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Elfghi M, Dunne D, Jones J, Gibson I, Flaherty G, McEvoy JW, Sultan S, Jordan F, Tawfick W. Mobile health technologies to improve walking distance in people with intermittent claudication. Cochrane Database Syst Rev 2024; 2:CD014717. [PMID: 38353263 PMCID: PMC10865447 DOI: 10.1002/14651858.cd014717.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is the obstruction or narrowing of the large arteries of the lower limbs, which can result in impaired oxygen supply to the muscle and other tissues during exercise, or even at rest in more severe cases. PAD is classified into five categories (Fontaine classification). It may be asymptomatic or various levels of claudication pain may be present; at a later stage, there may be ulceration or gangrene of the limb, with amputation occasionally being required. About 20% of people with PAD suffer from intermittent claudication (IC), which is muscular discomfort in the lower extremities induced by exertion and relieved by rest within 10 minutes; IC causes restriction of movement in daily life. Treatment for people with IC involves addressing lifestyle risk factors. Exercise is an important part of treatment, but supervised exercise programmes for individuals with IC have low engagement levels and high attrition rates. The use of mobile technologies has been suggested as a new way to engage people with IC in walking exercise interventions. The novelty of the intervention, low cost for the user, automation, and ease of access are some of the advantages mobile health (mhealth) technologies provide that give them the potential to be effective in boosting physical activity in adults. OBJECTIVES To assess the benefits and harms of mobile health (mhealth) technologies to improve walking distance in people with intermittent claudication. SEARCH METHODS The Cochrane Vascular Information Specialist conducted systematic searches of the Cochrane Vascular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and CINAHL, and also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. The most recent searches were carried out on 19 December 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) in people aged 18 years or over with symptomatic PAD and a clinical diagnosis of IC. We included RCTs comparing mhealth interventions to improve walking distance versus usual care (no intervention or non-exercise advice), exercise advice, or supervised exercise programmes. We excluded people with chronic limb-threatening ischaemia (Fontaine III and IV). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were change in absolute walking distance from baseline, change in claudication distance from baseline, amputation-free survival, revascularisation-free survival. Our secondary outcomes were major adverse cardiovascular events, major adverse limb events, above-ankle amputation, quality of life, and adverse events. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included four RCTs involving a total of 614 participants with a clinical diagnosis of IC. The duration of intervention of the four included RCTs ranged from 3 to 12 months. Participants were randomised to either mhealth or control (usual care or supervised exercise programme). All four studies had an unclear or high risk of bias in one or several domains. The most prevalent risk of bias was in the area of performance bias, which was rated high risk as it is not possible to blind participants and personnel in this type of trial. Based on GRADE criteria, we downgraded the certainty of the evidence to low, due to concerns about risk of bias, imprecision, and clinical inconsistency. Comparing mhealth with usual care, there was no clear evidence of an effect on absolute walking distance (mean difference 9.99 metres, 95% confidence interval (CI) -27.96 to 47.93; 2 studies, 503 participants; low-certainty evidence). None of the included studies reported on change in claudication walking distance, amputation-free survival, or revascularisation-free survival. Only one study reported on major adverse cardiovascular events (MACE) and found no clear difference between groups (risk ratio 1.37, 95% CI 0.07 to 28.17; 1 study, 305 participants; low-certainty evidence). None of the included studies reported on major adverse limb events (MALE) or above-ankle amputations. AUTHORS' CONCLUSIONS Mobile health technologies can be used to provide lifestyle interventions for people with chronic conditions, such as IC. We identified a limited number of studies that met our inclusion criteria. We found no clear difference between mhealth and usual care in improving absolute walking distance in people with IC; however, we judged the evidence to be low certainty. Larger, well-designed RCTs are needed to provide adequate statistical power to reliably evaluate the effects of mhealth technologies on walking distance in people with IC.
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Affiliation(s)
- Marah Elfghi
- School of Medicine, University of Galway, Galway, Ireland
| | - Denise Dunne
- National Institute for Prevention and Cardiovascular Health, Croí Heart and Stroke Centre, Newcastle, Galway, Ireland
- Croí Heart and Stroke Centre, Newcastle, Galway, Ireland
| | - Jennifer Jones
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
| | - Irene Gibson
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
| | | | | | - Sherif Sultan
- Vascular Surgery, Galway University Hospital, Galway, Ireland
| | - Fionnuala Jordan
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital, Galway, Ireland
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Forsyth F, Borregaard B, Norekvål TM, Gibson I. The heart of the matter: advocacy in cardiovascular nursing and allied professions. Eur J Cardiovasc Nurs 2023; 22:e120-e122. [PMID: 37249044 DOI: 10.1093/eurjcn/zvad053] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Faye Forsyth
- Clinical Nursing Research Group, Department of Public Health & Primary Care, University of Cambridge, Robinson Way, CB2 0SR
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense, Denmark
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odens, Denmark
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5009 Bergen, Norway
- Department of Clinical Science, Haukeland University Hospital, Jonas Lies veg, 875021 Bergen, Norway
- Department of Nursing and Caring Science, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway
| | - Irene Gibson
- School of Nursing & Midwifery, University of Galway, University Road, Galway, Ireland, H91 TK33
- National Institute of Prevention & Cardiovascular Health (NIPC), Croí House, Moyola Lane, Newcastle, Galway, H91 FF68, Ireland
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Finucane FM, Gibson I, Hughes R, Murphy E, Hynes L, Harris A, McGuire BE, Hynes M, Collins C, Cradock K, Seery S, Jones J, O’Brien T, O’Donnell MJ. Factors associated with weight loss and health gains in a structured lifestyle modification programme for adults with severe obesity: a prospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1257061. [PMID: 37916153 PMCID: PMC10616877 DOI: 10.3389/fendo.2023.1257061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023] Open
Abstract
Background Individual responses to behavioural weight loss interventions can vary significantly, and a better understanding of the factors associated with successful treatment might help to target interventions for those who will benefit the most. We sought to identify demographic and clinical characteristics that predicted intervention "success" (defined as ≥5% weight loss) and other health gains in patients with severe obesity attending a ten-week structured lifestyle modification programme. Methods We conducted a prospective cohort study of all 1122 patients (751 (66.9%) female, mean age 47.3 ± 11.9 years, mean body mass index (BMI) 46.7 ± 7.8 kgm-2) referred from our hospital-based obesity clinic, who started the structured lifestyle programme between 2012-2019. We compared routine clinical measures such as weight, fitness, blood pressure, lipids and HbA1c at baseline and follow-up. We also used validated questionnaires to quantify anxiety, depression and health-related quality of life. Results Of 1122 patients who started, 877 (78.2%) completed the programme and attended for follow up. Of these, 12.8% lost ≥5% body weight. The amount of weight lost was a strong and consistent predictor of improvements in metabolic, cardiovascular, and mental health, even after adjusting for age, sex, programme attendance and baseline fitness. Older age, male sex, being physically active and having lower anxiety and depression scores at baseline predicted greater weight loss. Younger age, depression and longer wait time to start the intervention were associated with drop-out. Conclusions In adults with severe obesity completing a structured lifestyle modification programme, older age and good mental health were associated with programme completion and attaining ≥5% weight loss. The magnitude of weight lost was a strong predictor of improvements in cardiovascular, metabolic and mental health associated with programme completion.
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Affiliation(s)
- Francis M. Finucane
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
| | - Irene Gibson
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Robert Hughes
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Enda Murphy
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
| | - Lisa Hynes
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Aisling Harris
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Brian E. McGuire
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- School of Psychology, University of Galway, Galway, Ireland
| | - Mary Hynes
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- School of Psychology, University of Galway, Galway, Ireland
| | - Chris Collins
- Department of Upper Gastrointestinal Surgery, Galway University Hospital, Galway, Ireland
| | - Kevin Cradock
- Department of Health and Nutrition Sciences, Atlantic Technological University, Sligo, Ireland
| | - Suzanne Seery
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Jennifer Jones
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Tim O’Brien
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
| | - Martin J. O’Donnell
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
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Gibson I, Jennings C, Neubeck L, Corcoran M, Wood D, Sharif F, Hynes L, Murphy AW, Byrne M, McEvoy JW. Using a digital health intervention "INTERCEPT" to improve secondary prevention in coronary heart disease (CHD) patients: protocol for a mixed methods non-randomised feasibility study. HRB Open Res 2023; 6:43. [PMID: 38414839 PMCID: PMC10897504 DOI: 10.12688/hrbopenres.13781.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 02/29/2024] Open
Abstract
Background: Digital health interventions (DHIs) are increasingly used for the secondary prevention of cardiovascular disease (CVD). The aim of this study is to determine the feasibility of "INTERCEPT", a co-designed DHI developed to improve secondary prevention in hospitalised coronary heart disease patients (CHD). Methods: This non-randomised feasibility study will be conducted using a mixed methods process evaluation with a sample of 40 patients in an acute hospital setting. Informed by behaviour change theory, the Intercept application (I-App) integrates a smartphone interface, health care professional portal, a fitness wearable and a blood pressure monitor. I-App is designed to support and motivate patients to set goals, self-monitor lifestyle and medical risk factors, and manage their medications, with the health care professional portal enabling monitoring and communication with patients. Using convenience sampling, eligible patients will be recruited in two phases, a pre-implementation phase and an implementation phase. During the pre-implementation phase participants will not immediately receive the I-App but will be invited to receive the I-App at 3 months follow-up. This will enable early learning about the processes of recruitment and conducting the assessment prior to full scale deployment of the I-App. During the implementation phase, participants will be invited to download the I-App to their smartphone prior to hospital discharge. Qualitative interviews will be conducted among a subset of patients and health care professionals to gain a greater insight into their experience of using the I-App. Primary outcomes will be assessed at baseline and 3-month follow-up. Using pre-defined feasibility criteria, including recruitment, retention and engagement rates, together with data on intervention acceptability, will determine the appropriateness of progressing to a definitive trial. Discussion: This study will provide important insights to help inform the feasibility of conducting a definitive trial of "INTERCEPT" among coronary heart disease patients in a critical health care setting.
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Affiliation(s)
- Irene Gibson
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Catriona Jennings
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - David Wood
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Faisal Sharif
- School of Medicine, University of Galway, Galway, Ireland
| | - Lisa Hynes
- Croí, West of Ireland Cardiac Foundation, Galway, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, University of Galway, Galway, Ireland
| | - John William McEvoy
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
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Sun Z, Zhang Z, Banu K, Gibson I, Colvin R, Yi Z, Zhang W, Djamali A, Gallon L, O'Connell P, Pober J, Heeger P, MENON M. WCN23-0197 Multiscale genetic architecture of donor-recipient differences reveals intronic LIMS1 locus mismatches associated with long-term renal transplant survival. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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Gibson I, McCrudden Z, Dunne D, Harris A, Hynes L, Murphy E, Murphy AW, Byrne M, McEvoy JW. Harnessing digital health to optimise the delivery of guideline-based cardiac rehabilitation during COVID-19: an observational study. Open Heart 2023; 10:openhrt-2022-002211. [PMID: 36927866 PMCID: PMC10030287 DOI: 10.1136/openhrt-2022-002211] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/09/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic accelerated the uptake of digital health interventions for the delivery of cardiac rehabilitation (CR). However, there is a need to evaluate these interventions. METHODS We examined the impact of an evidence-based, digital CR programme on medical, lifestyle and psychosocial outcomes. Delivered by an interdisciplinary team of healthcare professionals, the core components of this 12-week programme included lifestyle modification, medical risk factor management, psychosocial and behavioural change support. To support self-management, patients were provided with a Fitbit, a home blood pressure (BP) monitor and an interactive workbook. Patients received access to a bespoke web-based platform and were invited to attend weekly, online group-based supervised exercise sessions and educational workshops. Outcomes were assessed at baseline, end of programme and at 6-month follow-up. RESULTS Over a 3-month period, 105 patients (88% with coronary heart disease) were referred with 74% (n=77) attending initial assessment. Of these, 97% (n=75) enrolled in the programme, with 85% (n=64) completing the programme, 86% (n=55) of completers attended 6-month follow-up. Comparing baseline to end of programme, we observed significant improvements in the proportion of patients meeting guideline-recommended targets for physical activity (+68%, p<0.001), BP (+44%, p<0.001) and low-density lipoprotein cholesterol (+27%, p<0.001). There were significant reductions in mean weight (-2.6 kg, p<0.001). Adherence to the Mediterranean diet score improved from 5.2 to 7.3 (p<0.001). Anxiety and depression levels (Hospital Anxiety and Depression score) both reduced by more than 50% (p<0.001). The majority of these improvements were sustained at 6-month follow-up. CONCLUSION Outcomes from this study suggest that interdisciplinary digital CR programmes can be successfully implemented and help patients achieve guideline recommended lifestyle, medical and therapeutic targets.
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Affiliation(s)
- Irene Gibson
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | | | - Denise Dunne
- Community Healthcare West, Health Service Executive West, Galway, Ireland
| | - Aisling Harris
- Croí, West of Ireland Cardiac and Stroke Foundation, Galway, Ireland
| | - Lisa Hynes
- Croí, West of Ireland Cardiac and Stroke Foundation, Galway, Ireland
| | - Ella Murphy
- School of Medicine, University of Galway, Galway, Ireland
| | | | - Molly Byrne
- Health Behaviour Change Research Group, University of Galway, Galway, Ireland
| | - John William McEvoy
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
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Mitchelson KAJ, Tran TTT, Dillon ET, Vlckova K, Harrison SM, Ntemiri A, Cunningham K, Gibson I, Finucane FM, O'Connor EM, Roche HM, O'Toole PW. Yeast β-Glucan Improves Insulin Sensitivity and Hepatic Lipid Metabolism in Mice Humanized with Obese Type 2 Diabetic Gut Microbiota. Mol Nutr Food Res 2022; 66:e2100819. [PMID: 36038526 PMCID: PMC9787509 DOI: 10.1002/mnfr.202100819] [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: 09/03/2021] [Indexed: 12/30/2022]
Abstract
SCOPE Gut microbiota alterations are associated with obesity and type 2 diabetes. Yeast β-glucans are potential modulators of the innate immune-metabolic response, by impacting glucose, lipid, and cholesterol homeostasis. The study examines whether yeast β-glucan interacts differentially with either an obese healthy or obese diabetic gut microbiome, to impact metabolic health through hepatic effects under high-fat dietary challenge. METHODS AND RESULTS Male C57BL/6J mice are pre-inoculated with gut microbiota from obese healthy (OBH) or obese type 2 diabetic (OBD) subjects, in conjunction with a high-fat diet (HFD) with/without yeast β-glucan. OBD microbiome colonization adversely impacts metabolic health compared to OBH microbiome engraftment. OBD mice are more insulin resistant and display hepatic lipotoxicity compared to weight matched OBH mice. Yeast β-glucan supplementation resolves this adverse metabolic phenotype, coincident with increasing the abundance of health-related bacterial taxa. Hepatic proteomics demonstrates that OBD microbiome transplantation increases HFD-induced hepatic mitochondrial dysfunction, disrupts oxidative phosphorylation, and reduces protein synthesis, which are partly reverted by yeast β-glucan supplementation. CONCLUSIONS Hepatic metabolism is adversely affected by OBD microbiome colonization with high-fat feeding, but partially resolved by yeast β-glucan. More targeted dietary interventions that encompass the interactions between diet, gut microbiota, and host metabolism may have greater treatment efficacy.
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Affiliation(s)
- Kathleen A. J. Mitchelson
- Nutrigenomics Research Group and Institute of Food and HealthUniversity College DublinDublinDublin 4Republic of Ireland
| | - Tam T. T. Tran
- APC Microbiome IrelandUniversity College CorkCorkT12 K8AFRepublic of Ireland,School of MicrobiologyUniversity College CorkCorkT12 K8AFRepublic of Ireland,Present address:
Vietnam Academy of Science and TechnologyUniversity of Science and Technology of HanoiHanoiVietnam
| | - Eugene T. Dillon
- Mass Spectrometry ResourceConway Institute of Biomolecular & Biomedical ResearchUniversity College DublinDublinDublin 4Republic of Ireland
| | - Klara Vlckova
- APC Microbiome IrelandUniversity College CorkCorkT12 K8AFRepublic of Ireland,School of MicrobiologyUniversity College CorkCorkT12 K8AFRepublic of Ireland
| | - Sabine M. Harrison
- UCD School of Agriculture & Food ScienceUniversity College DublinDublinDublin 4Republic of Ireland
| | - Alexandra Ntemiri
- APC Microbiome IrelandUniversity College CorkCorkT12 K8AFRepublic of Ireland,School of MicrobiologyUniversity College CorkCorkT12 K8AFRepublic of Ireland
| | - Katie Cunningham
- Bariatric Medicine ServiceCentre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayH91 YR71Republic of Ireland,Heart and Stroke CentreCroiThe West of Ireland Cardiac FoundationMoyola Lane, NewcastleGalwayGalwayH91 FF68Republic of Ireland
| | - Irene Gibson
- Heart and Stroke CentreCroiThe West of Ireland Cardiac FoundationMoyola Lane, NewcastleGalwayGalwayH91 FF68Republic of Ireland
| | - Francis M. Finucane
- Bariatric Medicine ServiceCentre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayH91 YR71Republic of Ireland,HRB Clinical Research FacilityNational University of IrelandGalwayH91 TK33Republic of Ireland
| | - Eibhlís M. O'Connor
- APC Microbiome IrelandUniversity College CorkCorkT12 K8AFRepublic of Ireland,Department of Biological SciencesSchool of Natural SciencesUniversity of LimerickLimerickV94 T9PXRepublic of Ireland,Health Research InstituteUniversity of LimerickLimerickV94 T9PXRepublic of Ireland
| | - Helen M. Roche
- Nutrigenomics Research Group and Institute of Food and HealthUniversity College DublinDublinDublin 4Republic of Ireland,Diabetes Complications Research CentreUniversity College DublinDublinDublin 4Republic of Ireland,The Institute for Global Food SecuritySchool of Biological SciencesQueen's University BelfastBelfastBT9 5DLUK
| | - Paul W. O'Toole
- APC Microbiome IrelandUniversity College CorkCorkT12 K8AFRepublic of Ireland,School of MicrobiologyUniversity College CorkCorkT12 K8AFRepublic of Ireland
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Elfghi M, Jordan F, Dunne D, Gibson I, Mcevoy JW, Jones J, Sultan S, Tawfick W. The effect of lifestyle and risk factor modification on occlusive peripheral arterial disease outcomes: standard healthcare vs structured programme: a pilot randomised controlled study. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atherosclerotic risk factor modification plays an important role in reducing adverse outcomes in patients with atherosclerotic disease1. Despite the high prevalence of peripheral arterial disease (PAD) and strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive structured treatment for their atherosclerotic risk factors than patients with coronary artery disease2,3.
Purpose
We aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors.
Methods
This is a pilot randomised controlled study comparing a risk factor modification intervention programme to standard healthcare, for the reduction of modified risk factors in PAD patients. Patients randomised to the intervention arm underwent a 12-week supervised programme adjusting their risk factors. Primary outcome was patients reaching target risk factor improvement.
Results
Seventy-five patients were randomised. 36 were allocated to Standard Healthcare. 39 completed a 12-week Structured Programme. There was no significant difference between groups in baseline demographics, incidence and severity of risk factors, mobility and quality of life.
At 12-weeks the intervention group showed a significant improvement in target body weight (6.7±9.57 p=0.002), waist circumference (7.4±9.5 p=0.001), HbA1c (4.12±7.22 p=0.009), total cholesterol (0.63±0.99 p=0.004), low-density lipoprotein (0.59±1.040 p=0.00), triglycerides (0.24±0.38 p=0.005), Mediterranean diet score (2.48±1.35 p=0.0001), Absolute Walking Distance (8.2±7.8 p=0.0001), Claudication Distance (9.2±7.4 p=0.0001). There was no significant difference in the change of any of the other risk factors.
Conclusion
Risk factor modification intervention programme can significantly aid PAD patients reach their target risk factor improvement goals.
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Affiliation(s)
- M Elfghi
- National University of Ireland, Galway, Ireland
| | - F Jordan
- National University of Ireland, Galway, Ireland
| | - D Dunne
- National Institute of Preventive Cardiology, Galway, Ireland
| | - I Gibson
- Croi West of Ireland Cardiac Foundation, Galway, Ireland
| | - JW Mcevoy
- National Institute of Preventive Cardiology, Galway, Ireland
| | - J Jones
- National Institute of Preventive Cardiology, Galway, Ireland
| | - S Sultan
- Galway University Hospital, Galway, Ireland
| | - W Tawfick
- National University of Ireland, Galway, Ireland
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Gibson I, Mccrudden Z, Harris A, Hynes L, Dunne D, Murphy A, Byrne M, Mcevoy JW. Outcomes from a digital cardiovascular prevention and rehabilitation programme delivered in Ireland during COVID 19. Eur J Prev Cardiol 2022. [PMCID: PMC9384024 DOI: 10.1093/eurjpc/zwac056.253] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Government of Ireland's Sláintecare Integration Fund Health Research Board, Ireland Background & Aim COVID 19 has accelerated the uptake and acceptance of digital health tools for the prevention and management of Cardiovascular Disease. With health systems being urged to learn from the pandemic and to reassess how they will deliver services in future, robust audit and evaluation of digital interventions are required to inform best practice. This study aims to evaluate the clinical outcomes of a digital CVD prevention and rehabilitation programme which was established during COVID 19 to provide cardiac patients with efficient and timely access to a home-based, structured, comprehensive programme of care. Methods Developed and delivered by an interdisciplinary team (Nurse Prescriber, Physiotherapist, Dietitian, Cardiologist), the core components of this 12 week programme included, behavioural change support, lifestyle modification, medical risk factor management and electronic prescribing of cardio-protective medication. To support self-management, patients were provided with a Fitbit, blood pressure monitor and a workbook to support goal setting and overall tracking of progress. Patients were given access to a bespoke web-based platform and invited to attend weekly (2hr) group-based sessions, which included an exercise component and an interactive educational workshop. Results Over a 4 month period, 105 patients were referred with an uptake rate of 73% (n=77). Of these, 97% (n=75) enrolled in the programme, with an 85% (n=64) completion rate. Significant improvements in CVD risk factors were observed between initial and end of programme assessment. The proportion of patients meeting guideline-recommended physical activity targets increased from 14 to 82% (p<0.001), mean BMI (kg/m2) reduced from 28.7 to 27.7 (p<0.001), mean Mediterranean diet score improved from 5.2 to 7.3 (p<0.001), and anxiety and depression levels ≥8 (Hospital Anxiety and Depression score) both reduced by more than 50% (p<0.001). The proportions achieving the recommended blood pressure (<130/80 mmHg) and LDL cholesterol targets (<1.4 mmol/L) increased from 24 to 68% (p<0.001) and 14 to 41% (p<0.001), respectively. Conclusion Outcomes from this programme demonstrate that digital CVD prevention and rehabilitation programmes can achieve the recommended lifestyle, medical and therapeutic targets associated with reduced CVD events and improved health outcomes. This programme represents a scalable, accessible and effective option to deliver vital CVD preventive care in the patient’s home.
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Affiliation(s)
- I Gibson
- National University of Ireland, Galway, Ireland
| | - Z Mccrudden
- Croí, West of Ireland Cardiology Foundation, Galway, Ireland
| | - A Harris
- Croí, West of Ireland Cardiology Foundation, Galway, Ireland
| | - L Hynes
- Croí, West of Ireland Cardiology Foundation, Galway, Ireland
| | - D Dunne
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - A Murphy
- National University of Ireland, Galway, Ireland
| | - M Byrne
- National University of Ireland, Galway, Ireland
| | - JW Mcevoy
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
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10
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Wilhelm M, Abreu A, Adami PE, Ambrosetti M, Antonopoulou M, Biffi A, Cavarretta E, D'Ascenzi F, Gibson I, Grobbee DE, Iliou MC, Koskinas K, Marques-Vidal P, Nixdorff U, Papadakis M, Piepoli MF, Vassiliou V, Wood D, Dendale P, Halle M. EAPC Core Curriculum for Preventive Cardiology. Eur J Prev Cardiol 2022; 29:251-274. [PMID: 33791783 DOI: 10.1093/eurjpc/zwab017] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Preventive cardiology encompasses the whole spectrum of cardiovascular disease (CVD) prevention, at individual and population level, through all stages of life. This includes promotion of cardiovascular (CV) health, management of individuals at risk of developing CVD, and management of patients with established CVD, through interdisciplinary care in different settings. Preventive cardiology addresses all aspects of CV health in the context of the social determinants of health, including physical activity, exercise, sports, nutrition, weight management, smoking cessation, psychosocial factors and behavioural change, environmental, genetic and biological risk factors, and CV protective medications. This is the first European Core Curriculum for Preventive Cardiology, which will help to standardize, structure, deliver, and evaluate training in preventive cardiology across Europe. It will be the basis for dedicated fellowship programmes and a European Society of Preventive Cardiology (EAPC) subspecialty certification for cardiologists, with the intention to improve quality and outcome in CVD prevention.
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Affiliation(s)
- Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Ana Abreu
- Servico de Cardioologia, Hospital Universitario de Santa Maria/Centro Hospitalar Universitario Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal
| | - Paolo Emilio Adami
- Health and Science Department, World Athletics, Monaco Principality, 6-8 Quai Antoine 1er, 98007 Monaco, Monaco
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST, Via Medaglie D'Oro, 9, 26013 Crema, Italy
| | - Maria Antonopoulou
- Spili Primary Care Centre, Regional Health System of Crete, 740 53 Spili, Greece
| | - Alessandro Biffi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Via Vittorio Veneto 108, 00187 Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 97, 04100 Latina, Italy
- Mediterranea Cardiocentro, Via Orazio, 2, 80122 Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Irene Gibson
- National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway H91 FF68, Ireland
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, and University Medical Center Utrecht, 3584 CX Utrech, The Netherlands
| | - Marie-Christine Iliou
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Parvis Corentin Celton 4, 92130 Issy-les-Moulineaux, Paris, France
| | - Konstantinos Koskinas
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Uwe Nixdorff
- European Prevention Center c/o Medical Center Düsseldorf, Luise-Rainer-Straße 6-10, 40235 Düsseldorf, Germany
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, London SW17 0RE, UK
| | - Massimo F Piepoli
- Cardiac Unit, Guglielmo da Saliceto Hospital, University of Parma, 29121 Piacenza, Italy
| | - Vass Vassiliou
- Department of Cardiovascular Medicine, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, University Road, Galway H91 TK33, Ireland
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Paul Dendale
- Heart Centre Hasselt and Hasselt University, 3500 Hasselt, Belgium
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital rechts der Isar, Technical University Munich, German Centre for Cardiovascular Research, Georg-Brauchle-Ring 56, 80992 Munich, Germany
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11
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Breen C, O'Connell J, Geoghegan J, O'Shea D, Birney S, Tully L, Gaynor K, O'Kelly M, O'Malley G, O'Donovan C, Lyons O, Flynn M, Allen S, Arthurs N, Browne S, Byrne M, Callaghan S, Collins C, Courtney A, Crotty M, Donohue C, Donovan C, Dunlevy C, Duggan D, Fearon N, Finucane F, Fitzgerald I, Foy S, Garvey J, Gibson I, Glynn L, Gregg E, Griffin A, Harrington JM, Heary C, Heneghan H, Hogan A, Hynes M, Kearney C, Kelly D, Neff K, le Roux CW, Manning S, McAuliffe F, Moore S, Moran N, Murphy M, Murrin C, O'Brien SM, O'Donnell C, O'Dwyer S, O'Grada C, O'Malley E, O'Reilly O, O'Reilly S, Porter O, Roche HM, Rhynehart A, Ryan L, Seery S, Soare C, Shaamile F, Walsh A, Woods C, Woods C, Yoder R. Obesity in Adults: A 2022 Adapted Clinical Practice Guideline for Ireland. Obes Facts 2022; 15:736-752. [PMID: 36279848 PMCID: PMC9801383 DOI: 10.1159/000527131] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/06/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. SUMMARY It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients' lived experiences; move beyond simplistic approaches of "eat less, move more" and address the root drivers of obesity. KEY MESSAGES People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay.
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Affiliation(s)
- Cathy Breen
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
- *Cathy Breen,
| | - Jean O'Connell
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Justin Geoghegan
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Donal O'Shea
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
- National Clinical Programme for Obesity, Dublin, Ireland
| | - Susie Birney
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Irish Coalition for People Living with Obesity, Dublin, Ireland
| | - Louise Tully
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Obesity Research and Care Group, School of Physiotherapy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Karen Gaynor
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- National Clinical Programme for Obesity, Dublin, Ireland
| | - Mark O'Kelly
- Irish College of General Practitioners, Dublin, Ireland
| | - Grace O'Malley
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Obesity Research and Care Group, School of Physiotherapy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Clare O'Donovan
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Food Safety Authority of Ireland, Dublin, Ireland
| | - Oonagh Lyons
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Food Safety Authority of Ireland, Dublin, Ireland
| | - Mary Flynn
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Food Safety Authority of Ireland, Dublin, Ireland
| | | | - Niamh Arthurs
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Obesity Research and Care Group, School of Physiotherapy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Sarah Browne
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Molly Byrne
- School of Psychology, University of Galway, Galway, Ireland
| | - Shauna Callaghan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Chris Collins
- Bariatric Medicine Service, Galway University Hospital, Galway, Ireland
| | - Aoife Courtney
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | | | | | - Caroline Donovan
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Colin Dunlevy
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Diarmuid Duggan
- Metabolic Surgery Service, Bons Secours Hospital, Cork, Ireland
| | - Naomi Fearon
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Francis Finucane
- Bariatric Medicine Service, Galway University Hospital, Galway, Ireland
| | | | - Siobhan Foy
- Bariatric Medicine Service, Galway University Hospital, Galway, Ireland
| | - John Garvey
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Irene Gibson
- Collaborative Doctoral Programme in Chronic Disease Prevention, University of Galway, Galway, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Edward Gregg
- School of Population Health, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Anne Griffin
- School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Caroline Heary
- School of Psychology, University of Galway, Galway, Ireland
| | - Helen Heneghan
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Andrew Hogan
- Obesity Immunology Research Group, Maynooth University, Maynooth, Ireland
| | - Mary Hynes
- Bariatric Medicine Service, Galway University Hospital, Galway, Ireland
| | - Claire Kearney
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Karl Neff
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
- Obesity Research and Care Group, School of Physiotherapy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Sean Manning
- Department of Endocrinology, Cork University Hospital, Cork, Ireland
| | | | - Susan Moore
- Department of Psychiatry, St Vincent's University Hospital, Dublin, Ireland
| | - Niamh Moran
- Irish College of General Practitioners, Dublin, Ireland
| | - Maura Murphy
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Irish Coalition for People Living with Obesity, Dublin, Ireland
| | - Celine Murrin
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Sarah M. O'Brien
- Office of National Clinical Advisor, Integrated Care Programme for Prevention and Management of Chronic Disease, Dublin, Ireland
| | - Caitríona O'Donnell
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | | | - Cara O'Grada
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Emer O'Malley
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | | | - Sharleen O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Olivia Porter
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Helen M. Roche
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Amanda Rhynehart
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Leona Ryan
- School of Psychology, University of Galway, Galway, Ireland
| | - Suzanne Seery
- National Clinical Programme for Obesity, Dublin, Ireland
| | - Corina Soare
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Ferrah Shaamile
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Abigail Walsh
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Catherine Woods
- Department of Physical Education and Sports Science, University of Limerick, Limerick, Ireland
| | - Conor Woods
- Department of Endocrinology, Naas General Hospital, Kildare, and Tallaght University Hospital, Dublin, Ireland
| | - Ruth Yoder
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
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12
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Abstract
AIMS To evaluate the proportions of canine mammary gland lesions submitted to a New Zealand diagnostic laboratory, that were neoplastic vs. non-neoplastic lesions and, among neoplasms, malignant vs. benign, and to determine whether age, reproductive status or breed of dog, or size of the mammary mass were associated with the histological diagnosis. METHODS Canine mammary gland biopsies submitted between the start of 2012 and the end of 2016 were selected from the surgical biopsy database of IDEXX Laboratories, NZ. For each case, details on age, breed, and reproductive status of the patient were registered as reported by the submitting veterinarians, along with the size of the lesion and the histological diagnosis reported by the pathologists. χ2 tests and independent sample t-tests were performed to evaluate associations. RESULTS Samples (n=895) were submitted from 797 dogs, of which 673 had mammary neoplasms while 124 had non-neoplastic lesions. Neoplasms composed of a single nodule were found in 591/673 (87.8%) dogs while 82/673 (12.2%) dogs had multiple nodules. Of the total 771 neoplasms, 432 (56.0%) were histologically malignant, while 339 (44.0%) were benign. Among malignancies, the most common histological sub-types were simple carcinoma (160/771; 20.8%), complex carcinoma (54/771; 7%), and ductal carcinoma (32/771; 4.2%), while benign mixed mammary tumour (128/771, 16.6%) and complex adenoma (105/771; 13.6%) were the most frequently reported benign mammary neoplasms. Age (p=0.09), reproductive status (p=0.79) and size of the mass (p=0.21) were not significantly different between neoplastic and non-neoplastic lesions. However, neoplastic mammary gland lesions were more frequent in purebred dogs (612/671; 91.2%) than crossbred dogs (61/126; 48.4%; p<0.001). Age (p=0.15) reproductive status (p=0.36) or breed (p=0.45) were not significantly different between malignant and benign neoplasms. There was a significant strong association between size and histological benign or malignant status of a neoplasm (φ=0.65, p<0.001). CONCLUSIONS Most canine mammary gland samples submitted for examination were neoplastic with slightly more malignant than benign lesions. Masses submitted from purebred dogs were more likely to be neoplastic while large neoplasms were more likely to be malignant. CLINICAL RELEVANCE The present findings provide a first description of distribution of mammary gland lesions in a relatively large number of dogs in New Zealand, representing a preliminary investigation of canine mammary gland diseases in this country.
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Affiliation(s)
- H Ariyarathna
- Department of Pathobiology, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - D Aberdein
- Department of Pathobiology, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - N Thomson
- Department of Pathobiology, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - I Gibson
- IDEXX Laboratories, Palmerston North, New Zealand
| | - J S Munday
- Department of Pathobiology, School of Veterinary Science, Massey University, Palmerston North, New Zealand
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13
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Elfghi M, Dunne D, Jones J, Gibson I, Flaherty G, McEvoy JW, Sultan S, Jordan F, Tawfick W. Mobile health technologies to improve walking distance in people with intermittent claudication. Hippokratia 2021. [DOI: 10.1002/14651858.cd014717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Marah Elfghi
- College of Medicine; National University of Ireland Galway; Galway Ireland
| | - Denise Dunne
- National Institute for Prevention and Cardiovascular Health; Croí Heart and Stroke Centre; Newcastle, Galway Ireland
- Croí Heart and Stroke Centre; Newcastle, Galway Ireland
| | - Jennifer Jones
- Croí, The West of Ireland Cardiac Foundation; Galway Ireland
| | - Irene Gibson
- Croí, The West of Ireland Cardiac Foundation; Galway Ireland
| | - Gerard Flaherty
- School of Medicine; National University of Ireland; Galway Ireland
| | | | - Sherif Sultan
- Vascular Surgery; Galway University Hospital; Galway Ireland
| | - Fionnuala Jordan
- School of Nursing and Midwifery; National University of Ireland Galway; Galway Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery; Western Vascular Institute, University College Hospital; Galway Ireland
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14
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Gibson I, Carvalho M, Byrne M, Dunne D, Kenny E, Mcsharry J, Noone C, Meade O. What am I doing here? Enablers and barriers to community-based cardiac rehabilitation attendance: a qualitative study utilising a behavioural science approach. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Community Engaged Scholars Programme (CES-P), PPI Ignite, National University of Ireland, Galway
Background
Despite the well-established benefits of cardiovascular prevention and rehabilitation, programme uptake rates remain suboptimal. Delivering cardiac rehabilitation (CR) in the community offers an alternative model of care that may help address the challenges that exist around uptake and accessibility of CR. Yet in comparison to traditional hospital based CR programmes less is known about the enablers and barriers that may be unique to attending community based CR programmes.
Purpose
This study aimed to identify enablers and barriers to attending and completing a community-based CR programme from the patient perspective.
Methods
Individuals who were referred to a 12 week, interdisciplinary, multi-component community-based CR programme were invited to take part in semi-structured interviews. Reasons for attending or not attending the programme and for completing or not completing the full programme were discussed. Purposeful sampling was used to obtain variation in age, gender, and level of engagement with the programme. Interviews were transcribed verbatim and analysed using framework analysis guided by the Capability Opportunity Motivation (COM B) Model and the Theoretical Domains Framework, to explore initial attendance and programme completion.
Results
Data saturation was achieved with sixteen participants. The majority of the identified barriers and enablers were common to both initial programme attendance and completion of programme. Having the social opportunity to receive support from peers, family members and staff was seen as an important enabler. While ease of access to a programme based in the community enabled attendance and completion, for some, distance to the cardiac rehabilitation centre was a barrier. Further barriers related to capability issues regarding poor physical health, time, work commitments and travel. Key motivational enablers included, beliefs around consequences, improved health status, knowledge, goals, intentions and personality. Identity was an important determinant of attendance as participants discussed their understanding of "what am I doing here?" Some participants identified themselves as the type of person who would benefit from the programme and others did not. For example, some felt the programme would suit those who needed motivation to enhance their health and some felt the programme was more or less suited to people of different ages and fitness levels.
Conclusion
The results suggest that interventions to enhance attendance at community-based CR need to address multiple factors related to capability, opportunity and motivation. While there is no one model of cardiovascular prevention and rehabilitation that will meet the needs of all patients, patients should be offered community based programmes as part of a choice of options that fit their needs and personal preferences.
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Affiliation(s)
- I Gibson
- National Institute for Prevention and Cardiovascular Health , Galway, Ireland
| | - M Carvalho
- National University of Ireland, Galway, Ireland
| | - M Byrne
- National University of Ireland, Galway, Ireland
| | - D Dunne
- National Institute for Prevention and Cardiovascular Health , Galway, Ireland
| | - E Kenny
- National University of Ireland, Galway, Ireland
| | - J Mcsharry
- National University of Ireland, Galway, Ireland
| | - C Noone
- National University of Ireland, Galway, Ireland
| | - O Meade
- National Institute for Prevention and Cardiovascular Health , Galway, Ireland
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15
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Harris A, Keegan D, Seery S, Dunne D, Mc Crudden Z, Hynes L, Finucane F, Gibson I. Evaluation of a 10-week lifestyle and weight management programme on cardiovascular disease risk factors in a group of people living with obesity referred from a specialist bariatric clinic. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Service Executive Health and Wellbeing, Saolta University Healthcare Group
OnBehalf
Croí the West of Ireland Cardiac Foundation, Galway, Ireland and the National Institute for Prevention and Cardiovascular Health
Introduction
People living with obesity are at an increased risk of cardiovascular disease (CVD). While development of obesity is multifactorial, lifestyle modification is fundamental to obesity treatment and risk factor reduction. We sought to measure the effects of a structured lifestyle modification programme on the physical and mental health of people living with obesity.
Purpose
This study investigated the impact of a 10-week, community based, lifestyle modification programme on CVD risk factors in people living with obesity (BMI ≥35kg/m2 with a co-morbidity or BMI ≥40kg/m2) who were referred from a specialist bariatric service.
Methods
Delivered by an interdisciplinary team (Nurse, Dietitian & Physiotherapist) the programme included weekly group-based exercise sessions and health promotion workshops. A wide range of topics were addressed in workshops, including nutrition, food labels, emotional eating, physical activity, sedentary behaviour, stress management and CVD risk factor reduction. Outcomes were measured at initial and end of programme assessments.
Results
1122 people participated in the intervention between 2013 and 2019 with 78% (n = 877) completing the programme. At initial assessment 26.7% of participants had a diagnosis of type 2 diabetes; 37.3% were at high or very high risk of CVD; 44.7% were hypertensive and 31.4% had a history of depression. Mean BMI was 47.0kg/m2 with 56.4% of participants having a BMI >45kg/m2. The intervention had significant positive impacts on key outcomes such as psychosocial health, lipid profiles, blood pressure, adiposity and cardiovascular fitness. One of the most significant outcomes observed was the improvement in psycho-social health. Scores of anxiety and depression, assessed using the HADS, decreased by 1.5 and 2.2 points respectively (p <0.001). Mean EQ-VAS score increased by 11 points (p <0.001). There were significant changes in total cholesterol levels with a mean reduction in total cholesterol from 4.69mmol/l to 4.54mmol/l (p <0.001) and LDL cholesterol from 2.79mmol/l to 2.64mmol/l (p <0.001). There were also significant improvements in blood pressure with mean systolic blood pressure reducing by 15.7mmHg (p <0.001) and diastolic blood pressure reducing by 1.4mmHg (p <0.001). For people with type 2 diabetes, there was an increase in those achieving the recommended HbA1c target (<53mmol/l) from 47.6% to 57.4% (p <0.001). Mean reduction in bodyweight was 2.0kg (p <0.001), with 27.2% achieving a weight loss of >3% of initial bodyweight. The percentage of participants achieving the recommended physical activity guidelines increased by 31% (p <0.001).
Conclusions
A lifestyle modification programme delivered by an interdisciplinary team, aimed at individuals living with obesity, is not only acceptable to participants but also significantly reduces CVD risk factors. These findings should influence the design of future programmes and healthcare policies in Ireland and abroad.
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Affiliation(s)
- A Harris
- Croi West of Ireland Cardiac Foundation, Galway, Ireland
| | - D Keegan
- Croi West of Ireland Cardiac Foundation, Galway, Ireland
| | - S Seery
- Croi West of Ireland Cardiac Foundation, Galway, Ireland
| | - D Dunne
- Croi West of Ireland Cardiac Foundation, Galway, Ireland
| | - Z Mc Crudden
- Croi West of Ireland Cardiac Foundation, Galway, Ireland
| | - L Hynes
- Croi West of Ireland Cardiac Foundation, Galway, Ireland
| | - F Finucane
- Galway University Hospital, Galway, Ireland
| | - I Gibson
- Croi West of Ireland Cardiac Foundation, Galway, Ireland
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16
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Curneen JM, Judge C, Traynor B, Buckley A, Saiva L, Murphy L, Murray D, Fleming S, Kearney P, Murphy RT, Aleong G, Kiernan TJ, O'Neill J, Moore D, Nicaodhabhui B, Birrane J, Hall P, Crowley J, Gibson I, Jennings CS, Wood D, Kotseva K, McEvoy JW. Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study). Open Heart 2021; 8:openhrt-2021-001659. [PMID: 34172561 PMCID: PMC8237732 DOI: 10.1136/openhrt-2021-001659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/31/2021] [Indexed: 01/29/2023] Open
Abstract
Background Studying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes. Methods We studied outpatients who had an index CHD event in the preceding 6–24 months. Eligible CHD events included acute coronary syndrome (ACS) and coronary revascularisation for stable chronic coronary syndrome (CCS). Site training was provided by a core team and data were collected using standardised methods. Results Between 2017 and 2019, we enrolled 721 outpatients at nine Irish study sites; 81% were men and mean age was 63.9 (SD ±8.9) years. The study examination occurred a median of 1.16 years after the index CHD event, which was ACS in 399 participants (55%) and stable-CCS in 322. On examination, 42.5% had blood pressure (BP) >140/90 mm Hg, 63.7% had low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L and 44.1% of known diabetics had an HbA1c >7%. There was marked variability in risk factor control, both by study site and, in particular, by index presentation type. For example, 82% of outpatients with prior-ACS had attended cardiac rehabilitation versus 59% outpatients with prior-CCS (p<0.001) and there were also large differences in control of traditional risk factors like LDL-C (p=0.002) and systolic BP (p<0.001) among outpatients with prior-ACS versus prior-CCS as the index presentation. Conclusions Despite international secondary prevention guidelines broadly recommending the same risk factor targets for all adults with CHD, we found marked differences in outpatient risk factor control and management on the basis of hospital location and index CHD presentation type (acute vs chronic). These findings highlight the need to reduce hospital-level and patient-level variability in preventive care to improve outcomes; a lesson that should inform CHD prevention programmes in Ireland and around the world.
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Affiliation(s)
- James Mg Curneen
- Clinical Pharmacology and Therapeutics, Galway University Hospital, Galway, Ireland
| | - Conor Judge
- Medicine, Galway University Hospital, Galway, Ireland.,HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Bryan Traynor
- Cardiology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Anthony Buckley
- Cardiology, University of Limerick Hospitals Group, Limerick, Ireland
| | - Lavanya Saiva
- Cardiology, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
| | - Laura Murphy
- Cardiology, Tallaght University Hospital, Dublin, Ireland
| | - Donal Murray
- Cardiology, Sligo University Hospital, Sligo, Ireland
| | - Sean Fleming
- Cardiology, Midland Regional Hospital Portlaoise, Portlaoise, Ireland
| | | | | | - Godfrey Aleong
- Cardiology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Thomas J Kiernan
- Cardiology, University of Limerick Hospitals Group, Limerick, Ireland
| | - James O'Neill
- Cardiology, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
| | - David Moore
- Cardiology, Tallaght University Hospital, Dublin, Ireland
| | - Bridog Nicaodhabhui
- Medicine, Galway University Hospital, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - John Birrane
- Medicine, Galway University Hospital, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Patricia Hall
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - James Crowley
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Irene Gibson
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Catriona S Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - John William McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
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Elfghi M, Jordan F, Dunne D, Gibson I, Jones J, Flaherty G, Sultan S, Tawfick W. The effect of lifestyle and risk factor modification on occlusive peripheral arterial disease outcomes: standard healthcare vs structured programme-for a randomised controlled trial protocol. Trials 2021; 22:138. [PMID: 33581715 PMCID: PMC7881542 DOI: 10.1186/s13063-021-05087-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events. Patients with PAD, even in the absence of a history of myocardial infarction or ischemic stroke, have approximately the same relative risk of death from cardiovascular causes as patients with a history of coronary or cerebrovascular disease. Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease. Atherosclerotic risk factor identification and modification play an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. In this study, we aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors. Methods This is a randomised, parallel group, active-control trial to compare the effectiveness of the risk factor modification intervention programme to standard healthcare in a tertiary vascular care centre, in the reduction of modified risk factors in PAD patients. The primary outcome of this study is to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors at 3 and 12 months. The secondary outcomes are to compare the impact of the programme on clinical outcomes in PAD patients at 12 months. Secondary outcomes include amputation-free survival, clinical improvement, haemodynamic improvement, need for revascularisation procedures, outcomes of revascularisation procedures, changes in quality of life and the incidence of adverse events. Discussion This study will provide clear evidence on the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors, through a high-quality, well-powered clinical trial. Trial registration This trial was registered (11/07/2017) on the European Clinical Trials Database (EudraCT number 2017-002964-41) and ClinicalTrials.gov (NCT03935776) which was registered on 02 May 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05087-x.
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Affiliation(s)
- M Elfghi
- School of Medicine, National University of Ireland, University Road, Galway, Ireland.
| | - F Jordan
- School of Nursing and Midwifery, National University of Ireland, University Road, Galway, Ireland
| | - D Dunne
- National Institute for Prevention and Cardiovascular Health, Croi Heart and Stroke Centre, Mayola Lane, Newcastle, Galway, Ireland
| | - I Gibson
- School of Medicine, National University of Ireland, University Road, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, Croi Heart and Stroke Centre, Mayola Lane, Newcastle, Galway, Ireland
| | - J Jones
- National Institute for Prevention and Cardiovascular Health, Croi Heart and Stroke Centre, Mayola Lane, Newcastle, Galway, Ireland.,Brunel University, Kingston Ln, Uxbridge, London, UB8 3PH, UK
| | - G Flaherty
- School of Medicine, National University of Ireland, University Road, Galway, Ireland
| | - S Sultan
- Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Newcastle Road, Galway, Ireland
| | - W Tawfick
- School of Medicine, National University of Ireland, University Road, Galway, Ireland.,Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Newcastle Road, Galway, Ireland
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Bensaaud A, Seery S, Gibson I, Jones J, Flaherty G, Mcevoy J, Jordan F, Tawfick W, Sultan S. Dietary approaches to stop hypertension (DASH) for the primary and secondary prevention of cardiovascular diseases: A protocol for a cochrane systematic review and meta-analysis. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.743] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Finn Y, Gorecka M, Flaherty G, Dunne F, O'Brien T, Crowley J, Wood D, Connolly S, Jones J, Gibson I. Evaluation of a Community-Based Cardiovascular Prevention Program in Patients With Type 2 Diabetes. Am J Health Promot 2020; 35:68-76. [PMID: 32545994 DOI: 10.1177/0890117120931711] [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] [Indexed: 02/05/2023]
Abstract
PURPOSE An outcomes' evaluation of a community-based cardiovascular disease (CVD) prevention program in persons with newly diagnosed type 2 diabetes. DESIGN A prospective, observational study. SETTING A community-setting in Ireland. PARTICIPANTS Persons with newly diagnosed type 2 diabetes, aged 40 years or older, and 2 or more cardiovascular risk factors. INTERVENTION A 16-week community-based, cardiovascular prevention program, with health promotion seminars, group exercise, and individual consultations, delivered by a multidisciplinary team. MEASURES Medical, lifestyle, and well-being measures. ANALYSIS Changes in categorical and continuous variables were analyzed using the paired exact test and the t test/Wilcoxin matched-pairs test, respectively. RESULTS In total, 218 persons (134 men) participated, mean age was 59.8 (10.2) years. Completion rate was 75.2% (n = 164). The proportion achieving target glycosylated hemoglobin (HbA1c) increased from 53% at baseline to 75% (P < .001) at end of program. Systolic and diastolic blood pressures reduced by 8.8 mm Hg (95% CI: -11.2 to -6.4, P < .001) and 5.2 mm Hg (95% CI: -6.9 to -3.5, P < .001), respectively. Mean low-density lipoprotein cholesterol reduced from 2.45 to 2.05 mmol/L (P < .001). Significantly higher proportions met recommended targets in diet (6.9% vs 43.4%, P < .001) and physical activity (9.2% vs 56.6%, P < .001). Psychosocial measures significantly improved at end of program. The majority of improvements were sustained at 1 year. CONCLUSION Participation in this CVD prevention program was associated with significant improvements in glycemia and CVD risk factors in newly diagnosed patients with type 2 diabetes.
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Affiliation(s)
- Yvonne Finn
- School of Medicine, 8799National University of Ireland Galway, Galway, Ireland.,Centre for Diabetes, Endocrinology and Metabolism, 360706University Hospital Galway, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, Croí House, Galway, Ireland
| | - Miroslawa Gorecka
- Department of Cardiology, 360706University Hospital Galway, Galway, Ireland
| | - Gerard Flaherty
- School of Medicine, 8799National University of Ireland Galway, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, Croí House, Galway, Ireland
| | - Fidelma Dunne
- School of Medicine, 8799National University of Ireland Galway, Galway, Ireland.,Centre for Diabetes, Endocrinology and Metabolism, 360706University Hospital Galway, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, Croí House, Galway, Ireland
| | - Timothy O'Brien
- School of Medicine, 8799National University of Ireland Galway, Galway, Ireland.,Centre for Diabetes, Endocrinology and Metabolism, 360706University Hospital Galway, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, Croí House, Galway, Ireland
| | - James Crowley
- School of Medicine, 8799National University of Ireland Galway, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, Croí House, Galway, Ireland.,Department of Cardiology, 360706University Hospital Galway, Galway, Ireland
| | - David Wood
- School of Medicine, 8799National University of Ireland Galway, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, Croí House, Galway, Ireland
| | - Susan Connolly
- National Institute for Prevention and Cardiovascular Health, Croí House, Galway, Ireland
| | - Jennifer Jones
- National Institute for Prevention and Cardiovascular Health, Croí House, Galway, Ireland.,3890Brunel University, London, United Kingdom
| | - Irene Gibson
- School of Medicine, 8799National University of Ireland Galway, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, Croí House, Galway, Ireland
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Bensaaud A, Gibson I, Jones J, Flaherty G, Sultan S, Tawfick W, Jordan F. A telephone reminder to enhance adherence to interventions in cardiovascular randomized trials: A protocol for a study within a trial (SWAT). J Evid Based Med 2020; 13:81-84. [PMID: 32061121 DOI: 10.1111/jebm.12375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/02/2020] [Indexed: 11/26/2022]
Abstract
The impact of reduced adherence in randomized clinical trials is well documented in the literature. Nonadherence can negatively affect the trial sample size and estimation of the treatment effect. This protocol aims to evaluate the effects of a telephone call reminder on the adherence rates of participants to interventions in a cardiovascular randomized trial. This is a study within a trial (SWAT). The host trial is evaluating the effectiveness of a multidisciplinary 16-wk cardiovascular disease prevention program on risk factor profile among patients with carotid artery stenosis. Simultaneously, this SWAT will evaluate the effectiveness of telephone call reminders on the participants' adherence to the host trial intervention. The primary outcome is adherence to the protocol of the host trial. Secondary outcomes are level of adherence, number of dropouts, and time to drop out from the host trial.
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Affiliation(s)
- Abdelsalam Bensaaud
- Department of Vascular and Endovascular Surgery, University Hospital College Galway, Galway, Ireland
| | - Irene Gibson
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Jennifer Jones
- Brunel University Division of Physiotherapy Uxbridge, London, UK
| | - Gerard Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Sherif Sultan
- Department of Vascular and Endovascular Surgery, University Hospital College Galway, Galway, Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery, University Hospital College Galway, Galway, Ireland
| | - Fionnuala Jordan
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Hollander M, Deaton C, Gibson I, Kurpas D, Rutten F, Hanssen H, Antonopoulou M, Dendale P, Grobbee DE. The new Primary Care and Risk Factor Management (PCRFM) nucleus of the European Association of Preventive Cardiology: A call for action. Eur J Prev Cardiol 2019; 27:1328-1330. [PMID: 31841052 PMCID: PMC7391478 DOI: 10.1177/2047487319894107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Monika Hollander
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University of Utrecht, The Netherlands
| | - Christi Deaton
- University of Cambridge School of Clinical Medicine, Department of Public Health and Primary Care, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, UK
| | - Irene Gibson
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Donata Kurpas
- Department of Family Medicine, Wrocław Medical University, Poland.,Opole Medical School, Poland
| | - Frans Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University of Utrecht, The Netherlands
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Switzerland
| | | | - Paul Dendale
- Jessa Hospital, Heart Centre Hasselt, Belgium.,BIOMED - Biomedical Research Centre, Hasselt University, Belgium
| | - Diederick E Grobbee
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University of Utrecht, The Netherlands
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De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Ž, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Z, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, Kotseva K, De Backer G, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Bacquer DD, De Smedt D, De Sutter J, Deckers J, Dilic M, Dolzhenko M, Druais H, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Grobbee D, Gyberg V, Hasan Ali H, Heuschmann P, Hoes A, Jankowski P, Lalic N, Lehto S, Lovic D, Maggioni A, Mancas S, Marques-Vidal P, Mellbin L, Miličić D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Ž, Rydén L, Stagmo M, Störk S, Sundvall J, Tokgözoğlu L, Tsioufis K, Vulic D, Wood D, Wood D, Kotseva K, Jennings C, Adamska A, Adamska S, Rydén L, Mellbin L, Tuomilehto J, Schnell O, Druais H, Fiorucci E, Glemot M, Larras F, Missiamenou V, Maggioni A, Taylor C, Ferreira T, Lemaitre K, Bacquer DD, De Backer G, Raman L, Sundvall J, DeSmedt D, De Sutter J, Willems A, De Pauw M, Vervaet P, Bollen J, Dekimpe E, Mommen N, Van Genechten G, Dendale P, Bouvier C, Chenu P, Huyberechts D, Persu A, Dilic M, Begic A, Durak Nalbantic A, Dzubur A, Hadzibegic N, Iglica A, Kapidjic S, Osmanagic Bico A, Resic N, Sabanovic Bajramovic N, Zvizdic F, Vulic D, Kovacevic-Preradovic T, Popovic-Pejicic S, Djekic D, Gnjatic T, Knezevic T, Kovacevic-Preradovic T, Kos L, Popovic-Pejicic S, Stanetic B, Topic G, Gotcheva N, Georgiev B, Terziev A, Vladimirov G, Angelov A, Kanazirev B, Nikolaeva S, Tonkova D, Vetkova M, Milicic D, Reiner Ž, Bosnic A, Dubravcic M, Glavina M, Mance M, Pavasovic S, Samardzic J, Batinic T, Crljenko K, Delic-Brkljacic D, Dula K, Golubic K, Klobucar I, Kordic K, Kos N, Nedic M, Olujic D, Sedinic V, Blazevic T, Pasalic A, Percic M, Sikic J, Bruthans J, Cífková R, Hašplová K, Šulc P, Wohlfahrt P, Mayer O, Cvíčela M, Filipovský J, Gelžinský J, Hronová M, Hasan-Ali H, Bakery S, Mosad E, Hamed H, Ibrahim A, Elsharef M, Kholef E, Shehata A, Youssef M, Elhefny E, Farid H, Moustafa T, Sobieh M, Kabil H, Abdelmordy A, Lehto S, Kiljander E, Kiljander P, Koukkunen H, Mustonen J, Cremer C, Frantz S, Haupt A, Hofmann U, Ludwig K, Melnyk H, Noutsias M, Karmann W, Prondzinsky R, Herdeg C, Hövelborn T, Daaboul A, Geisler T, Keller T, Sauerbrunn D, Walz-Ayed M, Ertl G, Leyh R, Störk S, Heuschmann P, Ehlert T, Klocke B, Krapp J, Ludwig T, Käs J, Starke C, Ungethüm K, Wagner M, Wiedmann S, Tsioufis K, Tolis P, Vogiatzi G, Sanidas E, Tsakalis K, Kanakakis J, Koutsoukis A, Vasileiadis K, Zarifis J, Karvounis C, Crowley J, Gibson I, Houlihan A, Kelly C, O'Donnell M, Bennati M, Cosmi F, Mariottoni B, Morganti M, Cherubini A, Di Lenarda A, Radini D, Ramani F, Francese M, Gulizia M, Pericone D, Davletov K, Aigerim K, Zholdin B, Amirov B, Assembekov B, Chernokurova E, Ibragimova F, Kodasbayev A, Markova A, Mirrakhimov E, Asanbaev A, Toktomamatov U, Tursunbaev M, Zakirov U, Abilova S, Arapova R, Bektasheva E, Esenbekova J, Neronova K, Asanbaev A, Baigaziev K, Toktomamatov U, Zakirov U, Baitova G, Zheenbekov T, Erglis A, Andrejeva T, Bajare I, Kucika G, Labuce A, Putane L, Stabulniece M, Dzerve V, Klavins E, Sime I, Badariene J, Gedvilaite L, Pečiuraite D, Sileikienė V, Skiauteryte E, Solovjova S, Sidabraite R, Briedis K, Ceponiene I, Jurenas M, Kersulis J, Martinkute G, Vaitiekiene A, Vasiljevaite K, Veisaite R, Plisienė J, Šiurkaitė V, Vaičiulis Ž, Jankowski P, Czarnecka D, Kozieł P, Podolec P, Nessler J, Gomuła P, Mirek-Bryniarska E, Bogacki P, Wiśniewski A, Pająk A, Wolfshaut-Wolak R, Bućko J, Kamiński K, Łapińska M, Paniczko M, Raczkowski A, Sawicka E, Stachurska Z, Szpakowicz M, Musiał W, Dobrzycki S, Bychowski J, Kosior D, Krzykwa A, Setny M, Kosior D, Rak A, Gąsior Z, Haberka M, Gąsior Z, Haberka M, Szostak-Janiak K, Finik M, Liszka J, Botelho A, Cachulo M, Sousa J, Pais A, Aguiar C, Durazzo A, Matos D, Gouveia R, Rodrigues G, Strong C, Guerreiro R, Aguiar J, Abreu A, Cruz M, Daniel P, Morais L, Moreira R, Rosa S, Rodrigues I, Selas M, Gaita D, Mancas S, Apostu A, Cosor O, Gaita L, Giurgiu L, Hudrea C, Maximov D, Moldovan B, Mosteoru S, Pleava R, Ionescu M, Parepa I, Pogosova N, Arutyunov A, Ausheva A, Isakova S, Karpova A, Salbieva A, Sokolova O, Vasilevsky A, Pozdnyakov Y, Antropova O, Borisova L, Osipova I, Lovic D, Aleksic M, Crnokrak B, Djokic J, Hinic S, Vukasin T, Zdravkovic M, Lalic N, Jotic A, Lalic K, Lukic L, Milicic T, Macesic M, Stanarcic Gajovic J, Stoiljkovic M, Djordjevic D, Kostic S, Tasic I, Vukovic A, Fras Z, Jug B, Juhant A, Krt A, Kugonjič U, Chipayo Gonzales D, Gómez Barrado J, Kounka Z, Marcos Gómez G, Mogollón Jiménez M, Ortiz Cortés C, Perez Espejo P, Porras Ramos Y, Colman R, Delgado J, Otero E, Pérez A, Fernández-Olmo M, Torres-LLergo J, Vasco C, Barreñada E, Botas J, Campuzano R, González Y, Rodrigo M, de Pablo C, Velasco E, Hernández S, Lozano C, González P, Castro A, Dalmau R, Hernández D, Irazusta F, Vélez A, Vindel C, Gómez-Doblas J, García Ruíz V, Gómez L, Gómez García M, Jiménez-Navarro M, Molina Ramos A, Marzal D, Martínez G, Lavado R, Vidal A, Rydén L, Boström-Nilsson V, Kjellström B, Shahim B, Smetana S, Hansen O, Stensgaard-Nake E, Deckers J, Klijn A, Mangus T, Peters R, Scholte op Reimer W, Snaterse M, Aydoğdu S, Ç Erol, Otürk S, Tulunay Kaya C, Ahmetoğlu Y, Ergene O, Akdeniz B, Çırgamış D, Akkoyun H Kültürsay S, Kayıkçıoğlu M, Çatakoğlu A, Çengel A, Koçak A, Ağırbaşlı M, Açıksarı G, Çekin M, Tokgözoğlu L, Kaya E, Koçyiğit D, Öngen Z, Özmen E, Sansoy V, Kaya A, Oktay V, Temizhan A, Ünal S, İ Yakut, Kalkan A, Bozkurt E, Kasapkara H, Dolzhenko M, Faradzh C, Hrubyak L, Konoplianyk L, Kozhuharyova N, Lobach L, Nesukai V, Nudchenko O, Simagina T, Yakovenko L, Azarenko V, Potabashny V, Bazylevych A, Bazylevych M, Kaminska K, Panchenko L, Shershnyova O, Ovrakh T, Serik S, Kolesnik T, Kosova H, Wood D, Adamska A, Adamska S, Jennings C, Kotseva K, Hoye P Atkin A, Fellowes D, Lindsay S, Atkinson C, Kranilla C, Vinod M, Beerachee Y, Bennett C, Broome M, Bwalya A, Caygill L, Dinning L, Gillespie A, Goodfellow R, Guy J, Idress T, Mills C, Morgan C, Oustance N, Singh N, Yare M, Jagoda J, Bowyer H, Christenssen V, Groves A, Jan A, Riaz A, Gill M, Sewell T, Gorog D, Baker M, De Sousa P, Mazenenga T, Porter J, Haines F, Peachey T, Taaffe J, Wells K, Ripley D, Forward H, McKie H, Pick S, Thomas H, Batin P, Exley D, Rank T, Wright J, Kardos A, Sutherland SB, Wren L, Leeson P, Barker D, Moreby B, Sawyer J, Stirrup J, Brunton M, Brodison A, Craig J, Peters S, Kaprielian R, Bucaj A, Mahay K, Oblak M, Gale C, Pye M, McGill Y, Redfearn H, Fearnley M. Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis 2019; 285:135-146. [DOI: 10.1016/j.atherosclerosis.2019.03.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
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Heery S, Gibson I, Dunne D, Flaherty G. The role of public health nurses in risk factor modification within a high-risk cardiovascular disease population in Ireland – a qualitative analysis. Eur J Cardiovasc Nurs 2019; 18:584-592. [DOI: 10.1177/1474515119850072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background/aims: Health promotion for cardiovascular disease risk factors management is essential to secondary prevention of cardiovascular disease events. In Ireland, post-cardiac rehabilitation patients are discharged into the care of community public health nurses, who have a health promotion role. Little is known of the public health nurses’ perceptions or knowledge surrounding their role in cardiovascular disease risk factor management. Underpinned by a constructivist viewpoint, this study aims to generate empirical evidence on the phenomenon directly from public health nurses’ encounters within the context of the current health service. Methods: This qualitative cross-sectional analysis involved face-to-face, semi-structured interviews with a purposeful sample of 17 public health nurses. Interviews were audio-recorded, transcribed, subjected to thematic content analysis and subsequently reported incorporating verbatim quotes. Results: A significant gap exists between evidence-based guidelines for cardiovascular disease prevention and current practices. Variations in public health nurses’ training, experience and knowledge result in inconsistent practices, and public health nurses feel this is specialised area for which they are not equipped. The changing public health nurse role and increasing workloads result in prioritisation of other nursing duties over health promotion. Ineffective systems for care delivery and a lack of community-based rehabilitation programmes also negatively impact on secondary prevention practices. Conclusions: Findings support the need to develop a community cardiovascular disease specialist role to effectively support ongoing cardiovascular disease risk factor management. Evaluation of the mechanisms of current service delivery is required to ensure a quality-assured equitable service, in line with community needs and current evidence-based guidelines for practice. A quantitative triangulation study is recommended.
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Affiliation(s)
- Sheila Heery
- School of Medicine, National University of Ireland Galway, Ireland
- National Institute for Preventive Cardiology, Ireland
- Department of Public Health Nursing, Kerry Community Services, Ireland
- Croi West of Ireland Cardiac Foundation, Ireland
| | - Irene Gibson
- School of Medicine, National University of Ireland Galway, Ireland
- National Institute for Preventive Cardiology, Ireland
- Croi West of Ireland Cardiac Foundation, Ireland
| | - Denise Dunne
- School of Medicine, National University of Ireland Galway, Ireland
- National Institute for Preventive Cardiology, Ireland
- Croi West of Ireland Cardiac Foundation, Ireland
| | - Gerard Flaherty
- School of Medicine, National University of Ireland Galway, Ireland
- National Institute for Preventive Cardiology, Ireland
- Croi West of Ireland Cardiac Foundation, Ireland
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McGrath ER, Espie CA, Power A, Murphy AW, Newell J, Kelly C, Duffy N, Gunning P, Gibson I, Bostock S, O'Donnell MJ. Sleep to Lower Elevated Blood Pressure: A Randomized Controlled Trial (SLEPT). Am J Hypertens 2017; 30:319-327. [PMID: 28391289 DOI: 10.1093/ajh/hpw132] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/05/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Impaired sleep quality is common and associated with an increased risk of cardiovascular disease (CVD), thought to be mediated through adverse effects on established vascular risk factors, particularly hypertension. We determined if a web-delivered sleep intervention (sleep-hygiene education, stimulus control, and cognitive behavioral therapy) reduces blood pressure compared to vascular risk factor education (standard care) alone. METHODS Phase II randomized, blinded, controlled trial of 134 participants without CVD with mild sleep impairment and blood pressure 130-160/<110 mm Hg. The primary outcome was the difference in the mean change in 24-hour ambulatory systolic blood pressure (SBP) over 8 weeks between intervention and control groups. Secondary outcomes included measures of sleep quality and psychosocial health, namely Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS Participants in the sleep intervention group showed significantly greater improvements in sleep quality, including ISI [difference in mean improvement 2.8; 95% confidence interval (CI), 1.3-4.4], PSQI (1.1; 95% CI, 0.1-2.2), sleep condition indicator (0.8; 95% CI, 0.2-1.4), and psychosocial health, including BDI (2.0; 95% CI, 0.3-3.7) and BAI (1.4; 95% CI, 0.02-2.8). The mean improvement in 24-hour ambulatory SBP did not differ between the sleep intervention (0.9 mm Hg) and control (0.8 mm Hg) arms, (difference in mean improvement 0.1; 95% CI, -3.4 to 3.2). CONCLUSION A simple, low-cost, web-delivered sleep intervention is feasible and significantly improves sleep quality and measures of psychosocial health in individuals with mild sleep impairment but does not result in short-term improvements in blood pressure.
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Affiliation(s)
- Emer R McGrath
- HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- 3 Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Colin A Espie
- Sleep & Circadian Neuroscience Institute, University of Oxford, Oxford, UK
- Big Health Ltd, London, UK
| | - Alice Power
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Andrew W Murphy
- HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
| | - John Newell
- 8Croí, West of Ireland Cardiac Foundation, Galway, Ireland
| | - Caroline Kelly
- HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
| | - Niamh Duffy
- HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
| | - Patricia Gunning
- HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
| | - Irene Gibson
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Sophie Bostock
- Big Health Ltd, London, UK
- Department of Public Health and Epidemiology, University of Southampton, Southampton, UK
| | - Martin J O'Donnell
- HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
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Affiliation(s)
- Irene Gibson
- The West of Ireland Cardiology Foundation, University College Hospital, Galway, Ireland
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McGrath E, Espie C, Power A, Murphy A, Newell J, Kelly C, Duffy N, Gunning P, Gibson I, O’Donnell M. [OP.4C.06] SLEEP TO LOWER ELEVATED BLOOD PRESSURE. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000491462.58358.ca] [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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Kerins C, Cunningham K, Finucane FM, Gibson I, Jones J, Kelly C. Effects of an icon-based menu labelling initiative on consumer food choice. Perspect Public Health 2016; 137:45-52. [DOI: 10.1177/1757913916640826] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: The purpose of this study was to examine the impact of an icon-based menu labelling initiative on consumer buying behaviour. Methods: This quasi-experimental study recruited a convenience sample of eight food service establishments, all with at least one menu item meeting the heart healthy criteria. Data from sales of all menu items sold over an 8-week period were collated 4 weeks prior to and 4 weeks during the display of information icons related to healthy food choices on menus. Results: The absolute change in menu item sales showed a non-significant trend towards an increase in healthier menu item selections. Furthermore, there was no association between the type of food service establishment and the percentage change in labelled menu item sales. Conclusion: The study did not find a statistically significant influence of the icon-based menu labels on consumer food choice. Given the limited amount of research that examines alternative menu labelling formats in real-world settings, more studies are necessary to confirm these results. Further research is needed to identify the optimal format, content and impact of menu labels on consumer behaviour.
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Affiliation(s)
- Claire Kerins
- National Institute for Preventive Cardiology, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Katie Cunningham
- National Institute for Preventive Cardiology, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Francis M Finucane
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway, Ireland
| | - Irene Gibson
- National Institute for Preventive Cardiology, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Jenni Jones
- National Institute for Preventive Cardiology, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland; Health Promotion Research Centre, National University of Ireland, Galway, Ireland
| | - Colette Kelly
- Health Promotion Research Centre, National University of Ireland, Galway, Ireland
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Afshinnia K, Gibson I, Merrifield R, Baalousha M. The concentration-dependent aggregation of Ag NPs induced by cystine. Sci Total Environ 2016; 557-558:395-403. [PMID: 27016687 DOI: 10.1016/j.scitotenv.2016.02.212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 12/23/2015] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 06/05/2023]
Abstract
Cystine is widely used in cell culture media. Cysteine, the reduced form of cystine, is widely used to scavenge dissolved Ag in eco-toxicological studies to differentiate dissolved vs. nanoparticle uptake and toxicity. However, little is known about the impact of cysteine and cystine on the aggregation behavior of Ag NPs, in particular as a function of Ag NP concentration. Herein, we investigate how cystine (0-300μM) affects the stability of citrate-, polyvinylpyrrolidone-, and polyethylene glycol-coated silver nanoparticles (cit-Ag NPs, PVP-Ag NPs and PEG-Ag NPs, respectively) with and without Suwannee River fulvic acid (SRFA) as a function of Ag NPs concentration using UV-vis spectroscopy at environmentally and ecotoxicologically relevant Ag NP concentrations (ca. 125-1000μgL(-1)). The results demonstrate, for the first time, the concentration-dependent aggregation of cit-Ag NPs in the presence of cystine with a shift in the critical coagulation concentration (CCC) to lower cystine concentrations at lower cit-Ag NP concentrations. At the highest cit-Ag NP concentration (1000μgL(-1)), reaction limited aggregation was only observed and no CCC was measured. SRFA slowed the aggregation of cit-Ag NPs by cystine and aggregation occurred in reaction limited aggregation (RLA) regime only. No CCC value was measured in the presence of SRFA. Cystine replaces citrate, PVP and PEG coatings, resulting in aggregation of both electrostatically and sterically stabilized Ag NPs. These findings are important in understanding the factors determining the behavior of Ag NPs in cell culture media. Also due to the similarity between cystine and cysteine, these results are important in understanding the uptake and toxicity of Ag NPs vs. Ag ions, and suggest that the reduction of the toxicity of Ag NPs in the presence of cysteine could be due to a combined effect of scavenging Ag(+) ions and Ag NP aggregation in the presence of cysteine.
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Affiliation(s)
- K Afshinnia
- Center for Environmental Nanoscience and Risk, Department of Environmental Health Sciences, Arnold School of Public Health, University South Carolina, Columbia, SC 29208, United States
| | - I Gibson
- Center for Environmental Nanoscience and Risk, Department of Environmental Health Sciences, Arnold School of Public Health, University South Carolina, Columbia, SC 29208, United States
| | - R Merrifield
- Center for Environmental Nanoscience and Risk, Department of Environmental Health Sciences, Arnold School of Public Health, University South Carolina, Columbia, SC 29208, United States
| | - M Baalousha
- Center for Environmental Nanoscience and Risk, Department of Environmental Health Sciences, Arnold School of Public Health, University South Carolina, Columbia, SC 29208, United States.
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Jones J, Flaherty G, Gibson I, Walsh A, Kerins C, Costello C, Connolly S, Wood D. PT037 Health Economic Evaluation of a Preventive Cardiology Programme in Ireland. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.453] [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: 10/21/2022] Open
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Canavan M, Smyth A, Robinson SM, Gibson I, Costello C, O'Keeffe ST, Walsh T, Mulkerrin EC, O'Donnell MJ. Attitudes to outcomes measured in clinical trials of cardiovascular prevention. QJM 2016; 109:391-7. [PMID: 26231089 DOI: 10.1093/qjmed/hcv132] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Selecting outcome measures in cardiovascular prevention trials should be informed by their importance to selected populations. Major vascular event outcomes are usually prioritized in these trials with considerably less attention paid to cognitive and functional outcomes. AIM To examine views on importance of outcome measures used in clinical trials. DESIGN Cross-sectional survey. METHODS Of 367 individuals approached, 280 (76%) participated: outpatients attending cardiovascular prevention clinics (n = 97), active retirement groups members (n = 75), medical students (n = 108). Participants were asked to rank, in order of importance, outcome measures, which may be included in cardiovascular prevention trials. Results were compared between two groups: <65s (n = 157) and ≥65s (n = 104). RESULTS When asked what outcomes were most important to measure in cardiovascular prevention trials, respondents reported: death (31.6%) stroke (28.5%), dementia (26.9%), myocardial infarction (MI) (7.9%) and requiring nursing home (NH) care (5.1%). When asked the most relevant outcomes regarding successful ageing respondents reported; maintaining independence (32.4%), avoiding major illness (24.3%), good family life (23.6%), living as long as possible (15.8%), avoiding NH care (3.1%) and contributing to society (0.8%) as most important. When asked what outcome concerned them most about the future, respondents reported: dementia (32.6%), dependence (30.4%), death (12.8%), stroke (12.5%), cancer (6.2%) requiring NH care (4.8%) and MI (0.7%). Maintaining independence was considered most important in younger and older cohorts. CONCLUSION Cognitive and functional outcomes are important patient-relevant outcomes, sometimes more important than major vascular events. Incorporating these outcomes into trials may encourage patient participation and adherence to preventative regimens.
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Affiliation(s)
- M Canavan
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland, HRB Clinical Research Facility, National University of Ireland, Galway, Ireland and
| | - A Smyth
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland and
| | - S M Robinson
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
| | - I Gibson
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
| | - C Costello
- Croí-The West of Ireland Cardiac Foundation, Moyola Lane, Newcastle, Galway, Ireland
| | - S T O'Keeffe
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
| | - T Walsh
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
| | - E C Mulkerrin
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
| | - M J O'Donnell
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland, HRB Clinical Research Facility, National University of Ireland, Galway, Ireland and
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McFadden AMJ, Hanlon D, McKenzie RK, Gibson I, Bueno IM, Pulford DJ, Orr D, Dunowska M, Stanislawek WL, Spence RP, McDonald WL, Munro G, Mayhew IG. The first reported outbreak of equine herpesvirus myeloencephalopathy in New Zealand. N Z Vet J 2015; 64:125-34. [DOI: 10.1080/00480169.2015.1096853] [Citation(s) in RCA: 12] [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: 10/23/2022]
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Tobin L, Gibson I, O’Hare D, Kiernan T, Flaherty G. 42 Ireland versus Poland away, what’s the score? risk prediction using score charts for immigrants from high risk european countries in an Irish setting. Heart 2015. [DOI: 10.1136/heartjnl-2015-308621.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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O'Dea A, Tierney M, McGuire BE, Newell J, Glynn LG, Gibson I, Noctor E, Danyliv A, Connolly SB, Dunne FP. Can the Onset of Type 2 Diabetes Be Delayed by a Group-Based Lifestyle Intervention in Women with Prediabetes following Gestational Diabetes Mellitus (GDM)? Findings from a Randomized Control Mixed Methods Trial. J Diabetes Res 2015; 2015:798460. [PMID: 26347894 PMCID: PMC4546980 DOI: 10.1155/2015/798460] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 07/07/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate a 12-week group-based lifestyle intervention programme for women with prediabetes following gestational diabetes (GDM). DESIGN A two-group, mixed methods randomized controlled trial in which 50 women with a history of GDM and abnormal glucose tolerance postpartum were randomly assigned to intervention (n = 24) or wait control (n = 26) and postintervention qualitative interviews with participants. MAIN OUTCOME MEASURES Modifiable biochemical, anthropometric, behavioural, and psychosocial risk factors associated with the development of type 2 diabetes. The primary outcome variable was the change in fasting plasma glucose (FPG) from study entry to one-year follow-up. RESULTS At one-year follow-up, the intervention group showed significant improvements over the wait control group on stress, diet self-efficacy, and quality of life. There was no evidence of an effect of the intervention on measures of biochemistry or anthropometry; the effect on one health behaviour, diet adherence, was close to significance. CONCLUSIONS Prevention programmes must tackle the barriers to participation faced by this population; home-based interventions should be investigated. Strategies for promoting long-term health self-management need to be developed and tested.
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Affiliation(s)
- Angela O'Dea
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Marie Tierney
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Brian E. McGuire
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - John Newell
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Liam G. Glynn
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Irene Gibson
- Croí–The West of Ireland Cardiac Foundation, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Eoin Noctor
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Andrii Danyliv
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Cairnes Building, Galway, Ireland
| | - Susan B. Connolly
- Cardiovascular Medicine, International Centre for Circulatory Health, Imperial College London, London W2 1LA, UK
| | - Fidelma P. Dunne
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
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Crowe C, Gibson I, Cunningham K, Kerins C, Costello C, Windle J, O Shea PM, Hynes M, McGuire B, Kilkelly K, Griffin H, O Brien T, Jones J, Finucane FM. Effects of an eight-week supervised, structured lifestyle modification programme on anthropometric, metabolic and cardiovascular risk factors in severely obese adults. BMC Endocr Disord 2015; 15:37. [PMID: 26231181 PMCID: PMC4522055 DOI: 10.1186/s12902-015-0038-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 07/24/2015] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Lifestyle modification is fundamental to obesity treatment, but few studies have described the effects of structured lifestyle programmes specifically in bariatric patients. We sought to describe changes in anthropometric and metabolic characteristics in a cohort of bariatric patients after participation in a nurse-led, structured lifestyle programme. METHODS We conducted a retrospective, observational cohort study of adults with a body mass index (BMI) ≥ 40 kgm(-2) (or ≥ 35 kgm(-2) with significant co-morbidity) who were attending a regional bariatric service and who completed a single centre, 8-week, nurse-led multidisciplinary lifestyle modification programme. Weight, height, waist circumference, blood pressure, HbA1c, fasting glucose and lipid profiles as well as functional capacity (Incremental Shuttle Walk Test) and questionnaire-based anxiety and depression scores before and after the programme were compared in per-protocol analyses. RESULTS Of 183 bariatric patients enrolled, 150 (81.9%) completed the programme. Mean age of completers was 47.9 ± 1.2 years. 34.7% were male. There were statistically significant reductions in weight (129.6 ± 25.9 v 126.9 ± 26.1 kg, p < 0.001), BMI (46.3 ± 8.3 v 44.9 ± 9.0 kgm(-2), p < 0.001), waist circumference (133.0 ± 17.1 v 129.3 ± 17.5 cm in women and 143.8 ± 19.0 v 135.1 ± 17.9 cm in men, both p < 0.001) as well as anxiety and depression scores, total- and LDL-cholesterol and triglyceride levels, with an increase in functional capacity (5.9 ± 1.7 v 6.8 ± 2.1 metabolic equivalents of thermogenesis (METS), p < 0.001) in completers at the end of the programme compared to the start. Blood pressure improved, with reductions in systolic and diastolic blood pressure from 135 ± 16.2 to 131.6 ± 17.1 (p = 0.009) and 84.7 ± 10.2 to 81.4 ± 10.9 mmHg (p < 0.001), respectively. The proportion of patients achieving target blood pressure increased from 50.3 to 59.3% (p = 0.04). The proportion of patients with diabetes achieving HbA1c <53 mmol/mol increased from 28.6 to 42.9%, p = 0.02. CONCLUSIONS Bariatric patients completing an 8 week, nurse-led structured lifestyle programme had improved adiposity, fitness, lipid profiles, psychosocial health, blood pressure and glycaemia. Further assessment of this programme in a pragmatic randomised controlled trial seems warranted.
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MESH Headings
- Adult
- Anxiety/complications
- Anxiety/psychology
- Blood Glucose/metabolism
- Body Height
- Body Weight
- Cardiovascular Diseases
- Cholesterol, HDL/metabolism
- Cholesterol, LDL/metabolism
- Cohort Studies
- Depression/complications
- Depression/psychology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Diet Therapy
- Exercise Test
- Exercise Therapy
- Exercise Tolerance
- Female
- Glycated Hemoglobin/metabolism
- Humans
- Male
- Middle Aged
- Obesity, Morbid/complications
- Obesity, Morbid/metabolism
- Obesity, Morbid/psychology
- Obesity, Morbid/therapy
- Practice Patterns, Nurses'
- Retrospective Studies
- Risk Reduction Behavior
- Treatment Outcome
- Triglycerides/metabolism
- Waist Circumference
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Affiliation(s)
- Catherine Crowe
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland
| | - Irene Gibson
- Croi, the West of Ireland Cardiac Foundation, Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Katie Cunningham
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland
- Croi, the West of Ireland Cardiac Foundation, Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Claire Kerins
- Croi, the West of Ireland Cardiac Foundation, Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Caroline Costello
- Croi, the West of Ireland Cardiac Foundation, Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Jane Windle
- Croi, the West of Ireland Cardiac Foundation, Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Paula M O Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland
| | - Mary Hynes
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Brian McGuire
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Katriona Kilkelly
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland
| | - Helena Griffin
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland
| | - Tim O Brien
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland
- Discipline of Health Promotion, National University of Ireland, Galway, Ireland
| | - Jenni Jones
- Discipline of Health Promotion, National University of Ireland, Galway, Ireland
- National Institute of Preventive Cardiology, Galway, Ireland
| | - Francis M Finucane
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway University Hospital, Galway, Ireland.
- Discipline of Health Promotion, National University of Ireland, Galway, Ireland.
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Arogbonlo A, Usma C, Kouzani A, Gibson I. Design and Fabrication of a Capacitance Based Wearable Pressure Sensor Using E-textiles. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.protcy.2015.07.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berner A, Woodruff M, Lam C, Arafat M, Saifzadeh S, Steck R, Ren J, Nerlich M, Ekaputra A, Gibson I, Hutmacher D. Effects of scaffold architecture on cranial bone healing. Int J Oral Maxillofac Surg 2014; 43:506-13. [DOI: 10.1016/j.ijom.2013.05.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 04/11/2013] [Accepted: 05/14/2013] [Indexed: 11/26/2022]
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Infanti JJ, O’Dea A, Gibson I, McGuire BE, Newell J, Glynn LG, O’Neill C, Connolly SB, Dunne FP. Reasons for participation and non-participation in a diabetes prevention trial among women with prior gestational diabetes mellitus (GDM). BMC Med Res Methodol 2014; 14:13. [PMID: 24461045 PMCID: PMC3913964 DOI: 10.1186/1471-2288-14-13] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/20/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Lifestyle intervention can prevent progression to type 2 diabetes in high risk populations. We designed a randomised controlled trial (RCT) to evaluate the effectiveness of an established lifestyle intervention compared to standard care for delaying diabetes onset in European women with recent GDM. Recruitment into the RCT was more challenging than anticipated with only 89 of 410 (22%) women agreeing to participate. This paper identifies factors that could enhance participation of the target population in future interventions. METHODS We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined, and secondly that it would be possible to predict participation on the bases of those risk factors. To test our hypothesis, we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3-5 years following GDM, reducing the sample to 43 participants and 73 decliners. We considered established diabetes risk factors: smoking, daily fruit and vegetable intake, participation in exercise, family history of diabetes, glucose values and BMI scores on post-partum re-screens, use of insulin during pregnancy, and age at delivery. We also analysed narrative data from 156 decliners to further understand barriers to and facilitators of participation. RESULTS Two factors differentiated participants and decliners: age at delivery (with women older than 34 years being more likely to participate) and insulin use during pregnancy (with women requiring the use of insulin in pregnancy less likely to participate). Binary logistic regression confirmed that insulin use negatively affected the odds of participation. The most significant barriers to participation included the accessibility, affordability and practicality of the intervention. CONCLUSIONS Women with recent GDM face multiple barriers to lifestyle change. Intervention designers should consider: (i) the practicalities of participation for this population, (ii) research designs that capitalise on motivational differences between participants, (iii) alleviating concerns about long-term diabetes management. We hope this work will support future researchers in developing interventions that are more relevant, effective and successful in recruiting the desired population. TRIAL REGISTRATION Current Controlled Trials ISRCTN41202110.
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Affiliation(s)
- Jennifer J Infanti
- School of Medicine, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Angela O’Dea
- School of Medicine, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Irene Gibson
- Croí–The West of Ireland Cardiac Foundation, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Brian E McGuire
- School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland
| | - John Newell
- HRB Clinical Research Facility, National University of Ireland Galway, University Road, Galway, Ireland
| | - Liam G Glynn
- Discipline of General Practice, National University of Ireland Galway, 1 Distillery Road, Galway, Ireland
| | - Ciaran O’Neill
- J.E. Cairnes School of Business & Economics, Cairnes Building, National University of Ireland Galway, Galway, Ireland
| | - Susan B Connolly
- Division of Cardiology Cardiothoracic and Thoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Fidelma P Dunne
- School of Medicine, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
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Gibson I, Flaherty G, Cormican S, Jones J, Kerins C, Walsh AM, Costello C, Windle J, Connolly S, Crowley J. Translating guidelines to practice: findings from a multidisciplinary preventive cardiology programme in the west of Ireland. Eur J Prev Cardiol 2013; 21:366-76. [PMID: 23884981 DOI: 10.1177/2047487313498831] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The aim of this observational, descriptive study is to evaluate the impact of an intensive, evidence-based preventive cardiology programme on medical and lifestyle risk factors in patients at high risk of developing cardiovascular disease (CVD). METHODS Increased CVD risk patients and their family members/partners were invited to attend a 16-week programme consisting of a professional multidisciplinary lifestyle intervention, with appropriate risk factor and therapeutic management in a community setting. Smoking, dietary habits, physical activity levels, waist circumference and body mass index, and medical risk factors were measured at initial assessment, at end of programme, and at 1-year follow up. RESULTS Adherence to the programme was high, with 375 (87.2%) participants and 181 (84.6%) partners having completed the programme, with 1-year data being obtained from 235 (93.6%) patients and 107 (90.7%) partners. There were statistically significant improvements in both lifestyle (body mass index, waist circumference, physical activity, Mediterranean diet score, fish, fruit, and vegetable consumption, smoking cessation rates), psychosocial (anxiety and depression scales and quality of life indices), and medical risk factors (blood pressure, lipid and glycaemic targets) between baseline and end of programme, with these improvements being sustained at 1-year follow up. CONCLUSIONS These findings demonstrate how a holistic model of CVD prevention can improve cardiovascular risk factors by achieving healthier lifestyles and optimal medical management.
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Affiliation(s)
- Irene Gibson
- West of Ireland Cardiac Foundation, Galway, Ireland
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41
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Infanti JJ, Dunne FP, O’Dea A, Gillespie P, Gibson I, Glynn LG, Noctor E, Newell J, McGuire BE. An evaluation of Croí MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial. Trials 2013; 14:121. [PMID: 23782471 PMCID: PMC3747856 DOI: 10.1186/1745-6215-14-121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 04/18/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Universal screening using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria has identified a prevalence of gestational diabetes mellitus (GDM) of 12.4% in women living in Ireland. Women with prior GDM are at increased risk of developing type 2 diabetes later in life. A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes, and medical management. No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM. Through a two-group, parallel randomised controlled trial (RCT), this study aims to assess the clinical impact, cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM. METHODS/DESIGN A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction (impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)), are randomly assigned to a control arm (n=27) or to the Croí MyAction intervention group (n=27). The control arm receives usual health care advice--written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required. The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croí MyAction. Croí MyAction involves 2.5 hour sessions once per week (for 12 weeks) comprising a group exercise programme, group health promotion or education seminars, and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions. Randomisation and allocation to the intervention arms is carried out by an independent researcher, ensuring that the allocation sequence is concealed from study researchers until the interventions are assigned. The primary analysis is based on glucose dysfunction, comparing a mean reduction in fasting plasma glucose (FPG) levels on a 75 gram oral glucose tolerance test (OGTT) in the two groups at a one-year, post-intervention follow-up. The trial is funded by the Irish Health Research Board (HRB). Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee, Galway University Hospitals, Health Service Executive of Ireland (Ref: C.A.691). TRIAL REGISTRATION Current Controlled Trials ISRCTN41202110.
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MESH Headings
- Biomarkers/blood
- Blood Glucose/metabolism
- Clinical Protocols
- Community Health Services
- Cost-Benefit Analysis
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/economics
- Diabetes Mellitus, Type 2/prevention & control
- Diabetes Mellitus, Type 2/psychology
- Diabetes, Gestational/blood
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/economics
- Diabetes, Gestational/psychology
- Diabetes, Gestational/therapy
- Disease Progression
- Female
- Glucose Tolerance Test
- Health Care Costs
- Humans
- Ireland
- Life Style
- Patient Care Team
- Prediabetic State/blood
- Prediabetic State/diagnosis
- Prediabetic State/economics
- Prediabetic State/prevention & control
- Prediabetic State/psychology
- Pregnancy
- Preventive Health Services/economics
- Preventive Health Services/methods
- Research Design
- Risk Assessment
- Risk Factors
- Risk Reduction Behavior
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Jennifer J Infanti
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Fidelma P Dunne
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Angela O’Dea
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Paddy Gillespie
- J.E. Cairnes School of Business & Economics, Cairnes Building, National University of Ireland Galway, Galway, Ireland
| | - Irene Gibson
- Croí–The West of Ireland Cardiac Foundation, Croí House, Moyola Lane, Newcastle, Galway, Ireland
| | - Liam G Glynn
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Galway, Ireland
| | - Eoin Noctor
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - John Newell
- HRB Clinical Research Facility Galway, National University of Ireland Galway, University Road, Galway, Ireland
| | - Brian E McGuire
- School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland
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Huynh K, Gibson I, Jagdish B, Lu W. Development and validation of a discretised multi-body spine model in LifeMOD for biodynamic behaviour simulation. Comput Methods Biomech Biomed Engin 2013; 18:175-84. [DOI: 10.1080/10255842.2013.786049] [Citation(s) in RCA: 15] [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: 10/26/2022]
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Munday JS, Waropastrakul S, Gibson I, French AF. Papillomaviral DNA sequences are not amplifiable from canine subungual squamous cell carcinomas. N Z Vet J 2013; 61:234-6. [PMID: 23368943 DOI: 10.1080/00480169.2012.731718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIM To determine if papillomaviral DNA is more frequently present within canine subungual squamous cell carcinomas (SCCs) than in non-SCC digit lesions. METHODS Total DNA was extracted from 23 canine subungual SCCs and 23 non-SCC digit lesions. The presence of amplifiable DNA within each sample was confirmed by amplifying a section of the glyceraldehyde-3-phosphate dehydrogenase (GADPH) gene. Two different consensus PCR primer sets were used to amplify papillomaviral DNA from the samples. RESULTS The consensus primers only amplified papillomaviral DNA from the positive control samples. None of the 46 canine digit samples contained DNA that was amplifiable by the consensus PCR primers. CONCLUSION Papillomaviruses are unlikely to be a significant cause of canine subungual SCCs. CLINICAL RELEVANCE While circumstantial evidence suggests that canine subungual SCCs could develop due to papillomaviral infection, this study did not reveal any evidence to support papillomaviral aetiology of these neoplasms.
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Affiliation(s)
- J S Munday
- Department of Pathobiology, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand.
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44
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Infanti JJ, Dunne FP, O’Dea A, Gillespie P, Gibson I, Glynn LG, Noctor E, Newell J, McGuire BE. An evaluation of Croí MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial. Trials 2013. [DOI: 10.1186/1468-6708-14-121] [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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Abstract
It has been 3 years since the Chief Medical Officer reported on chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and the time has come for a thorough investigation by an All Party Group drawn from the House of Commons and the House of Lords. We have received many written submissions and are engaged in taking oral evidence in 2-h sessions, which we open to the public as well as interested groups. The group has received a fantastic response to its requests for written evidence over the past few months. Questions that arise for a government response are the lack of provision and support for patients with CFS/ME, the issue of the clinical definition of CFS/ME, the need for a diagnostic test for CFS/ME, effectiveness of the National Institute for Clinical Excellence guidelines, and criteria used to decide which treatments are best for patients with CFS or myalgic encephalomyelitis.
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Affiliation(s)
- I Gibson
- Norwich North Constituency, House of Commons, London, UK
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46
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Chow SP, Lam KW, Gibson I, Ngan AHW, Lu W, Ip WY, Chiu KY. A novel artificial prosthetic replacement for the proximal interphalangeal joint of the hand--from concept to prototype. Hand Surg 2006; 10:159-68. [PMID: 16568509 DOI: 10.1142/s0218810405002814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Accepted: 09/01/2004] [Indexed: 11/18/2022]
Abstract
This article describes the development of a proximal interphalangeal (PIP) joint prosthesis based on the principles of replicating anatomical surface components, the use of macrolocking intramedullary stem and the use of a cobalt-chrome alloy material. The design features are intended to obtain an optimal range of motion while retaining stability and longevity. The final prototype, for which a patent has been filed, is described.
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Affiliation(s)
- S P Chow
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, PR China.
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47
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Lusquiños F, De Carlos A, Pou J, Arias JL, Boutinguiza M, León B, Pérez-Amor M, Driessens FCM, Hing K, Gibson I, Best S, Bonfield W. Calcium phosphate coatings obtained by Nd:YAG laser cladding: physicochemical and biologic properties. J Biomed Mater Res A 2003; 64:630-7. [PMID: 12601774 DOI: 10.1002/jbm.a.10440] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [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: 11/10/2022]
Abstract
The plasma spray (PS) technique is the most popular method commercially in use to produce calcium phosphate (CaP) coatings to promote fixation and osteointegration of the cementless prosthesis. Nevertheless, PS has some disadvantages, such as the poor coating-to-substrate adhesion, low mechanical strength, and brittleness of the coating. In order to overcome the drawbacks of plasma spraying, we introduce in this work a new method to apply a CaP coating on a Ti alloy using a well-known technique in the metallurgical field: laser surface cladding. The physicochemical characterization of the coatings has been carried out by means of X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy dispersive X-ray analysis (EDX). The biologic properties of the coatings have been assessed in vitro with human osteoblast-like MG-63 cells. The overall results of this study affirm that the Nd:YAG laser cladding technique is a promising method in the biomedical field.
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Affiliation(s)
- F Lusquiños
- Dpto. Física Aplicada, Universidade de Vigo, Vigo, Spain
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48
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Peters SE, Beck-Sagué CM, Farshy CE, Gibson I, Kubota KA, Solomon F, Morse SA, Sievert AJ, Black CM. Behaviors associated with Neisseria gonorrhoeae and Chlamydia trachomatis: cervical infection among young women attending adolescent clinics. Clin Pediatr (Phila) 2000; 39:173-7. [PMID: 10752012 DOI: 10.1177/000992280003900307] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S E Peters
- Division of AIDS, STD, NCID, CDC, Atlanta, Georgia 30333, USA
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49
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Affiliation(s)
- A Padilla
- Parliamentary Office of Science and Technology, London, UK.
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50
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McKellar Q, Gibson I, Monteiro A, Bregante M. Pharmacokinetics of enrofloxacin and danofloxacin in plasma, inflammatory exudate, and bronchial secretions of calves following subcutaneous administration. Antimicrob Agents Chemother 1999; 43:1988-92. [PMID: 10428924 PMCID: PMC89402 DOI: 10.1128/aac.43.8.1988] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [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: 11/20/2022] Open
Abstract
Enrofloxacin (2.5 mg/kg of body weight) and danofloxacin (1.25 mg/kg) were administered subcutaneously to ruminating calves (n = 8) fitted with subcutaneous tissue cages. Concentrations of enrofloxacin, its metabolite ciprofloxacin, and danofloxacin in blood (plasma), tissue cage exudate (following intracaveal injection of 0.3 ml of 1% [vol/wt] carrageenan), and bronchial secretions were measured by high-performance liquid chromatography (HPLC) and microbiological assay (enrofloxacin plus ciprofloxacin and danofloxacin). Mean maximum concentrations (C(max)) +/- standard deviations of enrofloxacin (0.24 +/- 0.08 microg/ml), ciprofloxacin (0.11 +/- 0.03 [total, 0.34 +/- 0.10] microg/ml), and danofloxacin (0.23 +/- 0.05 microg/ml) were detected in the plasma of calves by HPLC. The C(max) were 0.49 +/- 0.17 microg/ml (enrofloxacin equivalents) and 0.24 +/- 0.03 microg/ml (danofloxacin) when they were measured by microbiological assay. Mean C(max) in exudate (HPLC) were 0.18 +/- 0.07 microg/ml (enrofloxacin), 0.10 +/- 0.04 microg/ml (ciprofloxacin), 0.27 +/- 0.09 microg/ml (enrofloxacin plus ciprofloxacin), and 0.19 +/- 0.05 microg/ml (danofloxacin), and concentrations in exudate exceeded those in plasma from 8 h (enrofloxacin and ciprofloxacin) or 6 h (danofloxacin) after drug administration. The C(max) were 0.34 +/- 0.09 microg/ml (enrofloxacin equivalents) and 0.22 +/- 0.04 microg/ml (danofloxacin) in exudate when they were measured by the microbiological assay. The maximum mean concentration achieved in bronchial secretions (HPLC) were 0.07 +/- 0.04 microg/ml (enrofloxacin), 0.04 +/- 0.07 microg/ml (ciprofloxacin), 0.10 +/- 0. 05 microg/ml (enrofloxacin plus ciprofloxacin), and 0.12 +/- 0.09 microg/ml (danofloxacin). The maximum mean concentration in bronchial secretions from a limited number of animals from which samples were available for microbiological assay were 0.27 +/- 0.11 microg/ml (n = 4 [enrofloxacin equivalents]) and 0.14 +/- 0.02 microg/ml (n = 3 [danofloxacin]). With predictive models of efficacy (C(max)/MIC and area under the concentration-time curve/MIC ratios in plasma) for Pasteurella multocida (MIC of enrofloxacin, 0.06 microg/ml [24]; MIC of danofloxacin, 0.06 microg/ml [6]), enrofloxacin produced scores of 8.17 and 52.00, respectively, compared to those of danofloxacin, which were 4.02 and 23.05, respectively. With the dosing rates recommended in some markets by manufacturers, enrofloxacin and danofloxacin achieved concentrations above the MICs for important pathogenic organisms in plasma, tissue cage exudate, and bronchial secretion. Since fluoroquinolones display concentration-dependent activities, C(max)/MIC ratios may be critical to efficacy. In the United States enrofloxacin is currently the only fluoroquinolone licensed for food animals and dosages for acute respiratory disease are 2.5 to 5 mg/kg for 3 days or 7.5 to 12. 5 mg/kg once. The higher dosages on a single occasion are likely to confer C(max)/MIC ratios that are associated with greater clinical efficacy.
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Affiliation(s)
- Q McKellar
- Department of Veterinary Pharmacology, University of Glasgow Veterinary School, Glasgow, United Kingdom.
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