSI before and after seven days following elective colorectal surgery. These factors could help establish specific preventive measures in each group.
Collapse
Affiliation(s)
- A Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain; VINCat Program, Spain.
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain; VINCat Program, Spain; University of Barcelona, Spain
| | - S Biondo
- VINCat Program, Spain; University of Barcelona, Spain; Department of General Surgery, Hospital Universitari de Bellvitge, Spain
| | - J M Badia
- VINCat Program, Spain; Department of General Surgery, Hospital General de Granollers, Spain; Universitat Internacional de Catalunya, Spain
| | - D Fraccalvieri
- VINCat Program, Spain; Department of General Surgery, Hospital Universitari de Bellvitge, Spain
| | - E Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain; VINCat Program, Spain
| | - V Diaz-Brito
- VINCat Program, Spain; Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Spain
| | - L Pagespetit
- VINCat Program, Spain; Department of Infectious Diseases, Consorci Sanitari de Terrassa, Spain
| | - N Freixas
- VINCat Program, Spain; Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Spain
| | - M Brugués
- VINCat Program, Spain; Department of Internal Medicine, Consorci Sanitari de l'Anoia, Spain
| | - L Mora
- VINCat Program, Spain; Department of General Surgery, Corporació Sanitària Parc Taulí, Spain
| | - R Perez
- VINCat Program, Spain; Department of Internal Medicine, Fundació Althaia, Spain
| | - C Sanz
- VINCat Program, Spain; Department of Internal Medicine, Hospital de Viladecans, Spain
| | - N Arroyo
- VINCat Program, Spain; Department of General Surgery, Hospital General de Granollers, Spain
| | - S Iftimie
- VINCat Program, Spain; Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Spain
| | - E Limón
- VINCat Program, Spain; University of Barcelona, Spain
| | - F Gudiol
- VINCat Program, Spain; University of Barcelona, Spain
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain; VINCat Program, Spain
| | | |
Collapse
|
41
|
Shaw E, Gavaldà L, Càmara J, Gasull R, Gallego S, Tubau F, Granada RM, Ciercoles P, Dominguez MA, Mañez R, Carratalà J, Pujol M. Control of endemic multidrug-resistant Gram-negative bacteria after removal of sinks and implementing a new water-safe policy in an intensive care unit. J Hosp Infect 2017; 98:275-281. [PMID: 29104124 DOI: 10.1016/j.jhin.2017.10.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/30/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Contaminated handwashing sinks have been identified as reservoirs that can facilitate colonization/infection of patients with multidrug-resistant (MDR) Gram-negative bacteria (GNB) in intensive care units (ICUs). AIM To assess the impact of removing patients' sinks and implementing other water-safe strategies on the annual rates of ICU-acquired MDR-GNB. METHODS This six-year quasi-experimental study was conducted from January 2011 to December 2016. The intervention was carried out in August 2014 in two adult ICU wards with 12 rooms each. To assess the changes in annual MDR-GNB rates before and after the intervention, we used segmented regression analysis of an interrupted time-series. Crude relative risk (RR) rates were also calculated. FINDINGS The incidence rates of MDR-GNB were 9.15 and 2.20 per 1000 patient-days in the pre- and post-intervention periods, respectively. This yielded a crude RR of acquiring MDR-GNB of 0.24 (95% confidence interval: 0.17-0.34). A significant change in level was observed between the MDR-GNB rate at the first point of the post-intervention period and the rate predicted by the pre-intervention time trend. CONCLUSION The implementation of a new water-safe policy, which included the removal of sinks from all patient rooms, successfully improved the control of MDR-GNB spread in an ICU with endemic infection. Our results support the contribution of sink use with the incidence of MDR-GNB in endemic environments.
Collapse
Affiliation(s)
- E Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.
| | - L Gavaldà
- Department of Preventive Medicine, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - J Càmara
- Department of Microbiology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - R Gasull
- Department of Intensive Medicine, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - S Gallego
- Department of Intensive Medicine, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - F Tubau
- Department of Microbiology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - R M Granada
- Department of Intensive Medicine, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - P Ciercoles
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - M A Dominguez
- Department of Microbiology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain; University of Barcelona, Barcelona, Spain
| | - R Mañez
- Department of Intensive Medicine, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain; University of Barcelona, Barcelona, Spain
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
42
|
Mehta A, Patel S, Robison W, Senkowski T, Allen J, Shaw E, Senkowski C. Can teenage novel users perform as well as General Surgery residents upon initial exposure to a robotic surgical system simulator? J Robot Surg 2017; 12:165-171. [PMID: 28585104 DOI: 10.1007/s11701-017-0715-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 03/02/2017] [Accepted: 05/16/2017] [Indexed: 02/02/2023]
Abstract
New techniques in minimally invasive and robotic surgical platforms require staged curricula to insure proficiency. Scant literature exists as to how much simulation should play a role in training those who have skills in advanced surgical technology. The abilities of novel users may help discriminate if surgically experienced users should start at a higher simulation level or if the tasks are too rudimentary. The study's purpose is to explore the ability of General Surgery residents to gain proficiency on the dVSS as compared to novel users. The hypothesis is that Surgery residents will have increased proficiency in skills acquisition as compared to naive users. Six General Surgery residents at a single institution were compared with six teenagers using metrics measured by the dVSS. Participants were given two 1-h sessions to achieve an MScoreTM in the 90th percentile on each of the five simulations. MScoreTM software compiles a variety of metrics including total time, number of attempts, and high score. Statistical analysis was run using Student's t test. Significance was set at p value <0.05. Total time, attempts, and high score were compared between the two groups. The General Surgery residents took significantly less Total Time to complete Pegboard 1 (PB1) (p = 0.043). No significant difference was evident between the two groups in the other four simulations across the same MScoreTM metrics. A focused look at the energy dissection task revealed that overall score might not be discriminant enough. Our findings indicate that prior medical knowledge or surgical experience does not significantly impact one's ability to acquire new skills on the dVSS. It is recommended that residency-training programs begin to include exposure to robotic technology.
Collapse
Affiliation(s)
- A Mehta
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
| | - S Patel
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA.
| | - W Robison
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
| | - T Senkowski
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
| | - J Allen
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
| | - E Shaw
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
| | - C Senkowski
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
| |
Collapse
|
43
|
Challa A, Shaw E, Pohlner P, Raffel C. Successful hybrid coronary artery revascularisation in a patient with severe cerebrovascular disease: a new treatment option to minimise the risk of stroke. BMJ Case Rep 2017; 2017:bcr-2016-218603. [PMID: 28551595 DOI: 10.1136/bcr-2016-218603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Here we present a case involving a patient with severe distal left main coronary artery stenosis with extensive coexisting extracranial cerebrovascular disease where hybrid coronary artery revascularisation was successfully performed. This illustrates the potential for hybrid revascularisation in those patients with an inherit risk of stroke.
Collapse
Affiliation(s)
- Abhinay Challa
- Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Elizabeth Shaw
- Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Peter Pohlner
- Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Christopher Raffel
- Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
| |
Collapse
|
44
|
Abstract
Purpose
The purpose of this paper is to improve the quality of care of patients presenting with challenging behaviour.
Design/methodology/approach
Current guidelines are described, and adherence to the standards is audited, with a particular emphasis on physical restraint.
Findings
The results of the clinical audit revealed that in the substantial majority of episodes of challenging behaviour, non-physical techniques were used prior to the need to intervene with physical restraint; however, when physical restraint was used, there was limited use of staff debriefs to facilitate reflection- and work-based learning. A potential diagnostic link to the likelihood of use of prone position restraint was also a finding. The results of a quality improvement project undertaken in response to the findings of the clinical audit demonstrated significant and sustained improvements in adherence to most standards.
Practical implications
Continuous improvements to the safety of both patients and staff when managing acute challenging behaviour requires ongoing quality improvement interventions underpinned by the application of human factors principles.
Originality/value
The completion of this audit cycle suggests that it is useful to measure specific points of care processes, however, continuous improvement interventions are indicated to lead to sustained improvement – in this paper this is demonstrated by the safer management of challenging behaviour.
Collapse
|
45
|
Shaw E. Should family physicians prescribe medication for obesity? NO. Can Fam Physician 2017; 63:103-105. [PMID: 28209668 PMCID: PMC5395374] [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: 06/06/2023]
Affiliation(s)
- Elizabeth Shaw
- Family physician and Professor of Family Medicine at McMaster University in Hamilton, Ont.
| |
Collapse
|
46
|
Shaw E. Les médecins de famille devraient-ils prescrire des médicaments contre l'obésité? NON. Can Fam Physician 2017; 63:108-109. [PMID: 28209670 PMCID: PMC5395376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Elizabeth Shaw
- Médecin de famille et professeure de médecine familiale à l'Université McMaster à Hamilton, en Ontario.
| |
Collapse
|
47
|
Shaw E. Rebuttal: Should family physicians prescribe medication for obesity? NO. Can Fam Physician 2017; 63:e83. [PMID: 28209694 PMCID: PMC5395400] [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: 06/06/2023]
Affiliation(s)
- Elizabeth Shaw
- Family physician and Professor of Family Medicine at McMaster University in Hamilton, Ont.
| |
Collapse
|
48
|
Shaw E. [Not Available]. Can Fam Physician 2017; 63:e85. [PMID: 28209696 PMCID: PMC5395402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Elizabeth Shaw
- Médecin de famille et professeure de médecine familiale à l'Université McMaster à Hamilton, en Ontario.
| |
Collapse
|
49
|
Shaw E. The Right to Bodily Integrity and the Rehabilitation of Offenders Through Medical Interventions: A Reply to Thomas Douglas. NEUROETHICS-NETH 2016. [DOI: 10.1007/s12152-016-9277-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
50
|
Gaikwad N, Butler T, Maxwell R, Shaw E, Strugnell WE, Chan J, Figtree GA, Slaughter RE, Hamilton-Craig C. Late gadolinium enhancement does occur in Tako-tsubo cardiomyopathy - A quantitative cardiac magnetic resonance and speckle tracking strain study. Int J Cardiol Heart Vasc 2016; 12:68-74. [PMID: 28616546 PMCID: PMC5454175 DOI: 10.1016/j.ijcha.2016.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/28/2016] [Indexed: 02/08/2023]
Abstract
Background Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been recommended to distinguish Tako-tsubo cardiomyopathy (TTC) from either acute myocardial infarction or myocarditis. Method 44 consecutive patients with confirmed Mayo Clinic criteria for TTC underwent CMR imaging at 1.5 Tesla during the acute phase. 10 patients who had CMRI to exclude scar related ventricular tachycardia, and had negative studies, were used as negative controls. LGE was quantitated at two signal intensity thresholds (CircleCVi software) at > 2 and > 5 standard-deviations (SD) above reference myocardium, and compared to biomarkers. Findings Mean door-to-CMR time was 57 hours. 18 patients (41%) had LGE > 2 SD localized to the area of abnormal wall motion, representing 28.9 ± 11.2% LV mass. In 16 of these 18 patients (89%) LGE signal intensity was > 5 SD above normal myocardium, representing 12.1 ± 10% LV mass. LGE signal intensity was significantly greater in TTC than in matched controls (p < 0.05) but lower than in STEMI patients (p < 0.05). Mean troponin was significantly higher in LGE positive patients (2.5 ± 1.8 vs 4.4 ± 6.9, p = 0.001). Mean ejection fraction (EF) by CMR was 45% ± 8.7 in LGE-negative, and 40% ± 7.1 in LGE-positive patients (p = 0.37). Recovery of segmental function was confirmed at follow-up, mean EF was 59% in both groups. Conclusion LGE was present in 41% of cases of TTC, 89% of which had intense enhancement > 5 SD above normal myocardium. Presence of LGE was associated with worse myocardial injury in the acute setting, with no difference in recovery of function.
Collapse
Affiliation(s)
- Niranjan Gaikwad
- Heart & Lung Institute, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Thomas Butler
- Heart & Lung Institute, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Ryan Maxwell
- Heart & Lung Institute, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Elizabeth Shaw
- Heart & Lung Institute, The Prince Charles Hospital, Brisbane, QLD, Australia.,Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
| | - Wendy E Strugnell
- Richard Slaughter Centre of Excellence in Cardiovascular MRI, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Jonathan Chan
- Heart & Lung Institute, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Gemma A Figtree
- Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
| | - Richard E Slaughter
- Richard Slaughter Centre of Excellence in Cardiovascular MRI, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Christian Hamilton-Craig
- Heart & Lung Institute, The Prince Charles Hospital, Brisbane, QLD, Australia.,Richard Slaughter Centre of Excellence in Cardiovascular MRI, The Prince Charles Hospital, Brisbane, QLD, Australia.,Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|