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van den Broek WWA, Gimbel ME, Hermanides RS, Runnett C, Storey RF, Knaapen P, Emans ME, Oemrawsingh RM, Cooke J, Galasko G, Walhout R, Stoel MG, von Birgelen C, van Bergen PFMM, Brinckman SL, Aksoy I, Liem A, Van't Hof AWJ, Jukema JW, Heestermans AACM, Nicastia D, Alber H, Austin D, Nasser A, Deneer V, Ten Berg JM. The impact of patient-reported frailty on cardiovascular outcomes in elderly patients after non-ST-acute coronary syndrome. Int J Cardiol 2024; 405:131940. [PMID: 38458385 DOI: 10.1016/j.ijcard.2024.131940] [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] [Received: 01/25/2024] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND As life expectancy increases, the population of older individuals with coronary artery disease and frailty is growing. We aimed to assess the impact of patient-reported frailty on the treatment and prognosis of elderly early survivors of non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS Frailty data were obtained from two prospective trials, POPular Age and the POPular Age Registry, which both assessed elderly NSTE-ACS patients. Frailty was assessed one month after admission with the Groningen Frailty Indicator (GFI) and was defined as a GFI-score of 4 or higher. In these early survivors of NSTE-ACS, we assessed differences in treatment and 1-year outcomes between frail and non-frail patients, considering major adverse cardiovascular events (MACE, including cardiovascular mortality, myocardial infarction, and stroke) and major bleeding. RESULTS The total study population consisted of 2192 NSTE-ACS patients, aged ≥70 years. The GFI-score was available in 1320 patients (79 ± 5 years, 37% women), of whom 712 (54%) were considered frail. Frail patients were at higher risk for MACE than non-frail patients (9.7% vs. 5.1%, adjusted hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.01-2.43, p = 0.04), but not for major bleeding (3.7% vs. 2.8%, adjusted HR 1.23, 95% CI 0.65-2.32, p = 0.53). Cubic spline analysis showed a gradual increase of the risk for clinical outcomes with higher GFI-scores. CONCLUSIONS In elderly NSTE-ACS patients who survived 1-month follow-up, patient-reported frailty was independently associated with a higher risk for 1-year MACE, but not with major bleeding. These findings emphasize the importance of frailty screening for risk stratification in elderly NSTE-ACS patients.
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Affiliation(s)
- W W A van den Broek
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - M E Gimbel
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - R S Hermanides
- Isala Hospital, Department of Cardiology, Zwolle, the Netherlands
| | - C Runnett
- Northumbria Healthcare NHS Foundation Trust, Department of Cardiology, Newcastle, United Kingdom
| | - R F Storey
- University of Sheffield, Division of Clinical Medicine, Sheffield, United Kingdom
| | - P Knaapen
- Amsterdam University Medical Centre, Department of Cardiology, Amsterdam, the Netherlands
| | - M E Emans
- Ikazia Hospital, Department of Cardiology, Rotterdam, the Netherlands
| | - R M Oemrawsingh
- Albert Schweitzer Hospital, Department of Cardiology, Dordrecht, the Netherlands
| | - J Cooke
- Chesterfield Royal Hospital NHS Foundation Trust, Department of Cardiology, Chesterfield, United Kingdom
| | - G Galasko
- Blackpool Teaching Hospital NHS Foundation Trust, Department of Cardiology, Blackpool, United Kingdom
| | - R Walhout
- Gelderse Vallei Hospital, Department of Cardiology, Ede, the Netherlands
| | - M G Stoel
- Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands
| | - C von Birgelen
- Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands; University of Twente, Department of Health Technology and Services Research, Technical Medical Centre, Enschede, the Netherlands
| | - Paul F M M van Bergen
- Dijklander Hospital, Department of Cardiology, Maelsonstraat 3, 1624 NP Hoorn, the Netherlands
| | - S L Brinckman
- Department of Cardiology, Tergooi MC, Blaricum, the Netherlands
| | - I Aksoy
- Admiraal de Ruyter Hospital, Department of Cardiology, Goes, the Netherlands
| | - A Liem
- Franciscus Gasthuis, Department of Cardiology, Rotterdam, the Netherlands
| | - A W J Van't Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Zuyderland Medical Centre, Department of Cardiology, Heerlen, the Netherlands
| | - J W Jukema
- Leids University Medical Centre, Department of Cardiology, Leiden, the Netherlands
| | - A A C M Heestermans
- Department of Cardiology, Noordwest Hospital Group, Alkmaar, the Netherlands
| | - D Nicastia
- Department of Cardiology, Gelre Hospital, Apeldoorn, the Netherlands
| | - H Alber
- KABEG Klinikum, Department for Internal Medicine and Cardiology, Klagenfurt am Wörthersee, Austria
| | - D Austin
- The James Cook University Hospital, Academic Cardiovascular Unit, Middlesbrough, United Kingdom
| | - A Nasser
- South Tyneside and Sunderland NHS Foundation Trust, Department of Cardiology, South Shields, United Kingdom
| | - V Deneer
- Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - J M Ten Berg
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
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O'Donnell D, O'Mahony A, Doyle M, O'Gorman M, O'Donoghue A, O'Halloran A, Mulcahy R, Pope G, Cooke J. Point Prevalence of Frailty and Cognitive Impairment Exceeds the Capacity of a Single Ward - Specialist Geriatric Wards to lead Best Practice. Ir Med J 2022; 115:690. [PMID: 36920487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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O'Keeffe E, Landers S, Kehoe B, Davey N, Cooke J. 307 THE FEASIBILITY OF USING AN INCLINOMETER TO PROVIDE OLDER HOSPITALISED PATIENTS WITH FEEDBACK ON THEIR ACTIVITY LEVELS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Low levels of physical activity in older adults are well documented and have been associated with functional decline, acute sarcopenia, prolonged length of stay and higher readmission rates. Interventions to modify behaviour in hospitalised older adults include providing feedback on performance. Commercially available activity trackers and pedometers which rely on step count, are often unable to detect steps at the walking speeds found in older hospitalised patients. This study investigated the feasibility of using an inclinometer to measure the time spent by older hospitalised adults in lying and sitting versus standing and walking, and to provide feedback to patients on their active versus sedentary levels.
Methods
This was a feasibility study using a cross-sectional single centre design. Twelve inpatients over 70 years of age were fitted with an ActivPAL accelerometer on their thigh, which was worn continuously for 3 days. A graphic display of sedentary versus active time was provided to the participants each morning. Acceptability of wearing the device and receiving feedback was determined using a modified technology acceptance questionnaire.
Results
Twelve hospitalised older adults (7 female, 5 male) were included in the study, median age 74 (66-84). A modified technology questionnaire showed that 83% of participants found the ActivPAL device comfortable to wear, 100% reported that the feedback from the device was clear and understandable and 92% reported that the information enhanced their motivation for physical activity and that they would wear the device again.
Conclusion
This feasibility study shows that the ActivPAL is a device that can be worn in the hospital setting to provide older adults with feedback on their activity levels in order to modify behaviour and increase their levels of physical activity while in hospital.
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Affiliation(s)
- E O'Keeffe
- Universtity Hospital Waterford , Waterford, Ireland
| | - S Landers
- Universtity Hospital Waterford , Waterford, Ireland
| | - B Kehoe
- Waterford Institute of Technology , Waterford, Ireland
| | - N Davey
- Universtity Hospital Waterford , Waterford, Ireland
| | - J Cooke
- Universtity Hospital Waterford , Waterford, Ireland
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Davey N, Fitzgerald R, Fauzi MYBM, Khan MA, O'Donnell N, Kumar S, Bambrick P, Pope G, Mulcahy R, Cooke J, O'Regan N. 295 SPEP IT UP! DEVELOPING AN ALGORITHM FOR ABNORMAL SERUM PLASMA ELECTROPHORESIS RESULTS IN HIP FRACTURE PATIENTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hip fracture is a common manifestation of osteoporosis. All patients who sustain a hip fracture should receive a specialist bone health assessment, including Serum Protein Electrophoresis (SPEP) because plasma cell disorders such as multiple myeloma are an important differential diagnosis. SPEP results can be challenging to interpret without training and expertise. We aimed to review the proportion of abnormal SPEP results in hip fracture patients and used a newly developed algorithm to assess urgency of referral to haematology.
Methods
The Orthogeriatrics and Haematology teams collaborated to develop an algorithm to help facilitate decision making in hip fracture patients with abnormal SPEP results. A retrospective study was then conducted using data from the local Hip Fracture Database from Quarters 1 and 3 in 2020, and the hospital electronic laboratory system. The algorithm was used to retrospectively determine which patients warranted haematology review. The electronic appointment system was then accessed to review whether those who warranted haematology referral had appointments on the system.
Results
Of 270 hip fracture presentations, 19 duplicate records were excluded. Five patients had no data and three patients had passed away. Of the remaining 243 patients, 193 (79.42%) had SPEP’s sent. Abnormalities were detected in 116 patients (47.74%). According to the SPEP referral pathway, two patients warranted routine referral and one patient required an urgent referral, none of whom appeared to have been referred to haematology. Two patients who did not warrant haematology referral were already under haematology for different conditions.
Conclusion
Not all patients who sustain acute osteoporotic fractures with an abnormal SPEP result require haematology referral. The need for an urgent or routine haematology can be guided by the SPEP result along with other clinical features. With the introduction of this pathway, it is proposed that all hip fracture patients will be triaged in a timely, appropriate, and consistent manner.
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Affiliation(s)
- N Davey
- University Hospital Waterford , Waterford, Ireland
| | - R Fitzgerald
- University Hospital Waterford , Waterford, Ireland
| | - MYBM Fauzi
- University Hospital Waterford , Waterford, Ireland
| | - MA Khan
- University Hospital Waterford , Waterford, Ireland
| | - N O'Donnell
- University Hospital Waterford , Waterford, Ireland
| | - S Kumar
- University Hospital Waterford , Waterford, Ireland
| | - P Bambrick
- University Hospital Waterford , Waterford, Ireland
| | - G Pope
- University Hospital Waterford , Waterford, Ireland
| | - R Mulcahy
- University Hospital Waterford , Waterford, Ireland
| | - J Cooke
- University Hospital Waterford , Waterford, Ireland
| | - N O'Regan
- University Hospital Waterford , Waterford, Ireland
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Connolly E, Reidy C, Murphy A, Pope G, Cooke J, Bambrick P, O'Regan N, Mulcahy R. 298 AN AUDIT OF HEALTH PROFESSIONALS’ KNOWLEDGE OF PARKINSON’S DISEASE AND ITS MEDICATION MANAGEMENT FOR HOSPITALISED PATIENTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Studies have shown that patients with Parkinson’s Disease (PD) have a higher rate of hospitalisation and longer lengths of stay than their age matched controls. Good inpatient management is key to maintaining functional ability and preventing complications, but many PD patients deteriorate while in hospital. Patients with PD are often on multiple time sensitive medications. This study aims to assess healthcare workers knowledge of PD, medications used to treat it and how they should be prescribed and administered.
Methods
A convenience sample survey was distributed to doctors, nurses and other health care professionals over a five-week period. This survey included multiple choice questions and open-ended short answer questions. Results were collated and analysed on Microsoft Excel.
Results
71 surveys were returned - 34 from doctors, 23 from nurses and the 14 others included pharmacists, physios and dieticians. Only 11 (15%) participants correctly identified all PD medications listed in the survey with Sinemet being the most recognised drug (n= 68). Non motor symptoms of PD correctly identified by participants included constipation (n=54, 76%), hallucinations (n=48, 68%) and anosmia (n=18, 25%). 32 participants (45%) were unable to correctly identify when to administer PD medications in relation to mealtimes. 29 participants surveyed (41%) would consider inserting a nasogastric tube for a patient who was fasting and unable to take oral medications. 12 participants (17%) did not know that Sinemet could be given via nasogastric tube.
Conclusion
This survey highlights a gap in knowledge of Parkinson’s Disease and its management. Participants displayed poor knowledge regarding optimum timing of medication administration and management of patients who are fasting. These findings suggest that education sessions and hospital specific guidelines regarding the management and administration of PD medications would assist healthcare professionals with a view to improving patient outcomes and preventing complications.
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Affiliation(s)
- E Connolly
- University Hospital Waterford , Waterford, Ireland
| | - C Reidy
- University Hospital Waterford , Waterford, Ireland
| | - A Murphy
- University Hospital Waterford , Waterford, Ireland
| | - G Pope
- University Hospital Waterford , Waterford, Ireland
| | - J Cooke
- University Hospital Waterford , Waterford, Ireland
| | - P Bambrick
- University Hospital Waterford , Waterford, Ireland
| | - N O'Regan
- University Hospital Waterford , Waterford, Ireland
| | - R Mulcahy
- University Hospital Waterford , Waterford, Ireland
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Davey N, Connolly E, McFeely A, Bambrick P, Pope G, Mulcahy R, Cooke J, O'Regan N. 286 PERCEPTIONS OF RESEARCH AMONGST OLDER ADULTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.253] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Older adults are often excluded from healthcare research, particularly those with cognitive impairment. It is crucial that study participants have given informed consent and partake in research of their own free will. People with cognitive impairment are not always able to engage in the informed consent process. This can lead to under-representation of this cohort in studies. Understanding older people’s perceptions of research is important to better design policies and research studies that are inclusive of older adults. This pilot study aimed to gain a better understanding of older adults’ views about healthcare research and what they imagine their wishes would be if they were unable to consent themselves due to memory problems.
Methods
In this prospective observational study, participants were recruited from outpatient clinics. Consenting participants were surveyed over the phone to ascertain their perceptions of healthcare research.
Results
Twenty-five interviews were conducted. Median age was 76.24 years (range 68-85 years). Most respondents reached at least second level education (80%), and most volunteered knowing very little about healthcare research. All participants had a nominated next of kin. Of 23 participants who had not previously been involved in healthcare research, none had been asked to do so.
Most participants would be interested or very interested in participating in research if the study involved either survey questions (64%), chart review (88%), or additional investigations (68%), however only a minority were interested or very interested in partaking in research involving a trial drug (16%). Most participants (88%) would be happy or very happy for their next of kin to ‘consent’ on their behalf (if they themselves were unable to do so).
Conclusion
In this study, older adults had clear views about healthcare research and a keenness to participate. This group of older adults expressed trust in their next of kin to make decisions on their behalf regarding research participation. More research is required to explore this area further.
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Affiliation(s)
- N Davey
- University Hospital Waterford , Waterford, Ireland
| | - E Connolly
- University Hospital Waterford , Waterford, Ireland
| | - A McFeely
- Tallaght University Hospital , Dublin, Ireland
| | - P Bambrick
- University Hospital Waterford , Waterford, Ireland
| | - G Pope
- University Hospital Waterford , Waterford, Ireland
| | - R Mulcahy
- University Hospital Waterford , Waterford, Ireland
| | - J Cooke
- University Hospital Waterford , Waterford, Ireland
| | - N O'Regan
- University Hospital Waterford , Waterford, Ireland
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Van Den Broek WW, Gimbel ME, Hermanides RS, Runnet C, Storey RF, Austin D, Oemrawsingh RM, Cooke J, Galasko G, Walhout R, Schellings DAAM, The SHK, Stoel MG, Van 'T Hof AWJ, Ten Berg JM. Treatment and prognosis of elderly patients with non-ST-elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2541] [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] Open
Abstract
Abstract
Background/Introduction
Elderly constitute a large though specific group of patients presenting with non-ST elevation myocardial infarction (NSTEMI), as they are at higher risk of adverse cardiovascular events, as well as treatment-related complications. However as they underrepresented in clinical trials, the optimal management strategy for older patients with NSTEMI remains unclear.
Purpose
The aim of this registry was to capture the medical and invasive treatment of elderly NSTEMI patients, find predictors for major adverse cardiovascular events (MACE) and estimate the impact of invasive management and revascularisation.
Methods
The POPular AGE registry is a prospective, observational multicentre study of patients ≥75 years of age presenting with NSTEMI at multiple sites in the Netherlands, United Kingdom and Austria. Management was at the discretion of the treating physician. MACE consisted of cardiovascular death, acute coronary syndrome (ACS) and stroke. Net adverse clinical events (NACE) was defined as composite of all-cause death, ACS, definite stent thrombosis, stroke, or major bleeding (Bleeding Academic Research Consortium [BARC] bleeding 3 or 5). The population was stratified into an invasively treated group defined as patients who underwent coronary angiography (CAG); and a conservatively-treated group with patients who received medical treatment only. The duration of follow-up was one year. Clinical variables were assessed for their predictive value for MACE and bleeding by means of a Cox proportional hazard regression.
Results
The total study population consisted of 1190 elderly patients with NSTEMI (median age 80 years [IQR 77–84], 43% female). Invasive treatment with CAG was performed in 67% of the population, of which 49% underwent PCI and 14% coronary artery bypass grafting (CABG). At discharge, the majority of patients (55%) were treated with dual antiplatelet therapy (DAPT). MACE occurred in 15% and major bleeding occurred in 5% of the total population. Age (HR 1.06, 95% CI 1.03–1.09), diabetes mellitus (HR 1.62, 95% CI 1.16–2.24), reduced LVEF (<50%) (HR 1.51, 95% CI 1.03–2.20), Killip class (HR 1.58, 95% CI 1.07–2.33) and electrocardiogram (ECG) changes at admission (HR 1.67, 95% CI 1.20–2.31) were predictors for MACE. MACE occurred more frequently in conservatively-treated than invasively-treated patients (20% vs. 12%, HR 0.52, 95% CI 0.38–0.70, p<0.001). Revascularization with PCI or CABG was associated with lower risk of MACE (PCI; HR 0.47, 95% CI 0.30–0.75, p=0.001 and CABG; HR 0.31, 95% CI 0.13– 0.73, p=0.008).
Conclusions
In this prospective registry of NSTEMI patients of ≥75 years, MACE and major bleeding were frequent. Age, diabetes mellitus, reduced LVEF, Killip class and ECG changes at admission were independent predictors for MACE. Although subject to selection bias, undergoing CAG and revascularisation, when indicated, were associated with better outcomes.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- W W Van Den Broek
- St Antonius Hospital, Department of Cardiology , Nieuwegein , The Netherlands
| | - M E Gimbel
- Heartcenter - Our Lady Hospital, Department of Cardiology , Amsterdam , The Netherlands
| | - R S Hermanides
- Isala Hospital, Department of Cardiology , Zwolle , The Netherlands
| | - C Runnet
- Northumbria Healthcare, Department of Cardiology , Newcastle-Upon-Tyne , United Kingdom
| | - R F Storey
- University of Sheffield, Department of Infection, Immunity and Cardiovascular Disease , Sheffield , United Kingdom
| | - D Austin
- James Cook University Hospital, Academic Cardiovascular Unit , Middlesbrough , United Kingdom
| | - R M Oemrawsingh
- Albert Schweitzer Hospital, Department of Cardiology , Dordrecht , The Netherlands
| | - J Cooke
- Chesterfield Royal Hospital, Department of Cardiology , Chesterfield , United Kingdom
| | - G Galasko
- Blackpool Teaching Hospitals NHS Trust, Department of Cardiology , Blackpool , United Kingdom
| | - R Walhout
- Gelderse Vallei Hospital, Department of Cardiology , Ede , The Netherlands
| | - D A A M Schellings
- Slingeland Hospital, Department of Cardiology , Doetinchem , The Netherlands
| | - S H K The
- Treant Zorggroep, Department of Cardiology , Emmen , The Netherlands
| | - M G Stoel
- Medical Spectrum Twente, Department of Cardiology , Enschede , The Netherlands
| | - A W J Van 'T Hof
- Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology , Maastricht , The Netherlands
| | - J M Ten Berg
- St Antonius Hospital, Department of Cardiology , Nieuwegein , The Netherlands
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Eakins J, Hager L, O'Connor U, Cooke J, O'Reilly G, Walsh C, Willson T. Personal dosimetry for positron emitters, and occupational exposures from clinical use of gallium-68. J Radiol Prot 2022; 42:031511. [PMID: 35947972 DOI: 10.1088/1361-6498/ac8885] [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] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
The current status and issues regarding positron dosimetry in nuclear medicine are summarized. The suitability of the United Kingdom Health Security Agency extremity and eye beta-gamma personal thermoluminescence dosemeters are then considered. Monte Carlo modelling is performed to determine their responses and derive sets of calibration factors, along withHp(0.07) andHp(3) conversion coefficients, for carbon-11, nitrogen-13, oxygen-15, fluorine-18 and gallium-68 sources, which are commonly used in positron emission tomography (PET) computed tomography; data for these isotopes is assumed extrapolatable to other positron sources. It is found that the dosemeters are adequate for assessing exposures to PET radionuclides, even if their routine calibrations to caesium-137 were maintained. An idealized set of measurements representing gallium-68 exposure scenarios is then described, including reproducible mock-ups of individuals manipulating vials and syringes. Finally, a short case-study is presented that explores occupational doses during routine clinical use of gallium-68. The extremity dosemeter results demonstrated significant variations dependent upon the exposure conditions, with some seen to be comparatively large; whole-body and eye dose rates per activity were found to be lower. The importance of routine dose monitoring of workers is emphasized, with the need for a longer-termed follow-up study demonstrated.
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Affiliation(s)
- J Eakins
- United Kingdom Health Security Agency (UKHSA) RCE, Didcot, Oxfordshire, United Kingdom
| | - L Hager
- United Kingdom Health Security Agency (UKHSA) RCE, Didcot, Oxfordshire, United Kingdom
| | - U O'Connor
- Medical Physics & Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - J Cooke
- Medical Physics & Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - G O'Reilly
- Medical Physics & Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - C Walsh
- Medical Physics & Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - T Willson
- Nuclear Medicine Department, Royal Free London NHS Foundation Trust, London, United Kingdom
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Chang D, Holgate R, Court Pinto K, Olmsted-Davis E, Hopkin A, Mangum L, Bush K, Quick A, Godin B, Cooke J. 771 Novel approach for skin regeneration: mRNA-based telomerase enhancement of autologous skin cell suspension. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dewa L, Pappa S, Mitchell L, Hadley M, Cooke J, Aylin P. Reflections, impact and recommendations of a co-produced ecological momentary assessment (EMA) study with young people who have experience of suicidality and psychiatric inpatient care. Eur Psychiatry 2022. [PMCID: PMC9566421 DOI: 10.1192/j.eurpsy.2022.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Patient and public involvement (PPI) in suicide research is ethical, moral and can deliver impact. However, inconsistent reporting of meaningful PPI, and hesitancy in sharing power with people with experience of suicidality (i.e.co-researchers) in research makes it difficult to understand the full potential impact of PPI on the research, researchers and co-researchers. Objectives To describe how our ecological momentary assessment (EMA) study, examining the sleep-suicide relationship in young psychiatric inpatients (aged 18-35) transitioning to the community, has been co-produced, whilst reflecting on impact, challenges, and recommendations. Methods We built on our experience of co-produced mental health research to conduct meaningful PPI in our study. Young adults with experience of psychiatric inpatient care and suicidality were appointed November 2020 to work across all research stages. Reflections on challenges, recommendations and impact have been collected throughout. Results Three young people became co-researchers. Researcher and co-researcher reflections indicated establishing and maintaining safe environments for open discussion, and continued communication (e.g.WhatsApp group) were vital to effectively share power and decision making. Safeguarding and support requirements for both co-researchers (e.g.individualised strategy) and researcher (e.g.clinical supervision) were particularly evident. To date, the co-produced recruitment poster, research documentation, and research article have demonstrated significant impact. Conclusions This is the first EMA study focused on suicide-sleep during transitions to be co-produced with young people with experience of suicidality. Co-producing suicide research is intensive, time-consuming, and challenging but makes a significant impact to the research, researchers, and co-researchers. We expect our learning will directly influence, and help others produce, meaningful co-produced suicide research. Disclosure No significant relationships.
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Low A, Liang D, Rajakariar K, Gayed D, Backhouse B, Gould M, Schwarer A, Cooke J, Freeman M. A Rapid and Reversible Case of Restrictive Cardiomyopathy Secondary to Loeffler’s Hypereosinophilic Carditis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Liang D, Nguyen M, L'Abbate C, Gayed D, Rajakariar K, Backhouse B, Cooke J, Teh A. mRNA COVID-19 Vaccine (mCV) Related Myocarditis in Monozygotic Dichorionic Diamniotic (DCDA) Twins. Heart Lung Circ 2022. [PMCID: PMC9345540 DOI: 10.1016/j.hlc.2022.06.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chandrasekhar J, Soon K, Freeman M, Cooke J, Roodenburg O, Yang Y, Dyett J. Unique Collaboration Between Cardiology and Intensive Care for Mechanical Support Initiation With ECMO: Single Australian Network Experience. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Choi B, Lasica M, Huynh N, Sirdesai S, Nagarethinam M, Ting S, Cooke J, Hare J, Gibbs S. The Increasing Recognition of Transthyretin Cardiac Amyloidosis (ATTR-CA): Patient Characteristics and Survival in the Australian Context. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.133] [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: 10/16/2022]
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15
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Carter A, Hall A, Thorpe V, Cochrane L, Cooke J. Clinical experience of paediatric self-expanding foam cuffed tracheostomy tubes. Int J Pediatr Otorhinolaryngol 2021; 151:110933. [PMID: 34601293 DOI: 10.1016/j.ijporl.2021.110933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 09/01/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Use of self-expanding foam-filled tracheostomy tube cuffs (Bivona® FOME cuf®) in paediatrics has become a recent practice within our institution for patients with intractable aspiration. The current literature, clinical indications and subsequent management is lacking. We present our experience with a cohort of children with a foam-cuffed tracheostomy tube managed at Great Ormond Street Hospital, describing their indications and outcomes, as well as routine and emergency management. METHOD Our tracheostomy patient population was reviewed and those with a Bivona® FOME cuf® tracheostomy tube were identified and reviewed. The indications for foam-cuffed tracheostomy tube insertion, progress, and further management, including emergency care, were reviewed. RESULTS Ten patients were identified, all with a chronic history of respiratory infections secondary to aspiration being the leading indication. All patients had an ongoing improvement in their chest function following insertion with no episodes of cuff trauma. One patient had difficulty when a port line was accidently cut, which resulted in difficulty of removal, and we outline a strategy for dealing with this. CONCLUSION The foam-cuffed tracheostomy tube is a useful tracheostomy tube to use in the management of chronic aspiration in children with poor chest health, however due to the lack of knowledge and experience they can prove to be a difficult tube to manage. Further educational information should be available as to the indications, routine care and emergency management of Bivona® FOME cuf® tracheostomy tubes. We believe they represent a useful option for institutions to consider in the paediatric population.
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Affiliation(s)
- A Carter
- ENT Department, Great Ormond Street Hospital for Children, London, UK.
| | - A Hall
- ENT Department, Great Ormond Street Hospital for Children, London, UK
| | - V Thorpe
- ENT Department, Great Ormond Street Hospital for Children, London, UK
| | - L Cochrane
- ENT Department, Great Ormond Street Hospital for Children, London, UK
| | - J Cooke
- ENT Department, Great Ormond Street Hospital for Children, London, UK
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16
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Buckley E, O'Regan N, Pope G, Mulcahy R, Cooke J. 92 THE RISE OF SIMULATION BASED TRAINING IN GERIATRIC MEDICINE? Age Ageing 2021. [DOI: 10.1093/ageing/afab219.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Simulation-based training (SBT) offers opportunities for teaching and learning in safe spaces, while learners navigate the acquisition of these complex skills, and work in clinically-realistic teams, supported by faculty. Geriatric medicine is a diverse speciality, requiring trainees to navigate complex social, medical, and ethical issues, necessitating a multifaceted and interdisciplinary approach. Studies describing SBT in geriatric medicine are limited.
Methods
We hosted an in-situ competition designed to encourage participation in simulation and to develop a simulation faculty network across a hospital group. All healthcare professionals in the hospital group were eligible to enter. Contestants designed a simulation case scenario within a speciality of their choice. Entrants participated in five virtual workshops on core elements of SBT. Six cases were selected to participate in the virtual final. The finalists submitted a video summarising the performance of and evaluation of the learners’ experience of the scenario.
Results
Thirty-four teams submitted initial SBT proposals and participated in the five virtual SBT workshops over a three-week period. Of these,17.6% (n = 6) were geriatric medicine teams, comprising seven geriatric medicine consultants, four advanced nurse practitioners and 13 non-consultant hospital doctors (five registrars, six senior house officers and two interns). Case scenarios submitted by geriatric medicine teams included acute stroke care, diagnosis and management of delirium, management of perioperative delirium post hip fracture and capacity assessment.
Conclusion
The level of interest in SBT generated amongst geriatric medicine faculty and trainees suggests this may be a useful tool to enhance the training experience. SBT offers geriatric medicine trainees the opportunity to practice the technical and non-technical skills required to navigate complex, interdisciplinary and challenging patient scenarios, in a protected environment. In this innovation, we identified a range of geriatric medicine-related topics for which SBT was deemed to be valuable by both faculty and trainees and could be facilitated through in-situ simulation settings.
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Affiliation(s)
- E Buckley
- University Hospital Waterford , Waterford, Ireland
| | - N O'Regan
- University Hospital Waterford , Waterford, Ireland
| | - G Pope
- University Hospital Waterford , Waterford, Ireland
| | - R Mulcahy
- University Hospital Waterford , Waterford, Ireland
| | - J Cooke
- University Hospital Waterford , Waterford, Ireland
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17
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Duff E, Moran J, Doyle M, O'Gorman M, Ryan MD, Finucane P, Cooke J, Pope G, Mulcahy R, O’Regan N. 108 COMBATTING CONFUSION: SIMULATION-BASED MEDICAL EDUCATION FOR DEALING WITH DELIRIUM. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Delirium is a complex, costly, and common clinical syndrome. Simulation-based medical education has been shown to be effective in enhancing the confidence, knowledge and skills of healthcare professionals in the management of delirium. We piloted an inter-professional education simulation on delirium in an acute hospital setting. The session’s design was informed by participating in ‘Sim Stars’, a regional simulation development competition.
Methods
We iteratively developed a low-fidelity simulation scenario on the recognition, prevention and management of delirium. The resulting simulation was piloted during an hour-long multidisciplinary departmental teaching session in a lecture hall setting. A candidate was asked to review an acutely confused patient (played by a ‘confederate’) on call. The candidate was expected to screen for delirium using the 4AT tool; assess for possible causes of delirium; and implement an appropriate management plan. After the session, qualitative feedback from the participants and audience was sought.
Results
This pilot simulation included one candidate (medical Senior House Officer); two confederates (Consultant Geriatrician, Advanced Nurse Practitioner); two facilitators (Consultant Geriatrician, Advanced Nurse Practitioner); and an audience of 17 members. Feedback indicated that learners and trainers found this a helpful and enjoyable pedagogical method. Areas for improvement were highlighted, including providing advance notice for learners of the topic to be simulated; a more structured introduction defining the learning outcomes and declaring a ‘blame free’ environment; improved script for the patient confederate; and that having a team of learners (rather than specialists) to play ‘confederates’ may help improve team-building and reduce learner anxiety.
Conclusion
This pilot simulation received positive appraisals from the team, and plans are underway to incorporate simulation more regularly into departmental teaching. Suggestions to improve future simulations were welcomed. Given its low-fidelity, this scenario can easily be used at any site for simulation-based training.
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Affiliation(s)
- E Duff
- University Hospital Waterford , Waterford, Ireland
| | - J Moran
- University Hospital Waterford , Waterford, Ireland
| | - M Doyle
- University Hospital Waterford , Waterford, Ireland
| | - M O'Gorman
- University Hospital Waterford , Waterford, Ireland
| | - M D Ryan
- University Hospital Waterford , Waterford, Ireland
| | - P Finucane
- University Hospital Waterford , Waterford, Ireland
| | - J Cooke
- University Hospital Waterford , Waterford, Ireland
| | - G Pope
- University Hospital Waterford , Waterford, Ireland
| | - R Mulcahy
- University Hospital Waterford , Waterford, Ireland
| | - N O’Regan
- University Hospital Waterford , Waterford, Ireland
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18
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Murphy B, Laffan S, Sullivan SO, Ballester GW, Meagher MK, Noone I, Cassidy T, Murphy T, Cooke J, Pope G, Mulcahy R, O'Regan N. 79 SIMULATION-BASED MEDICAL EDUCATION: A ‘HIP’ WAY TO LEARN ABOUT ORTHO-GERIATRICS! Age Ageing 2021. [PMCID: PMC8690087 DOI: 10.1093/ageing/afab219.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Simulation-based medical education (SBME) is emerging as a key method of medical education, particularly in the setting of the COVID-19 pandemic. As part of a simulation development competition (SimStars) run by the National Doctors Training and Planning Unit and the South–South West Hospital Group, we brought together an inter-disciplinary team to develop a simulation scenario on hip fracture. Methods Our development team consisted of members of the Geriatric Medicine and Orthopaedic Departments. We developed a scenario that can be adapted to suit the needs of learners in orthopaedics, medicine, or nursing. We ran the simulation on a medical ward with one candidate and four facilitators from the Geriatric Medicine Department. The candidate (medical SHO) was presented with a patient (facilitator one), who had sustained a hip fracture following a fall. The candidate was directed to elicit a falls and bone health history, screen for delirium, and suggest further investigations and management. Subsequently, feedback was sought from all participants. Results The simulation took twenty minutes, debriefing took fifteen minutes. All considered, the simulation an enjoyable and feasible method for teaching and learning, and a novel way to promote team-building. The candidate felt competent in some areas, reporting that the scenario provided positive reinforcement. She reported feeling supported in identifying areas for further learning. The facilitators also considered this method a useful way to highlight a candidate’s learning needs and direct further teaching. The candidate requested further SBME-based sessions. Conclusion This SBME session in Ortho-Geriatrics was well-received by the candidate and facilitators. All participants enjoyed teaching and learning through this medium. Areas of high competency were reinforced and areas for future learning were identified. Further SBME was requested across more topics and for simulation training to be brought in as part of formal training.
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Affiliation(s)
- B Murphy
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland,Department of Geriatric Medicine, St Vincents University Hospital, Dublin, Ireland
| | - S Laffan
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - S O Sullivan
- Department of Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - G W Ballester
- Department of Geriatric Medicine, St Vincents University Hospital, Dublin, Ireland
| | - M K Meagher
- Department of Geriatric Medicine, St Vincents University Hospital, Dublin, Ireland
| | - I Noone
- Department of Geriatric Medicine, St Vincents University Hospital, Dublin, Ireland
| | - T Cassidy
- Department of Geriatric Medicine, St Vincents University Hospital, Dublin, Ireland
| | - T Murphy
- Department of Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - J Cooke
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - G Pope
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - R Mulcahy
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - N O'Regan
- Department of Geriatric Medicine, Waterford Intergratred Care for Older People, University Hospital Waterford, Waterford, Ireland
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19
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Davis H, Mishra S, Cooke J. 1454 The Challenges of Consent and COVID-19: Analysis of Documentation of Risk of Hospital Acquired COVID-19 Infection in a District General Hospital. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The COVID-19 pandemic has been a challenging time for society and raised further challenges for medical practice. It poses a new material risk to any hospital admission or procedure, and consenting practice must modify to accommodate this.
Aim
To assess the documentation of the risk of COVID-19 infection and associated morbidity in consenting practice, using the existing consent form as benchmark, for patient’s undergoing general surgical procedures under general anaesthesia.
Method
Retrospective case-note analysis of 41 general surgical inpatient consent forms and operation notes during April 2020. Data were gathered on multiple points mentioned in Royal College of Surgeons (RCS) guidance. This includes documentation of risk of COVID-19 infection, the patient’s diagnosis, other risk documentation, peri-operative lifestyle advice and likelihood of success.
Results
Of 41 cases, 16 (39%) had risk of chest infection documented. Of these 16, 10 (63%) specified COVID-19 in the risk documentation. Further, morbidity related to COVID-19 was documented in 4 out of 41 (10%) cases identified.
Conclusions
A material risk is classified as anything that poses substantial risk to a patient, and it is vital that they are made aware of this prior to undertaking any form of medical intervention. This study demonstrates deviation from RCS guidance, and the results have been discussed and distributed within the general surgical department. Advice has been communicated regarding improvements required in consenting practice from the clinical lead. We aim to re-audit practice in the coming months.
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Affiliation(s)
- H Davis
- William Harvey Hospital, Kent, United Kingdom
| | - S Mishra
- William Harvey Hospital, Kent, United Kingdom
| | - J Cooke
- William Harvey Hospital, Kent, United Kingdom
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20
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Ibitoye RT, Castro P, Desowska A, Cooke J, Edwards AE, Guven O, Arshad Q, Murdin L, Kaski D, Bronstein AM. Small vessel disease disrupts EEG postural brain networks in 'unexplained dizziness in the elderly'. Clin Neurophysiol 2021; 132:2751-2762. [PMID: 34583117 PMCID: PMC8559782 DOI: 10.1016/j.clinph.2021.07.027] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/15/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
Unexplained dizziness in the elderly may result from
cerebral small vessel disease. Dizzy elderly patients differed from controls in EEG
power when standing. EEG power when standing correlated with subjective
(perceived) instability.
Objective To examine the hypothesis that small vessel disease
disrupts postural networks in older adults with unexplained dizziness in the
elderly (UDE). Methods Simultaneous electroencephalography and postural sway
measurements were undertaken in upright, eyes closed standing, and sitting
postures (as baseline) in 19 younger adults, 33 older controls and 36 older
patients with UDE. Older adults underwent magnetic resonance imaging to
determine whole brain white matter hyperintensity volumes, a measure of small
vessel disease. Linear regression was used to estimate the effect of instability
on electroencephalographic power and connectivity. Results Ageing increased theta and alpha desynchronisation on
standing. In older controls, delta and gamma power increased, and theta and
alpha power reduced with instability. Dizzy older patients had higher white
matter hyperintensity volumes and more theta desynchronisation during periods of
instability. White matter hyperintensity volume and delta power during periods
of instability were correlated, positively in controls but negatively in dizzy
older patients. Delta power correlated with subjective dizziness and
instability. Conclusions Neural resource demands of postural control increase
with age, particularly in patients with UDE, driven by small vessel
disease. Significance EEG correlates of postural control saturate in older
adults with UDE, offering a neuro-physiological basis to this common
syndrome.
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Affiliation(s)
- R T Ibitoye
- Neuro-otology Unit, Imperial College London, London, UK; The Computational, Cognitive and Clinical Neuroimaging Laboratory (C3NL), Imperial College London, London, UK
| | - P Castro
- Neuro-otology Unit, Imperial College London, London, UK
| | - A Desowska
- The Computational, Cognitive and Clinical Neuroimaging Laboratory (C3NL), Imperial College London, London, UK
| | - J Cooke
- Neuro-otology Unit, Imperial College London, London, UK
| | - A E Edwards
- Neuro-otology Unit, Imperial College London, London, UK
| | - O Guven
- Neuro-otology Unit, Imperial College London, London, UK
| | - Q Arshad
- Neuro-otology Unit, Imperial College London, London, UK; inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - L Murdin
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Kaski
- Neuro-otology Unit, Imperial College London, London, UK; Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - A M Bronstein
- Neuro-otology Unit, Imperial College London, London, UK.
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21
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Sheppeard R, Dubash F, Cooke J. Athena: Speciality Certificate Examination case for Dermatopathology. Clin Exp Dermatol 2021; 47:1386-1387. [PMID: 34101226 DOI: 10.1111/ced.14793] [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] [Received: 04/27/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
- R Sheppeard
- Departments of, Dermatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - F Dubash
- Departments of, Dermatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - J Cooke
- Department of, Pathology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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22
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Mannion J, Tariq S, Bolger M, Faisal R, Nugent M, O'Donoghue P, Walsh J, Courtney W, Jeyaseelan A, Pope G, Mulcahy R, O'Regan N, Farrell M, Cooke J, Henin M. Rare Variant of Lateral Medullary Syndrome; Opalski Syndrome with Cerebellar Infarction. Ir Med J 2021; 114:244. [PMID: 37556158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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23
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Ye S, Yao H, Houlihan K, Kalubowilage S, Teo A, Lucarelli N, Koshy A, Teh A, Buntine P, Hamer A, Cooke J, Roberts L, Sajeev J. Outcomes and Trends: Recurrent Syncope Presentations to the Emergency Department. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.310] [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: 10/20/2022]
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24
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Ye S, Yao H, Kalubowilage S, Houlihan K, Teo A, Lucarelli N, Koshy A, Teh A, Buntine P, Hamer A, Cooke J, Roberts L, Sajeev J. Investigational Burden in Undifferentiated Syncope Presentations. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.301] [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: 10/20/2022]
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25
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Liang D, Dinh D, Gayed D, Tan M, Clark D, Duffy S, Brennan A, Ajani A, Oquiel E, Roberts L, Cooke J, Reid C, Chandrasekhar J, Freeman M. Are Public Holidays, Sporting Events and Significant Historical Events Triggers of ST-elevation Myocardial Infarction (STEMI) Presentations in Victoria? A Melbourne Interventional Group (MIG) Observational Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Greenberg N, Cooke J, Sullivan E, Tracy DK. Mental health plan for workers of the London Nightingale Hospital: following the evidence to support staff. BMJ Mil Health 2020; 167:107-109. [PMID: 33122399 DOI: 10.1136/bmjmilitary-2020-001624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/04/2022]
Abstract
The COVID-19 pandemic has extracted an enormous physical health toll on many millions worldwide, and the wider societal impact from economic turmoil, unemployment, social isolation and so forth continue to be measured. A less explored aspect has been the psychological impact on treating healthcare staff, with emerging evidence of 'moral injury' and mental illness for some. This review explores the evidence base for implementing a tiered model of care to minimise this and foster 'post-traumatic growth', and describes the authors' implementation of this in the London Nightingale hospital, with lessons for the armed forces.
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Affiliation(s)
- Neil Greenberg
- Health Protection Research Unit, The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Cooke
- Great Ormond Street Hospital for Children, London, London, UK.,256 Fd Hospital, London, UK
| | - E Sullivan
- 256 Fd Hospital, London, UK.,Royal Marsden Hospital NHS Trust, London, London, UK
| | - D K Tracy
- Cognition, Schizophrenia, and Imaging Laboratory, Department of Psychosis Studies, the Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK .,Oxleas NHS Foundation Trust, London, UK
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27
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Mojiri A, Walter B, Jiang C, Matrone G, Holgate R, Qiu Q, Chen K, Cooke J. TELOMERASE THERAPY REVERSES VASCULAR SENESCENCE IN HGPS. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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28
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Power M, Roberts L, Cooke J, Chandrasekhar J. 543 Review of Frequency and Outcomes of Culturally and Linguistically Diverse Patients Presenting With Myocardial Infarction. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Johns E, Roberts L, Cooke J, Chandrasekhar J. 474 Differences in STEMI Treatment Times in Patients With or Without Culturally and Linguistically Diverse (CALD) Backgrounds. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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30
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Tan M, Sajeev J, Roberts L, Cooke J, Teh A. 480 Does Sex-Specific High-Sensitivity Troponin T Cut-Off Values Alter Clinical Outcomes in Chest Pain Presentations to the Emergency Department? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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O'Brien J, Roberts L, Ford C, Cooke J, Chandrasekhar J. 573 Utility of Fractional Flow Reserve (FFR) Testing for Assessment of Coronary Artery Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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32
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Ye S, Lucarelli N, Yao H, Teo, Koshy A, Teh A, Hamer A, Buntine P, Roberts L, Cooke J, Sajeev J. 458 Clinical Utility of Contemporary Guideline-Based High-Risk Features in the Prediction of Cardiac Syncope. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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33
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Ye S, Teo A, Lucarelli N, Yao H, Koshy A, Teh A, Buntine P, Hamer A, Cooke J, Roberts L, Sajeev J. 508 Lack of a Discharge Diagnosis following a Presentation With Syncope is Associated With Inadequate Follow-Up. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Mojiri A, Matrone G, Walther B, Cooke J. HUMAN TELOMERASE M-RNA TREATMENT RESTORES FUNCTIONS IN PROGERIA IPSC- DERIVED ENDOTHELIAL CELLS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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35
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MacPherson M, Sajeev J, Wong G, Kalman J, Dewey H, Koshy A, Roberts L, Cooke J, Teh A. An Elevated P Wave Terminal Force V1 is not Associated with Worsening Atrial Electroanatomic Substrate. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Ye S, Teh A, Buntine P, Koshy A, Cooke J, Hamer A, Roberts L, Teh A, Sajeev J. High Risk Syncope: Guideline-Based Monitoring and Follow Up. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sajeev J, Burrell L, Dewey H, Kalman J, Chou B, Frost T, Patel S, Roberts L, Cooke J, Koshy A, Gould M, Ngoh J, Denver R, Teh A. Elevated Plasma Angiotensin Converting Enzyme 2 (ACE2) Activity is Associated with Embolic Stroke of Undetermined Source. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Doherty C, Neal R, English C, Cooke J, Atkinson D, Bates L, Moore J, Monks S, Bowler M, Bruce IA, Bateman N, Wyatt M, Russell J, Perkins R, McGrath BA. Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies. Anaesthesia 2018; 73:1400-1417. [PMID: 30062783 DOI: 10.1111/anae.14307] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 01/09/2023]
Abstract
Temporary and permanent tracheostomies are required in children to manage actual or anticipated long-term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.
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Affiliation(s)
- C Doherty
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Neal
- Paediatric Intensive Care Medicine, Paediatrics, Birmingham Children's Hospital, Birmingham, UK
| | - C English
- Department of Paediatric ENT, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Cooke
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - D Atkinson
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Bates
- Department of Anaesthesia and Intensive Care Medicine, Royal Bolton Hospital, Bolton, UK
| | - J Moore
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Monks
- Department of Anaesthesia, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - M Bowler
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - I A Bruce
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - N Bateman
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
| | - M Wyatt
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - J Russell
- Department of Paediatric ENT, Our Lady's Children's Hospital, Dublin, Ireland
| | - R Perkins
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - B A McGrath
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Sajeev J, Bhatia M, Dewey H, Koshy A, Roberts L, Cooke J, Denver R, Teh A. The Utility of P-Wave Terminal Force V1 is Limited by its Reliability. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sajeev J, Abrahams T, Marceddo L, Roberts L, Cooke J, Denver R, Teh A. Electrolyte Replacement for Atrial Fibrillation in the Emergency Department does not Promote Cardioversion. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lasica M, Ting S, Cooke J, Wong C, Slocombe A, Zimmet H, Hosking P, Hare J, Gibbs S. Cardiac Transthyretin Amyloidosis: Are we Under-Diagnosing and Under-Treating? Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.088] [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: 12/01/2022]
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Sajeev J, Abrahams T, Roberts L, Koshy A, Denver R, Cooke J, Marceddo L, Teh A. Atrial Fibrillation: Predictors of Re-Presentation to the Emergency Department. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sajeev J, Abrahams T, Roberts L, Koshy A, Cooke J, Denver R, Marceddo L, Teh A. Atrial Fibrillation: Predictors of Inpatient Hospital Admission. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Murphy GH, Chiu P, Triantafyllopoulou P, Barnoux M, Blake E, Cooke J, Forrester-Jones RVE, Gore NJ, Beecham JK. Offenders with intellectual disabilities in prison: what happens when they leave? J Intellect Disabil Res 2017; 61:957-968. [PMID: 28573662 DOI: 10.1111/jir.12374] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/11/2017] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND People with intellectual disabilities, if convicted of offences, may be sentenced to prison, but little is known about their life when they are released. METHOD This study followed up men with intellectual disabilities who were leaving prisons in England. RESULTS The men were hard to contact, but 38 men were interviewed, on average 10 weeks after leaving prison. The men were living in a variety of situations and often were very under-occupied, with limited social networks. A total of 70% were above the clinical cut-off for anxiety, and 59.5% were above the clinical cut-off for depression. The men were receiving little support in the community, and many had been reinterviewed by police. CONCLUSIONS Community teams need to provide better support to this very vulnerable group.
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Affiliation(s)
- G H Murphy
- Tizard Centre, University of Kent, Canterbury, UK
| | - P Chiu
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - M Barnoux
- Tizard Centre, University of Kent, Canterbury, UK
| | - E Blake
- Tizard Centre, University of Kent, Canterbury, UK
| | - J Cooke
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - N J Gore
- Tizard Centre, University of Kent, Canterbury, UK
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Bilku D, Hall T, Al-Leswas D, Horst C, Cooke J, Metcalfe M, Dennison A. MON-P052: A Randomised Controlled Trial Investigating the Effects of Parenteral Fish Oil on Pro-Inflammatory Resolvin & Protectin Profile in Critically Ill Patients with Sepsis. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)31031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Isherwood J, Arshad A, Chung W, Runau F, Cooke J, Pollard C, Thompson J, Metcalfe M, Dennison A. SUN-P107: Parenteral Omega 3 Significantly Reduces Myeloid-Derived Suppressor Cells in Palliative Pancreatic Patients Receiving Gemcitabine and Intravenous Omega 3 Compared to Patients Receiving Gemcitabine only Treatment. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30520-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bilku D, Hall T, Al-Leswas D, Horst C, Cooke J, Metcalfe M, Dennison A. OR68: Parenteral Omega-3 Reduced Levels of Pro-Inflammatory Interleukin-17, Results of a Randomised Controlled Trial in Critically Ill Patients with Sepsis. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Koshy A, Sajeev J, Pham C, Wong M, Cooray S, Khavar Y, Hamer A, Rajakariar K, Cooke J, Roberts L, Teh A. Point-of-Care Utilisation of Single Lead Smartphone Electrocardiogram in Screening for Arrhythmias: PULSE Trial. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Koshy A, Sajeev J, Cosgrave N, Tan M, Rajakariar K, Pham C, Cooke J, Dewey H, Kynt C, Roberts L, Teh A. High-Sensitivity Troponin Elevation in Ischaemic Stroke and Associated Cardiac Abnormalities. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thakkar H, Mahindajit A, Taylor D, Roberts L, Cooke J. Conscious Sedation for Transoesophageal Echocardiography in Cannabis Users. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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