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Murphy F, O'Reilly S, Clarke C, Kennelly S. 32 HOLISTIC PERSON-CENTRED CARE FOR PEOPLE LIVING WITH DEMENTIA AND CO EXISTING MENTAL HEALTH ILLNESSES: A CASE FOR INTEGRATION. Age Ageing 2022. [PMCID: PMC9620330 DOI: 10.1093/ageing/afac218.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background 65,000 people live with dementia in Ireland, many have co-existing or emerging mental health illnesses and non-cognitive symptoms. During the COVID-19 pandemic there was a need to provide innovative solutions to service provision. As Medicine for the Elderly (MEDEL) and Psychiatry of Later Life (PLL) were established stand-alone services, there was no formalised working relationship, resulting in an overlap of cases and disparity in service provision. Methods A description of three cases to illustrate the joint working interface with MEDEL and PLL. These cases highlight their complex care needs and the speciality input required by both services within a shared catchment area. The age range was 78-88 years. All presented with at least two medical co-morbidities, including vascular risk factors and delirium. Each had at least one mental health illness including new onset psychotic and mood disorders. Sharing of resources including diagnostic services, nursing, medical, occupational therapy, physiotherapy and social work facilitated cost effective holistic care. Results Given the existing structures of MEDEL and PLL, it was possible to link with community partners attached to each service, allowing domiciliary visits for crisis intervention and best use of expertise from both disciplines. This resulted in the provision of timely patient centred care, reduced polypharmacy through a unified pharmacological approach, enhanced communication, shared learning and cost effectiveness. Care that is in the right place at the right time, in line with Sláinte Care, allowed timely access to diagnostics, improved care outcomes and a cohesive response. Conclusion This cohort present with complex care needs. An integrated approach enables patients to receive holistic care without duplication of resources or disparity of treatment and care options. Going forward this should involve a fully integrated memory service, with shared governance.
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Affiliation(s)
- F Murphy
- Connolly Hospital , Dublin, Ireland
| | | | - C Clarke
- Dublin North City and County Mental Health Services , Dublin, Ireland
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2
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Powell LG, Gillies S, Fernandes TF, Murphy F, Giubilato E, Cazzagon V, Hristozov D, Pizzol L, Blosi M, Costa AL, Prina-Mello A, Bouwmeester H, Sarimveis H, Janer G, Stone V. Developing Integrated Approaches for Testing and Assessment (IATAs) in order to support nanomaterial safety. Nanotoxicology 2022; 16:484-499. [PMID: 35913849 DOI: 10.1080/17435390.2022.2103470] [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: 10/16/2022]
Abstract
Due to the unique characteristics of nanomaterials (NM) there has been an increase in their use in nanomedicines and innovative medical devices (MD). Although large numbers of NMs have now been developed, comprehensive safety investigations are still lacking. Current gaps in understanding the potential mechanisms of NM-induced toxicity can make it challenging to determine the safety testing necessary to support inclusion of NMs in MD applications. This article provides guidance for implementation of pre-clinical tailored safety assessment strategies with the aim to increase the translation of NMs from bench development to clinical use. Integrated Approaches to Testing and Assessment (IATAs) are a key tool in developing these strategies. IATAs follow an iterative approach to answer a defined question in a specific regulatory context to guide the gathering of relevant information for safety assessment, including existing experimental data, integrated with in silico model predictions where available and appropriate, and/or experimental procedures and protocols for generating new data to fill gaps. This allows NM developers to work toward current guidelines and regulations, while taking NM specific considerations into account. Here, an example IATA for NMs with potential for direct blood contact was developed for the assessment of haemocompatibility. This example IATA brings together the current guidelines for NM safety assessment within a framework that can be used to guide information and data gathering for the safety assessment of intravenously injected NMs. Additionally, the decision framework underpinning this IATA has the potential to be adapted to other testing needs and regulatory contexts.
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Affiliation(s)
| | - S Gillies
- Heriot-Watt University, Edinburgh, UK
| | | | - F Murphy
- Heriot-Watt University, Edinburgh, UK
| | - E Giubilato
- University Ca' Foscari of Venice, Venice, Italy.,GreenDecision Srl, Venice, Italy
| | - V Cazzagon
- University Ca' Foscari of Venice, Venice, Italy
| | - D Hristozov
- University Ca' Foscari of Venice, Venice, Italy
| | - L Pizzol
- GreenDecision Srl, Venice, Italy
| | - M Blosi
- Institute of Science and Technology for Ceramics, CNR, Italy
| | - A L Costa
- Institute of Science and Technology for Ceramics, CNR, Italy
| | - A Prina-Mello
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - H Bouwmeester
- Division of Toxicology, Wageningen University, Wageningen, The Netherlands
| | - H Sarimveis
- National Technical University of Athens, Athens, Greece
| | - G Janer
- Leitat Technological Centre, Barcelona, Spain
| | - V Stone
- Heriot-Watt University, Edinburgh, UK
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3
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Murphy F, Mcloughlin A, Butler A, Davoren M, Kennedy H. Frailty in Secure Forensic Mental Health Settings: A Study from Dundrum Hospital, Ireland. Eur Psychiatry 2022. [PMCID: PMC9566090 DOI: 10.1192/j.eurpsy.2022.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Frailty is defined as a clinical syndrome that encompasses a combination of decreased physiological reserve and low resistance to stressors. There is an association between mental illness and frailty among elderly cohorts. Frailty is also associated with obesity and smoking. There are high rates of treatment resistant schizophrenia among patients in secure forensic services. Patients with schizophrenia have high rates of morbidity and early mortality.
Objectives
The primary aim of this study was to examine the rates of frailty present in a complete cohort of forensic in-patients.
Methods
An assessment using Fried Frailty criteria was offered to all in-patients (n=95) in Ireland’s National Forensic Service, which included measures of walking speed, grip strength, low physical activity and exhaustion. Demographic details and details pertaining to diagnoses and medications were also gathered.
Results
Of the 95 in-patients, 92 patients agreed to participate. The majority were male (89%). The most common diagnosis was schizophrenia (71.7%). Mean age was 44.7 years (SD 11.42), and 58.2% met criteria for obesity. Of the total group, 47 patients met criteria for ‘pre-frail’ and 10 met criteria for ‘frail’ using Fried criteria.
Conclusions
This is the first study examining frailty in a cohort of patients in secure forensic settings. We found high rates of patients meeting frailty criteria at very young ages. Rates of frailty in this group were comparable to those found amongst elders in community settings. We consider this demonstrates significant medical vulnerability in this patient group.
Disclosure
No significant relationships.
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Lawal O, Ramlaul A, Murphy F. Problem based learning in radiography education: A narrative review. Radiography (Lond) 2020; 27:727-732. [PMID: 33223417 DOI: 10.1016/j.radi.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/03/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Radiography practice is fast developing with new imaging updates and challenging scenarios to deal with on a frequent basis. There is a need to equip students with the skill to be independent learners and develop critical thinking skills, so they can change their practice as the profession evolves. Problem Based Learning (PBL) has widely been adopted in medical and nursing training worldwide as a result of its desirable benefits. In order to ascertain the efficacy of the technique, this paper presents a review of the essential aspects of PBL, such as the theories, process, key roles and implication for radiography education and practice. KEY FINDINGS The use of a defined model provides a useful structure to the PBL exercise with the addition of reflection, which is a pertinent inclusion within the process. The role of the facilitator in PBL is significant to students' learning as they help guide the students to the learning outcomes and provide support to the group; however, their skills development is an important factor to consider in PBL. CONCLUSION This teaching approach has key benefits in radiography education and training in particular, its impact on preparing students for autonomous clinical practice. IMPLICATIONS FOR PRACTICE The application of PBL in developing students' critical thinking and decision-making abilities support the narrowing of the spoon-feeding expectation of students and render it a useful pedagogical implementation within radiography programmes.
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Affiliation(s)
- O Lawal
- Department of Allied Health Professions, Midwifery and Social Work, School of Health and Social Work, University of Hertfordshire, UK.
| | - A Ramlaul
- Department of Allied Health Professions, Midwifery and Social Work, School of Health and Social Work, University of Hertfordshire, UK
| | - F Murphy
- School of Health and Society, University of Salford, Salford, UK
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Higgins R, Murphy F, Hogg P. The impact of teaching experimental research on-line: Research-informed teaching and COVID-19. Radiography (Lond) 2020; 27:539-545. [PMID: 33262051 PMCID: PMC7680207 DOI: 10.1016/j.radi.2020.11.014] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/26/2020] [Accepted: 11/16/2020] [Indexed: 11/08/2022]
Abstract
Introduction As part of the BSc (Hons) Diagnostic Radiography programme students learn and undertake research relevant to their development as first post radiographers (dose optimisation and image quality) within the Research-Informed Teaching experience (RiTe). Due to the COVID-19 pandemic, the delivery of RiTe to our year 2 students was moved to an online format using Microsoft Teams and Blackboard Collaborate and focused on a key area of current practice - COVID-19 and chest X-ray imaging. Within RiTe students are placed into collaborative enquiry-based learning (CEBL) groups to share tasks, but to also support and learn from one another. Methods An online survey was used to explore the year 2 student cohort task value and self-efficacy of this online version of RiTe. Results A 73% (32/44) response rate was achieved. Students found the online version of RiTe to be a positive learning and development experience. There was strong agreement that they not only found it relevant to their area of practice (task-value), but also strongly agreed that they understood and could master the skills taught (self-efficacy). Conclusion This online version of RiTe was effectively structured to help scaffold student learning and development of research data analysis skills despite the lack of face-to-face teaching. The students also valued the topic area (COVID-19 and chest X-ray imaging). A blended learning approach with RiTe will be used next year with a combination of collaborative online teaching and physical data collection and analysis in the university-based X-ray imaging laboratory. Further evaluation and data collection will also be undertaken. Implications for practice University-based empirical work in groups to learn about research can be replaced by an online mechanism whilst still maintaining task-value and acceptable self-efficacy.
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Affiliation(s)
- R Higgins
- School of Health and Society, University of Salford, Salford, M5 4WT, United Kingdom.
| | - F Murphy
- School of Health and Society, University of Salford, Salford, M5 4WT, United Kingdom
| | - P Hogg
- School of Health and Society, University of Salford, Salford, M5 4WT, United Kingdom
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Brook H, Caspari S, Weber B, Grimmler M, Murphy F, Mccusker M, Matters D, Harding S. Measurement of Lipoprotein (a) using the binding site Optilite® turbidimetric analyzer and Lipoprotein (a) assay. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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7
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Brook H, Jamil O, Mcentee D, Murphy F, Mccusker M, Matters D, Harding S. Evaluation of the Freelite MX™ kappa free and lambda free assays on the binding site Optilite® turbidimetric analyzer using CSF samples. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sroa B, Weber B, Grimmler M, Murphy F, Matters D, Harding S. Apolipoprotein B assay performance on the binding site Optilite® turbidimetric analyzer. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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Brook H, Johnson-Brett B, Brohet F, Stordeur P, Mcentee D, Murphy F, Matters D, Harding S. Measurement of Complement C2 using the binding site SPAPLUS® turbidimetric analyzer and Complement C2 assay. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.047] [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]
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10
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Aldridge C, Hardy E, Mcentee D, Antanaitis A, Twomey P, Freund D, Kuehn S, Hegel K, Murphy F, Matters D, Harding S. Performance of the low level IgG assay for human factor testing on the binding site Optilite ® analyzer. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Scala C, McDonnell S, Murphy F, Leone Roberti Maggiore U, Khalil A, Bhide A, Thilaganathan B, Papageorghiou AT. Diagnostic accuracy of midtrimester antenatal ultrasound for multicystic dysplastic kidneys. Ultrasound Obstet Gynecol 2017; 50:464-469. [PMID: 27643400 DOI: 10.1002/uog.17305] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 09/06/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To establish the diagnostic accuracy of obstetric ultrasound at a tertiary fetal medicine center in the prenatal detection of unilateral and bilateral multicystic dysplastic kidney (MCDK) in fetuses in which this condition was suspected, and to undertake a systematic review of the relevant literature. METHODS This was a retrospective observational study of all cases referred to a regional tertiary fetal medicine unit due to suspicion of either unilateral or bilateral MCDK between 1997 and 2015. Diagnosis was confirmed by postnatal ultrasound reports or postmortem examination. The accuracy of prenatal ultrasound in the diagnosis of MCDK was calculated. Using a systematic search strategy we also performed a review of the literature regarding the prenatal diagnosis and diagnostic accuracy of MCDK. RESULTS We included 144 women in our analysis; 37 (25.7%) opted for pregnancy termination (TOP) (due to unilateral MCDK with additional abnormalities, suspected bilateral MCDK or severe obstructive uropathy). Complete pre- and postnatal data were available in 126 pregnancies, including 104 livebirths, 19 TOPs with postmortem findings available and three intrauterine fetal deaths. Two infants died shortly after birth (due to known bilateral MCDK or known cranial vault defect). The overall number of cases of MCDK confirmed postnatally was 100; of these, 98 were diagnosed prenatally (true positive), while two were thought to be hydronephrosis prenatally (false negative) and the diagnosis of MCDK was made after birth. In nine cases, the initial antenatal diagnosis of suspected MCDK was revised, either later in pregnancy (n = 2) or postnatally (n = 7) (false positive). Overall, the diagnostic accuracy in our population for the use of antenatal ultrasound to detect MCDK was 91.3%, while that reported in the existing literature was found to range from 53.3% to 100%. MCDK was isolated in the majority (71%) of cases, while in 29% of cases it was found to be associated with other renal and extrarenal fetal abnormalities. CONCLUSIONS Antenatal ultrasound had a diagnostic accuracy of about 91% in the prediction of postnatal MCDK and can therefore be used to guide antenatal counseling. However, prenatal or postnatal revision of the diagnosis occurred in about 7% of cases and parents should be counseled appropriately. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Scala
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - S McDonnell
- Department of Paediatric Surgery, St George's Healthcare NHS Trust, London, UK
| | - F Murphy
- Department of Paediatric Surgery, St George's Healthcare NHS Trust, London, UK
| | - U Leone Roberti Maggiore
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino, IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - A Khalil
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Bhide
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - B Thilaganathan
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A T Papageorghiou
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
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Akaateba D, Andan M, Hadfield K, Elmusharaf K, Leddin D, Murphy F, Ofosu W, Sheehan C, Finucane P. Ghana health services and the Irish health system - bridging the gap. Ir Med J 2017; 110:518. [PMID: 28657263] [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: 06/07/2023]
Affiliation(s)
- D Akaateba
- Ghana Medical Help
- Upper West Region Health Service,Ghana
| | | | - K Hadfield
- Ghana Medical Help
- University of Limerick
| | | | - D Leddin
- University of Limerick
- Dalhousie University, Canada
| | - F Murphy
- University of Limerick
- University of Limerick Hospitals Group
| | - W Ofosu
- Upper West Region Health Service,Ghana
| | - C Sheehan
- Upper West Region Health Service,Ghana
| | - P Finucane
- University of Limerick
- University of Limerick Hospitals Group
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Thompson A, Dickinson R, Murphy F, Thomson JP, Marriott H, Tavares A, Willson J, Williams L, Lewis A, Mirchandani A, Dos Santos Coelho P, Doherty C, Ryan E, Watts E, Morton NM, Forbes S, Stimson RH, Hameed AG, Arnold N, Preston J, Lawrie A, Finisguerra V, Mazzone M, Sadiku P, Goveia J, Taverna F, Carmeliet P, Foster S, Chilvers E, Cowburn A, Dockrell D, Johnson R, Meehan RR, Whyte M, Walmsley S. Hypoxia determines survival outcomes of bacterial infection through HIF-1alpha dependent re-programming of leukocyte metabolism. Sci Immunol 2017; 2:eaal2861. [PMID: 28386604 PMCID: PMC5380213 DOI: 10.1126/sciimmunol.aal2861] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hypoxia and bacterial infection frequently co-exist, in both acute and chronic clinical settings, and typically result in adverse clinical outcomes. To ameliorate this morbidity, we investigated the interaction between hypoxia and the host response. In the context of acute hypoxia, both S. aureus and S. pneumoniae infections rapidly induced progressive neutrophil mediated morbidity and mortality, with associated hypothermia and cardiovascular compromise. Preconditioning animals through longer exposures to hypoxia, prior to infection, prevented these pathophysiological responses and profoundly dampened the transcriptome of circulating leukocytes. Specifically, perturbation of HIF pathway and glycolysis genes by hypoxic preconditioning was associated with reduced leukocyte glucose utilisation, resulting in systemic rescue from a global negative energy state and myocardial protection. Thus we demonstrate that hypoxia preconditions the innate immune response and determines survival outcomes following bacterial infection through suppression of HIF-1α and neutrophil metabolism. The therapeutic implications of this work are that in the context of systemic or tissue hypoxia therapies that target the host response could improve infection associated morbidity and mortality.
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Affiliation(s)
- A.A.R. Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - R.S. Dickinson
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - F. Murphy
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J. P. Thomson
- MRC Human Genetics Unit at the Institute of Genetics and Molecular Medicine at the University of Edinburgh, Edinburgh, UK
| | - H.M. Marriott
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A. Tavares
- University of Edinburgh/BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J. Willson
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - L. Williams
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A. Lewis
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A. Mirchandani
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - P. Dos Santos Coelho
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - C. Doherty
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - E. Ryan
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - E. Watts
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - N. M. Morton
- University of Edinburgh/BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - S. Forbes
- University of Edinburgh/BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - R. H. Stimson
- University of Edinburgh/BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - A. G. Hameed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - N. Arnold
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - J.A. Preston
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A. Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - V. Finisguerra
- Laboratory of Molecular Oncology and Angiogenesis, Vesalius Research Center, VIB, Leuven, B3000, Belgium
- Laboratory of Molecular Oncology and Angiogenesis, Vesalius Research Center, Department of Oncology, KU Leuven, Leuven, B3000, Belgium
| | - M. Mazzone
- Laboratory of Molecular Oncology and Angiogenesis, Vesalius Research Center, VIB, Leuven, B3000, Belgium
- Laboratory of Molecular Oncology and Angiogenesis, Vesalius Research Center, Department of Oncology, KU Leuven, Leuven, B3000, Belgium
| | - P. Sadiku
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J. Goveia
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, VIB, Leuven, B3000, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, K.U. Leuven, B3000, Belgium
| | - F. Taverna
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, VIB, Leuven, B3000, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, K.U. Leuven, B3000, Belgium
| | - P. Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, VIB, Leuven, B3000, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, K.U. Leuven, B3000, Belgium
| | - S.J. Foster
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, UK
| | - E.R. Chilvers
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - A.S. Cowburn
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Physiology, Development and Neuroscience, University of Cambridge, UK
| | - D.H. Dockrell
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - R.S. Johnson
- Department of Physiology, Development and Neuroscience, University of Cambridge, UK
| | - R. R. Meehan
- MRC Human Genetics Unit at the Institute of Genetics and Molecular Medicine at the University of Edinburgh, Edinburgh, UK
| | - M.K.B. Whyte
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - S.R. Walmsley
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Dickinson RS, Thompson AAR, Thomson JP, Murphy F, Marriott HM, Tavares A, Willson J, Williams L, Lewis A, Forbes S, Stimson RH, Hameed AG, Preston JA, Lawrie A, Finisguerra V, Mazzone M, Foster SJ, Chilvers ER, Cowburn AS, Dockrell DH, Johnson RS, Meehan RR, Whyte MKB, Walmsley SR. S104 Hypoxia preconditions the innate immune response to acute bacterial pulmonary infections. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.110] [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: 11/04/2022]
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15
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Sinha CK, Decker E, Rex D, Mukhtar Z, Murphy F, Nicholls E, Okoye B, Giuliani S. Thirty-days readmissions in pediatric surgery: The first U.K. experience. J Pediatr Surg 2016; 51:1877-1880. [PMID: 27430864 DOI: 10.1016/j.jpedsurg.2016.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 06/25/2016] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to investigate readmissions within 30days of operation (ReAd) in the setting of a tertiary pediatric surgical practice in the UK. METHODS Using Hospital Episode Statistics, cases that were readmitted within 30days of primary operation were identified retrospectively. Demographics including age, gender, preexisting comorbidities, diagnosis on primary admission and the treatment, length of stay, and diagnosis on readmission with treatment, including further surgical intervention, were collected from discharge summaries and hospital notes. Neonates were excluded from this study. Comorbidities, involving one or more systems, were also identified for each case of readmission. ReAds were classified into emergency and elective cohort depending on the nature of the primary operation. Outcomes were compared between these two groups. Data were quoted as median (range) unless indicated otherwise. Data were analyzed using SPSS software Desktop 22.0, using Mann-Whitney U and Chi-Squared tests, with a consideration that a P≤0.05 was significant. RESULTS A total of 2378 procedures were performed during the study period. Elective cases, including day cases, accounted for 77% (n=1837) of all cases. The remaining 23% (n=541) were emergency cases. Total unplanned readmission rate within 30days (ReAd) was 2%. Further surgical procedures were required in 38%. Having excluded neonates, the most common primary procedure leading to readmission within 30days was appendicectomy (26%). Overall, the most common cause for readmission within 30days was postoperative infection (30%). The ReAd in emergency cohort was 3.5% in comparison to 1.5% in elective, which was significantly different (P value=0.007). CONCLUSION Readmission within thirty days of primary procedure in pediatric surgery has little published data. An efficient discharge planning may play a vital role in preventing unwanted readmission. Elective operations had a significantly lower readmission rate than emergency operations. Having excluded neonates, appendicectomy was found to be the most common operation associated with readmission in the pediatric surgical practice. Although widely used as quality care indicator in adults, more studies are required to validate readmission rate as a quality of care indicator in pediatric surgery practice.
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Affiliation(s)
- C K Sinha
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK.
| | - E Decker
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - D Rex
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - Z Mukhtar
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - F Murphy
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - E Nicholls
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - B Okoye
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - S Giuliani
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
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Abstract
The effects of T-2 toxin on a murine model of the acute phase response were studied. Two murine acute phase reactants, serum amyloid P component and plasma fibronectin, were measured after subcutaneous and intraperitoneal administration of T-2 toxin in varying doses. No acute phase response was observed. Furthermore, T-2 toxin also blocked the acute phase reaction to subcutaneous AgNO3 in a dose-dependent fashion. These observations were not explained by damage to liver, the site of synthesis of acute phase proteins. Since the acute phase response is an immediate physiological reaction to tissue injury and may be a nonspecific participant in the repair phenomenon, its abrogation by T-2 toxin may contribute to the toxicity of this trichothecene mycotoxin.
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Affiliation(s)
- R. F. Dyck
- Department of Medicine University Hospital Saskatoon, SK S7N 0X0 Canada
| | - M.I.C. Issa
- Department of Medicine University Hospital Saskatoon, SK S7N 0X0 Canada
| | - S.L. Rogers
- Department of Medicine University Hospital Saskatoon, SK S7N 0X0 Canada
| | - F. Murphy
- Department of Medicine University Hospital Saskatoon, SK S7N 0X0 Canada
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Nightingale JM, Murphy F, Eaton C, Borgen R. A qualitative analysis of staff-client interactions within a breast cancer assessment clinic. Radiography (Lond) 2016; 23:38-47. [PMID: 28290339 DOI: 10.1016/j.radi.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/30/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Breast screening clients recalled to an assessment clinic experience high levels of anxiety. The culture of the assessment clinic may impact upon client experience, which may influence their future re-engagement in screening. This study aimed to explore the culture of staff-client interactions within a breast cancer assessment clinic. MATERIALS AND METHODS Following an ethnographic approach, twenty-three client journeys were observed, followed by semi-structured interviews with the clients. The observation and interview data were analysed to produce research themes, which were then explored within two focus groups to add a practitioner perspective. RESULTS Multiple staff-client interaction events were observed over a period of several weeks. Client interview feedback was overwhelmingly positive. Three recurrent and sequential themes emerged: breaking down barriers, preparing the ground and sign-posting. These themes outline the changing focus of staff-client interactions during the client's clinic journey, encompassing how anxieties were expressed by clients, and responded to by practitioners. CONCLUSION This study was the first to explore in depth the staff-client interaction culture within a breast assessment clinic using an ethnographic approach. A new perspective on professional values and behaviours has been demonstrated via a model of staff-client interaction. The model documents the process of guiding the client from initial confusion and distress to an enhanced clarity of understanding. A recommendation most likely to have a positive impact on the client experience is the introduction of a client navigator role to guide the clients through what is often a lengthy, stressful and confusing process.
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Affiliation(s)
| | - F Murphy
- University of Salford, United Kingdom
| | - C Eaton
- University of Salford, United Kingdom
| | - R Borgen
- East Lancashire Hospitals NHS Trust, United Kingdom
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Williams HRT, Oliver NS, Murphy F, Howell M, Badman MK, Hillson RM, Thomas DJB. The role of the biochemistry department in the diagnosis of pituitary apoplexy. Ann Clin Biochem 2016; 41:162-5. [PMID: 15025811 DOI: 10.1258/000456304322880096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 47-year-old man presented with severe clinical hypoglycaemia. He had long-standing insulin-dependent diabetes with previously good glycaemic control. Intense headaches and vomiting initiated hospitalization. A brain computed tomography (CT) scan was normal, and a lumbar puncture showed elevated cerebrospinal fluid (CSF) protein [0.67 g/L; normal range (NR) 0.15-0.45 g/L], suggesting resolving viral meningitis. Routine thyroid function tests were abnormal (free thyroxine 10.6 pmol/L, NR 9-22.5 pmol/L; thyroid-stimulating hormone 0.16 mU/L, NR 0.35-5 mU/L). In the absence of evident thyroid therapy, the laboratory policy required an urgent cortisol assay to be added; this was very abnormal (42 nmol/L), suggesting hypopituitarism. Later analysis showed that concentrations of gonadotrophins and adrenocorticotrophin were low. An urgent pituitary magnetic resonance imaging scan revealed an unsuspected pituitary tumour with recent haemorrhage (pituitary apoplexy). The patient was given intravenous hydrocortisone and then stabilized on oral hydrocortisone, thyroxine and mesterolone. He made a full recovery and the hypoglycaemia resolved. The normal brain CT scan was falsely reassuring and the CSF protein was not due to viral meningitis but to haemorrhage into the pituitary tumour. If laboratory policy had not required the urgent cortisol assay be added, the diagnosis of hypopituitarism would have been delayed or even missed altogether. This could have led to the death of the patient.
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Affiliation(s)
- H R T Williams
- Department of Medicine, The Hillingdon Hospital, Uxbridge UB8 3NN, UK
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Horwell CJ, Baxter PJ, Hillman SE, Calkins JA, Damby DE, Delmelle P, Donaldson K, Dunster C, Fubini B, Kelly FJ, Le Blond JS, Livi KJT, Murphy F, Nattrass C, Sweeney S, Tetley TD, Thordarson T, Tomatis M. Physicochemical and toxicological profiling of ash from the 2010 and 2011 eruptions of Eyjafjallajökull and Grímsvötn volcanoes, Iceland using a rapid respiratory hazard assessment protocol. Environ Res 2013; 127:63-73. [PMID: 24267795 DOI: 10.1016/j.envres.2013.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 08/15/2013] [Accepted: 08/17/2013] [Indexed: 06/02/2023]
Abstract
The six week eruption of Eyjafjallajökull volcano in 2010 produced heavy ash fall in a sparsely populated area of southern and south eastern Iceland and disrupted European commercial flights for at least 6 days. We adopted a protocol for the rapid analysis of volcanic ash particles, for the purpose of informing respiratory health risk assessments. Ash collected from deposits underwent a multi-laboratory physicochemical and toxicological investigation of their mineralogical parameters associated with bio-reactivity, and selected in vitro toxicology assays related to pulmonary inflammatory responses. Ash from the eruption of Grímsvötn, Iceland, in 2011 was also studied. The results were benchmarked against ash from Soufrière Hills volcano, Montserrat, which has been extensively studied since the onset of eruptive activity in 1995. For Eyjafjallajökull, the grain size distributions were variable: 2-13 vol% of the bulk samples were <4 µm, with the most explosive phases of the eruption generating abundant respirable particulate matter. In contrast, the Grímsvötn ash was almost uniformly coarse (<3.5 vol%<4 µm material). Surface area ranged from 0.3 to 7.7 m2 g(-1) for Eyjafjallajökull but was very low for Grímsvötn (<0.6 m2 g(-1)). There were few fibre-like particles (which were unrelated to asbestos) and the crystalline silica content was negligible in both eruptions, whereas Soufrière Hills ash was cristobalite-rich with a known potential to cause silicosis. All samples displayed a low ability to deplete lung antioxidant defences, showed little haemolysis and low acute cytotoxicity in human alveolar type-1 like epithelial cells (TT1). However, cell-free tests showed substantial hydroxyl radical generation in the presence of hydrogen peroxide for Grímsvötn samples, as expected for basaltic, Fe-rich ash. Cellular mediators MCP-1, IL-6, and IL-8 showed chronic pro-inflammatory responses in Eyjafjallajökull, Grímsvötn and Soufrière Hills samples, despite substantial differences in the sample mineralogy and eruptive styles. The value of the pro-inflammatory profiles in differentiating the potential respiratory health hazard of volcanic ashes remains uncertain in a protocol designed to inform public health risk assessment, and further research on their role in volcanic crises is warranted.
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Affiliation(s)
- C J Horwell
- Institute of Hazard, Risk and Resilience, Department of Earth Sciences, Durham University, Science Labs, South Road, Durham DH1 3LE, UK.
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Furst D, Gathany T, Kay J, Wasko M, Keystone E, Kavanaugh A, Deodhar A, Murphy F, Han C, Doyle M. AB0456 Improvement and maintenance of hemoglobin levels among rheumatoid arthritis, psoriatic arthritis & ankylosing spondylitis patients with anemia of inflammation after treatment with golimumab: 3 yr pooled analysis from golimumab rheumatology clinical program. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.456] [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: 11/04/2022]
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Murphy F, Kroll ME, Pirie K, Reeves G, Green J, Beral V. Body size in relation to incidence of subtypes of haematological malignancy in the prospective Million Women Study. Br J Cancer 2013; 108:2390-8. [PMID: 23640394 PMCID: PMC3681016 DOI: 10.1038/bjc.2013.159] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background: Greater adiposity and height have been associated with increased risk of haematological malignancies. Associations for disease subtypes are uncertain. Methods: A cohort of 1.3 million middle-aged UK women was recruited in 1996–2001 and followed for 10 years on average. Potential risk factors were assessed by questionnaire. Death, emigration, and incident cancer were ascertained by linkage to national registers. Adjusted relative risks were estimated by Cox regression. Results: During follow-up, 9162 participants were diagnosed with lymphatic or haematopoietic cancers. Each 10 kg m−2 increase in body mass index was associated with relative risk of 1.20 (95% confidence interval: 1.13–1.28) for lymphoid and 1.37 (1.22–1.53) for myeloid malignancy (P=0.06 for heterogeneity); similarly, Hodgkin lymphoma 1.64 (1.21–2.21), diffuse large B-cell lymphoma 1.36 (1.17–1.58), plasma cell neoplasms 1.21 (1.06–1.39), acute myeloid leukaemia 1.47 (1.19–1.81), and myeloproliferative/myelodysplastic syndromes 1.32 (1.15–1.52). Each 10 cm increase in height was associated with relative risk of 1.21 (1.16–1.27) for lymphoid and 1.11 (1.02–1.21) for myeloid malignancy (P=0.07 for heterogeneity); similarly, mature T-cell malignancies 1.36 (1.03–1.79), diffuse large B-cell lymphoma 1.28 (1.14–1.43), follicular lymphoma 1.28 (1.13–1.44), plasma cell neoplasms 1.12 (1.01–1.24), chronic lymphocytic leukaemia/small lymphocytic lymphoma 1.23 (1.08–1.40), and acute myeloid leukaemia 1.22 (1.04–1.42). There was no significant heterogeneity between subtypes. Conclusion: In middle-aged women, greater body mass index and height were associated with modestly increased risks of many subtypes of haematological malignancy.
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Affiliation(s)
- F Murphy
- Cancer Epidemiology Unit, Nuffield Department of Medicine, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
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22
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Kroll ME, Murphy F, Pirie K, Reeves GK, Green J, Beral V. Alcohol drinking, tobacco smoking and subtypes of haematological malignancy in the UK Million Women Study. Br J Cancer 2012; 107:879-87. [PMID: 22878373 PMCID: PMC3425977 DOI: 10.1038/bjc.2012.333] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [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: 04/04/2012] [Revised: 06/21/2012] [Accepted: 06/24/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Previous research suggests associations of lower alcohol intake and higher tobacco consumption with increased risks of haematological malignancy. The prospective Million Women Study provides sufficient power for reliable estimates of subtype-specific associations in women. METHODS Approximately 1.3 million middle-aged women were recruited in the United Kingdom during 1996-2001 and followed for death, emigration and cancer registration until 2009 (mean 10.3 years per woman); potential risk factors were assessed by questionnaire. Adjusted relative risks were estimated by Cox regression. RESULTS During follow-up, 9162 incident cases of haematological malignancy were recorded, including 7047 lymphoid and 2072 myeloid cancers. Among predominantly moderate alcohol drinkers, higher intake was associated with lower risk of lymphoid malignancies, in particular diffuse large B-cell lymphoma (relative risk 0.85 per 10 g alcohol per day (95% confidence interval 0.75-0.96)), follicular lymphoma (0.86 (0.76-0.98)) and plasma cell neoplasms (0.86 (0.77-0.96)). Among never- and current smokers, higher cigarette consumption was associated with increased risk of Hodgkin lymphoma (1.45 per 10 cigarettes per day (1.22-1.72)), mature T-cell malignancies (1.38 (1.10-1.73)) and myeloproliferative/myelodysplastic disease (1.42 (1.31-1.55)). CONCLUSION These findings confirm and extend existing evidence for associations of subtypes of haematological malignancy with two common exposures in women.
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Affiliation(s)
- M E Kroll
- Cancer Epidemiology Unit, Nuffield Department of Medicine, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK.
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Murphy F, Gleeson FV, Middleton MR. Pulmonary nodules in patients with melanoma--assume nothing. Ann Oncol 2012; 23:545-546. [PMID: 22201180 DOI: 10.1093/annonc/mdr577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
| | - F V Gleeson
- Departments of Radiology, Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Oxford, UK
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Murphy F, Khalil BA, Gozzini S, King B, Bianchi A, Morabito A. Erratum to: Controlled Tissue Expansion in the Initial Management of the Short Bowel State. World J Surg 2011. [DOI: 10.1007/s00268-011-1341-y] [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: 10/14/2022]
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Murphy F, Khalil BA, Gozzini S, King B, Bianchi A, Morabito A. Controlled tissue expansion in the initial management of the short bowel state. World J Surg 2011; 35:1142-5. [PMID: 21318429 DOI: 10.1007/s00268-011-0991-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The treatment of short gut syndrome has evolved dramatically during the past decade. The combination of surgical techniques and medical management in the context of a multidisciplinary approach has improved the outcomes of these children. The authors describe in detail their technique of controlled tissue expansion of the bowel before lengthening procedures. Monitoring of the child and troubleshooting actions during the controlled tissue expansion program also are discussed.
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Affiliation(s)
- F Murphy
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, England, UK.
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Kourinov I, Ealick SE, Capel M, Banerjee S, Murphy F, Neau D, Perry K, Rajashankar K, Schuermann J, Sukumar N. NE-CAT crystallography beamlines for challenging structural biology research. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311087770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Good M, Clegg T, Murphy F, More S. The comparative performance of the single intradermal comparative tuberculin test in Irish cattle, using tuberculin PPD combinations from different manufacturers. Vet Microbiol 2011; 151:77-84. [DOI: 10.1016/j.vetmic.2011.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tebbutt NC, Murphy F, Zannino D, Wilson K, Cummins MM, Abdi E, Strickland AH, Lowenthal RM, Marx G, Karapetis C, Shannon J, Goldstein D, Nayagam SS, Blum R, Chantrill L, Simes RJ, Price TJ. Risk of arterial thromboembolic events in patients with advanced colorectal cancer receiving bevacizumab. Ann Oncol 2011; 22:1834-8. [PMID: 21273347 DOI: 10.1093/annonc/mdq702] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Bevacizumab is an antiangiogenic mAb with efficacy against several cancers, but it is associated with risk of arterial thromboembolism (ATE). Further data are needed to determine the safety of bevacizumab. PATIENTS AND METHODS We recorded grade 3, 4, or 5 ATE events and other data (including age, baseline cardiovascular risk factors, history of ATE, and aspirin use) from 471 patients with metastatic colorectal cancer in the MAX (Mitomycin, Avastin, Xeloda) trial of capecitabine monotherapy versus capecitabine with bevacizumab with or without mitomycin C. RESULTS Bevacizumab-treated patients had 12 grade 3, 4, or 5 ATEs (3.8% incidence). ATEs occurred in 2.1% of patients >65 years, 5% of those with a history of ATE, and 5% of those with cardiac risk factors. Age, history of ATE, or vascular risk factors did not increase risk. Aspirin users had a higher incidence than nonusers (8.9% versus 2.7%) but had higher rates of vascular risk factors. CONCLUSIONS Bevacizumab was associated with a modestly higher risk of ATE, but safety was not significantly worse in older patients or patients with a history of ATE or vascular risk factors. The effect of aspirin in preventing ATE in patients receiving bevacizumab could not be determined from this study.
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Affiliation(s)
- N C Tebbutt
- Department of Medical Oncology, Austin Health, Melbourne, Australia.
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Murphy F, Cochran D, Thornton S. Impact of a Bereavement and Donation Service incorporating mandatory ‘required referral’ on organ donation rates: a model for the implementation of the Organ Donation Taskforce’s recommendations. Anaesthesia 2009; 64:822-8. [DOI: 10.1111/j.1365-2044.2009.05932.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Terkeltaub R, Sundy JS, Schumacher HR, Murphy F, Bookbinder S, Biedermann S, Wu R, Mellis S, Radin A. The interleukin 1 inhibitor rilonacept in treatment of chronic gouty arthritis: results of a placebo-controlled, monosequence crossover, non-randomised, single-blind pilot study. Ann Rheum Dis 2009; 68:1613-7. [PMID: 19635719 PMCID: PMC2732898 DOI: 10.1136/ard.2009.108936] [Citation(s) in RCA: 235] [Impact Index Per Article: 15.7] [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: 01/28/2023]
Abstract
Background: Recent studies suggest that blockade of the NLRP3 (cryopyrin) inflammasome interleukin 1β (IL1β) pathway may offer a new treatment strategy for gout. Objective: To explore the potential utility of rilonacept (IL1 Trap) in patients with chronic active gouty arthritis in a proof-of-concept study. Methods: This 14-week, multicentre, non-randomised, single-blind, monosequence crossover study of 10 patients with chronic active gouty arthritis included a placebo run-in (2 weeks), active rilonacept treatment (6 weeks) and a 6-week post-treatment follow-up. Results: Rilonacept was generally well tolerated. No deaths and no serious adverse events occurred during the study. One patient withdrew owing to an injection-site reaction. Patients’ self-reported median pain visual analogue scale scores significantly decreased from week 2 (after the placebo run-in) to week 4 (2 weeks of rilonacept) (5.0 to 2.8; p<0.049), with sustained improvement at week 8 (1.3; p<0.049); 5 of 10 patients reported at least a 75% improvement. Median symptom-adjusted and severity-adjusted joint scores were significantly decreased. High-sensitivity C-reactive protein levels fell significantly. Conclusions: This proof-of-concept study demonstrated that rilonacept is generally well tolerated and may offer therapeutic benefit in reducing pain in patients with chronic refractory gouty arthritis, supporting the need for larger, randomised, controlled studies of IL1 antagonism such as with rilonacept for this clinical indication.
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Affiliation(s)
- R Terkeltaub
- VAMC Rheumatology, 111K, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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Larkin C, Murphy F, Browne I. Anaesthetic management of pregnancy complicated by a symptomatic arachnoid cyst. Int J Obstet Anesth 2009; 18:291-2. [DOI: 10.1016/j.ijoa.2009.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 02/03/2009] [Indexed: 12/01/2022]
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Abstract
Vascular access for renal replacement therapy (RRT) is seen as one of the most challenging areas confronting the nephrology multidisciplinary team. The vascular access of choice is the arterio-venous fistula (AVF) followed by the arterio-venous graft (AVG) and central venous catheter (CVC). A successful vascular access programme requires forward planning ensuring that enough time is available for the preservation of the access site, its creation and maturation. Successful cannulation of the vascular access requires on the part of the nephrology nurse, clinical expertise and knowledge on the management of different types of vascular access including different cannulation techniques.
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Affiliation(s)
- Margaret McCann
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland.
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Kourinov I, Ealick E, Capel M, Lynch E, Murphy F, Rajashankar K, Sukumar N, Unik P, Withrow J. NorthEastern Collaborative Access Team (NE-CAT) beam lines at the Advanced Photon Source. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308094300] [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: 11/10/2022] Open
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Sirohi B, Cunningham D, Powles R, Murphy F, Arkenau T, Norman A, Oates J, Wotherspoon A, Horwich A. Long-term outcome of autologous stem-cell transplantation in relapsed or refractory Hodgkin's lymphoma. Ann Oncol 2008; 19:1312-1319. [PMID: 18356139 DOI: 10.1093/annonc/mdn052] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess prognostic factors and outcome of patients with relapsed/refractory Hodgkin's lymphoma (HL) who received high-dose chemotherapy and autologous stem-cell transplant (ASCT). PATIENTS AND METHODS Data on 195 patients who received ASCT between 1985 and June 2005 were reviewed. Median time from first treatment to ASCT was 2.6 years (0.4-27.3). Demography at ASCT was 61% stage IV, median age 31 years (18-69), median prior treatment (tx) regimens 3 (2-7), median Hasenclever index 3 (0-6); 150 patients had responding disease [54 complete remission (CR), 96 partial remission (PR)], and 45 patients had untested relapse/refractory disease. RESULTS Post-ASCT, 61% (119/195) patients attained CR with an overall response (CR + PR) of 85%. Twelve patients had nonrelapse mortality. Of 119 patients attaining CR, 27 relapsed: 3 after attaining CR for >5 years and 1 after attaining CR for >10 years. Median overall survival (OS)/progression-free survival (PFS) from ASCT was 9 years/2.9 years. Five-year OS/PFS was 55% of 44% and 10-year OS/PFS was 49.4% of 37% for whole group. Twenty (10%) patients developed second cancer (seven secondary acute myeloid leukaemia (AML)/myelodysplastic syndrome (MDS)). Probability of developing second cancer at 10 years was 14.7% (95% confidence interval 8.9% to 23.8%) and 24.8% at 19 years. CONCLUSION These data provide the longest follow-up reported for patients receiving ASCT for relapsed/refractory HL. In addition to previously described prognostic factors, our data show that Hasenclever index <3 influences outcome favorably and attaining CR at ASCT leads to a better outcome.
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Affiliation(s)
- B Sirohi
- Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK
| | - D Cunningham
- Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
| | - R Powles
- Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK
| | - F Murphy
- Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK
| | - T Arkenau
- Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK
| | - A Norman
- Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK
| | - J Oates
- Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK
| | - A Wotherspoon
- Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK
| | - A Horwich
- Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK
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Sandford RM, Bown MJ, Fishwick G, Murphy F, Naylor M, Sensier Y, Sharpe R, Walker J, Hartshorn T, London NJ, Sayers RD. Duplex Ultrasound Scanning is Reliable in the Detection of Endoleak Following Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2006; 32:537-41. [PMID: 16875850 DOI: 10.1016/j.ejvs.2006.05.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Accepted: 05/23/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the value of duplex ultrasound scanning (DUSS) in the routine follow up of patients following EVAR. METHODS Imaging was reviewed for 310 consecutive patients undergoing EVAR at a single centre. Concurrent ultrasound and CT scans were defined as having occurred within 6 months of each other. There were 244 paired concurrent DUSS and CT scans which were used for further analysis. These modalities were compared with respect to sensitivity, specificity, positive and negative predictive values and level of agreement (by Kappa statistics) using CT as the 'gold standard'. RESULTS DUSS failed to detect a number of endoleaks which were seen on CT and the sensitivity of this test was therefore poor (67%). However, the specificity of DUSS compared more favourably with a value of 91%. Positive predictive values ranged from 33-100% but negative predictive values were more reliable with values of 91-100% at all time points post operatively. There were no type I leaks, or endoleaks requiring intervention which were missed on DUSS. Overall, there was a 'fair' level of agreement between the two imaging modalities using Kappa statistics. CONCLUSION Although DUSS is not as sensitive as CT scanning in the detection of endoleak, no leaks requiring intervention were missed on DUSS in this study. DUSS is much cheaper than CT and avoids high doses of radiation. DUSS therefore remains a valuable method of follow up after EVAR and can reduce the need for repeated CT scans.
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Affiliation(s)
- R M Sandford
- Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Level 2 RKCSB, Leicester Royal Infirmary, Leicester LE2 7LX, United Kingdom.
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Sandford R, Bown M, Fishwick G, Murphy F, Naylor M, Sensier Y, Sharpe R, Walker J, Hartshorn T, London N, Sayers R. Duplex Ultrasound Scanning is Reliable in the Detection of Endoleak Following Endovascular Aneurysm Repair. J Vasc Surg 2006. [DOI: 10.1016/j.jvs.2006.09.033] [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]
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Leach W, Reid J, Murphy F. Continuous passive motion following total knee replacement: a prospective randomized trial with follow-up to 1 year. Knee Surg Sports Traumatol Arthrosc 2006; 14:922-6. [PMID: 16489477 DOI: 10.1007/s00167-006-0042-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Accepted: 08/09/2005] [Indexed: 12/19/2022]
Abstract
We have carried out a prospective randomised, single blind clinical trial to investigate the effect of continuous passive motion on range of knee flexion, lack of extension, pain levels and analgesic use after total knee replacement surgery. 85 subjects were randomly allocated to control or study group. All subjects followed the existing rehabilitation protocol, which permits immediate active range of motion exercises and mobilisation with the study group using continuous passive motion for 1 h, twice a day. Outcome measures employed were range of motion, pain assessed on a visual analogue scale and analgesic use according to the WHO ladder. Blinded evaluation was carried out preoperatively, at time of discharge from hospital, 6 weeks, 6 and 12 months postoperation. No significant difference was observed between groups at all time intervals for each outcome variable using Wilcoxon Rank sum tests. The results substantiate previous findings that short duration continuous passive motion following total knee arthroplasty does not influence outcome of range of motion or reported pain.
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Affiliation(s)
- W Leach
- Department of Orthopaedics, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, UK
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Murphy F. Assessment and management of patients with surgical cavity wounds. Nurs Stand 2006; 20:57-8, 60, 62 passim. [PMID: 16881591 DOI: 10.7748/ns2006.07.20.45.57.c4469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article explores the management of surgical cavity wounds. The effectiveness of healing depends on wound assessment and constant re-evaluation of the management strategy adopted. Management strategies should be holistic and take into account the wound bed and local and systemic barriers to healing, as well as patients' thoughts and concerns about their wound. Nurses have a pivotal role in wound management and dressing selection, and should aim to keep up to date in this dynamic specialty.
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Affiliation(s)
- F Murphy
- Papworth Hospital NHS Foundation Trust, Cambridge.
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Porter S, Anderson L, Chetty A, Dyker S, Murphy F, Cheyne H, Latto D, Grant A, McLachlan M, Wild P, McDonald A, Kettles AM. Operational competency development in E and F grade nursing staff: preparation for management. J Nurs Manag 2006; 14:384-90. [PMID: 16787473 DOI: 10.1111/j.1365-2934.2006.00628.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is limited literature for operational management competency development in E and F grade nursing staff. These grades of nursing staff have to take over from G grade nurses ward managers on a regular basis. With human resources doing less of the operational management and taking more of an advisory role, nursing staff are now required to deal with disciplinary procedures and other management issues in a more consistent manner. Therefore, this development programme in a Scottish primary care NHS psychiatric service was designed to enable E and F grade nurses to take over from ward managers and to enable ward managers to 'succession plan' for times when they will be absent. The literature is reviewed, the background to the development programme described and the design of the development programme is explained. The results from both the pilot study (n=13) and first group (n=8) through the course are presented, evaluated discussed.
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Affiliation(s)
- S Porter
- Divisional Research Unit, Ground Floor, Bennachie, Royal Cornhill Hospital, Aberdeen, UK
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Murphy F, Norman A, Christmas T, Andreyev H, Eeles R, Khoo V. Assessing the Incidence of Bowel Incontinence in Patients with Urological Cancers Who Have and Have Not Received Pelvic Radiotherapy using the Vaizey and RTOG: Interim Results. Clin Oncol (R Coll Radiol) 2006. [DOI: 10.1016/j.clon.2006.03.008] [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]
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Murphy F. An investigation into stress levels amongst renal nurses. EDTNA ERCA J 2004; 30:226-9. [PMID: 15835416 DOI: 10.1111/j.1755-6686.2004.tb00373.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A qualitative study was designed to explore renal nurses' perception of stress within their unit. This study collected information from ten staff nurses through semi structured taped interviews. Using content analysis, interviews were coded and categories and themes were identified. Findings indicate that stress was derived from the following categories: job content, resource issues, professional concerns, professional working relationships, extrinsic factors, and coping mechanisms. The actual words of the nurses were included to provide depth and substance to the categories and themes. A discussion was held regarding the relationship of these findings to theory. These findings have implications for nursing practice, administration and education. Recommendations are also made for future studies.
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Affiliation(s)
- F Murphy
- School of Nursing & Midwifery Studies, Trinity College, Dublin, Ireland.
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Hu X, Murphy F, Karwautz A, Li T, Freeman B, Franklin D, Giotakis O, Treasure J, Collier DA. Analysis of microsatellite markers at the UCP2/UCP3 locus on chromosome 11q13 in anorexia nervosa. Mol Psychiatry 2002; 7:276-7. [PMID: 11920154 DOI: 10.1038/sj.mp.4001044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Murphy F, Nightingale A. Accident and emergency nurses as researchers: exploring some of the ethical issues when researching sensitive topics. Accid Emerg Nurs 2002; 10:72-7. [PMID: 12400181 DOI: 10.1054/aaen.2001.0342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The breadth and complexity of accident and emergency (A&E) services is potentially a fruitful area for nursing and interdisciplinary research. A significant proportion of potential areas for research in A&E settings could be considered as 'sensitive topic areas'. Sensitive topic research raises many challenges; in particular, it raises specific ethical issues. This paper defines and identifies examples of sensitive topic area research in A&E and discusses some of the ethical issues to be considered before embarking on such research in A&E settings.
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Affiliation(s)
- F Murphy
- School of Health Science, University of Wales Swansea, Singleton Park, Swansea 5A2 8PP, UK
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Kang H, Magee C, Mahan C, Lee K, Murphy F, Jackson L, Matanoski G. Pregnancy outcomes among U.S. Gulf War veterans: a population-based survey of 30,000 veterans. Ann Epidemiol 2001; 11:504-11. [PMID: 11557183 DOI: 10.1016/s1047-2797(01)00245-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We evaluated an association between veterans' Gulf War service and reported adverse pregnancy outcomes. METHODS We conducted a health survey in which selected reproductive outcomes of a population-based sample of 15,000 Gulf War veterans representing four military branches and three unit components (active, reserve, and National Guard) were compared to those of 15,000 non-Gulf veteran controls. RESULTS Male Gulf veterans, compared with their non-Gulf veteran controls, reported a significantly higher rate of miscarriage (odds ratio [OR] = 1.62; 95% confidence interval [CI] = 1.32-1.99). Female Gulf veterans also reported more miscarriages than their respective controls, although their excess was not statistically significant (OR= 1.35; CI = 0.97-1.89). Both men and women deployed to the Gulf theater reported significant excesses of birth defects among their liveborn infants. These excess rates also extended to the subset of "moderate to severe" birth defects [males: OR= 1.78 (CI = 1.19-2.66); females: OR = 2.80 (CI = 1.26-6.25)]. No statistically significant differences by deployment status were found among men or women for stillbirths, pre-term deliveries or infant mortality. CONCLUSION The risk of veterans reporting birth defects among their children was significantly associated with veteran's military service in the Gulf War. This observation needs to be confirmed by a review of medical records to rule out possible reporting bias.
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Affiliation(s)
- H Kang
- Environmental Epidemiology Service, Department of Veterans Affairs, 1120 20th Street NW, Washington, DC 20036, USA
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Murphy F. Observations on FMD-infected sheep in Ireland. Vet Rec 2001; 148:791. [PMID: 11465274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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McManus T, McConville J, Collery P, Murphy F. Diagnosis of the first two outbreaks of FMD in Ireland. Vet Rec 2001; 148:486-7. [PMID: 11334079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Rosenthal D, Murphy F, Gottschalk R, Baxter M, Lycka B, Nevin K. Using a topical anaesthetic cream to reduce pain during sharp debridement of chronic leg ulcers. J Wound Care 2001; 10:503-5. [PMID: 12964231 DOI: 10.12968/jowc.2001.10.1.26042] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This multicentre, double-blind, placebo-controlled, parallel-group study assessed the efficacy and safety of using Emla (lignocaine/prilocaine) anaesthetic cream to achieve pain control during sharp debridement of chronic leg ulcers of arterial, venous or arteriovenous aetiology. A total of 101 patients (51 Emla, 50 placebo), aged 29-99 years, who had experienced pain associated with previous debridement were included. Patients with an amide anaesthetic allergy, anaesthetic diabetic ulcers, or ulcers > 50 cm2 were excluded. Debridement was initiated approximately 30 minutes after the application of a thick layer of Emla or placebo cream to an ulcer occluded with a plastic wrap. The patient and investigator assessed the pain associated with debridement on a 100 mm visual analogue scale (VAS). The median patient VAS scores were 18 mm and 53.5 mm in the Emla and placebo groups, respectively (p < 0.0001). The corresponding investigator values in the two groups were 20 mm and 49.5 mm, respectively (p = 0.004). Local reactions were mainly transient and mild, and were observed in roughly the same percentage of placebo and Emla-treated patients. After a 30-minute application Emla cream significantly reduced the pain of debridement compared with the placebo.
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Affiliation(s)
- D Rosenthal
- Division of Dermatology, McMaster University, Faculty of Health Sciences, St. Joseph's Hospital, Hamilton, Ontario, Canada
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Abstract
BACKGROUND Mycobacterium chelonae is an atypical "fast-growing Mycobacteria" that is a rare cause of human infection. There have been several reports of cutaneous infection among immunosuppressed patients, as well as in immunocompetent individuals following trauma. Most cases to date seem to have occurred among renal transplant recipients, raising the possibility that there is something inherent to the renal transplant patient that increases their susceptibility more than other immunocompromised patients. OBJECTIVE The differential diagnosis of subcutaneous nodules distributed in a sporotrichoid pattern is extensive, particularly in an immunocompromised host. Although several cases of cutaneous M. chelonae abscessus infection have been reported among both immunosuppressed and immunocompetent patients, the clinical presentation has varied, and few cases have reported the appearance of lesions in a sporotrichoid pattern. We present a case of a renal transplant patient with a reported history of trauma to the lower extremities, who presents with subcutaneous nodules distributed in a sporotrichoid pattern. The patient is found to have M. chelonae abscessus infection, fails several treatment regimens, and presents with a recurrence. The literature of M. chelonae infection is reviewed, and the various treatment options are discussed. METHODS An initial skin biopsy was stained with Hematoxylin and Eosin and revealed deep dermal abscesses with acid-fast bacilli in clusters. The culture became positive for Mycobacterium chelonae abscesses in four days and was found to be sensitive to multiple antibiotics. The patient underwent surgical excision of 14 nodules, which revealed findings consistent with the skin biopsy, and was subsequently treated with the appropriate antibiotics. RESULTS Despite treatment with a full course of an organism-sensitive antibiotic regimen, the patient returned with persistent and recurrent nodules six weeks later. The patient was then treated as an inpatient with a seven-week course of intravenous antibiotics and was discharged home on a combined intravenous and oral regimen. CONCLUSION Although M. chelonae abscessus is an extremely rare cause of infection among humans, there seems to be a predominance of cases reported among renal transplant patients. The explanation for this is not entirely clear; however, the organism must be considered as a cause of infection in any renal transplant recipient who presents with subcutaneous nodules. Eradication of the organism presents a tremendous challenge to the clinician, and, as presented here, even with appropriate antibiotics, there is a high rate of recurrence.
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Affiliation(s)
- C H Endzweig
- Department of Dermatology, New York Presbyterian Hospital-Cornell University Medical College, New York, USA
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Abstract
The care of women having termination of pregnancy has always presented social, ethical and legal concerns to nurses and other healthcare professionals. Women having first-trimester termination of pregnancy may have the choice between medical and surgical methods. The process and procedure of these two approaches are discussed and the implications for nursing practice identified. There is now research evidence that explores women's experiences of these various methods and gives some insight into what the woman may experience. Nurses must have knowledge of these methods of termination to enable women to make the correct choices. The challenge for nurses then is to provide and evaluate information that is as effective as possible in meeting the needs of the individual woman.
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Affiliation(s)
- F Murphy
- School of Health Science, University of Wales, Swansea, UK
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