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Palmer S, Coad J, Gamble J, Jones C, Lees-Deutsch L, McWilliams D, Murphy E, Kneafsey R. Nursing, midwifery, and allied health professions research capacities and cultures: a survey of staff within a university and acute healthcare organisation. BMC Health Serv Res 2023; 23:647. [PMID: 37328877 DOI: 10.1186/s12913-023-09612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/28/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND There is an increasing focus on the development of research capacity and culture in Nursing, Midwifery and Allied Health Professions (NMAHP). However, better understanding of the existing research success and skills, motivators, barriers, and development needs of NMAHP professionals is required to inform this development. This study sought to identify such factors within a university and an acute healthcare organisation. METHODS An online survey, incorporating the Research Capacity and Culture tool, was administered to NMAHP professionals and students at a university and an acute healthcare organisation in the United Kingdom. Ratings of success/skill levels of teams and individuals were compared between professional groups using Mann-Whitney U tests. Motivators, barriers, and development needs were reported using descriptive statistics. Descriptive thematic analysis was used for open-ended text responses. RESULTS A total of 416 responses were received (N&M n = 223, AHP n = 133, Other n = 60). N&M respondents were more positive than their AHP counterparts about the success/skill levels of their teams. There were no significant differences between N&M and AHP in their ratings of individual successes/skills. Finding and critically reviewing relevant literature were identified as specific individual strengths; with weaknesses in securing research funding, submitting ethics applications, writing for publication, and advising less experienced researchers. The main motivators for research were to develop skills, increased job satisfaction, and career advancement; whilst barriers included lack of time for research and other work roles taking priority. Key support needs identified included mentorship (for teams and individuals) and in-service training. Open-ended questions generated main themes of 'Employment & staffing', 'Professional services support', 'Clinical & academic management', 'Training & development', 'Partnerships' and 'Operating principles'. Two cross-cutting themes described issues common to multiple main themes: 'Adequate working time for research' and 'Participating in research as an individual learning journey'. CONCLUSIONS Rich information was generated to inform the development of strategies to enhance research capacity and culture in NMAHP. Much of this can be generic but some nuances may be required to address some specific differences between professional groups, particularly related to perceived team success/skills and priorities identified for support and development.
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Affiliation(s)
- S Palmer
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - J Coad
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
- School of Health Sciences, Nottingham University Queen's Medical Centre, Nottingham, UK
| | - J Gamble
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - C Jones
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - L Lees-Deutsch
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - D McWilliams
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - E Murphy
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK
| | - R Kneafsey
- Centre for Care Excellence, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, UK.
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Welikhe P, Williams MR, King K, Bos J, Akland M, Baffaut C, Beck EG, Bierer A, Bosch DD, Brooks ES, Buda AR, Cavigelli M, Faulkner J, Feyereisen GW, Fortuna A, Gamble J, Hanrahan BR, Hussain MZ, Kovar JL, Lee B, Leytem AB, Liebig MA, Line D, Macrae ML, Moorman TB, Moriasi D, Mumbi R, Nelson N, Ortega-Pieck A, Osmond D, Penn C, Pisani O, Reba ML, Smith DR, Unrine J, Webb P, White KE, Wilson H, Witthaus LM. Uncertainty in phosphorus fluxes and budgets across the U.S. long-term agroecosystem research network. J Environ Qual 2023. [PMID: 37145888 DOI: 10.1002/jeq2.20485] [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] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/28/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
Phosphorus (P) budgets can be useful tools for understanding nutrient cycling and quantifying the effectiveness of nutrient management planning and policies; however, uncertainties in agricultural nutrient budgets are not often quantitatively assessed. The objective of this study was to evaluate uncertainty in P fluxes (fertilizer/manure application, atmospheric deposition, irrigation, crop removal, surface runoff, leachate) and the propagation of these uncertainties to annual P budgets. Data from 56 cropping systems in the P-FLUX database, which spans diverse rotations and landscapes across the U.S. and Canada, were evaluated. Results showed that across cropping systems, average annual P budget was 22.4 kg P ha-1 (range = -32.7 to 340.6 kg P ha-1 ), with an average uncertainty of 13.1 kg P ha-1 (range = 1.0 to 87.1 kg P ha-1 ). Fertilizer/manure application and crop removal were the largest P fluxes across cropping systems and, as a result, accounted for the largest fraction of uncertainty in annual budgets (61 and 37%, respectively). Remaining fluxes individually accounted for <2% of the budget uncertainty. Uncertainties were large enough that determining whether P was increasing, decreasing, or not changing was inconclusive in 39% of the budgets evaluated. Findings indicate that more careful and/or direct measurements of inputs, outputs, and stocks are needed. Recommendations for minimizing uncertainty in P budgets based on the results of the study were developed. Quantifying, communicating, and constraining uncertainty in budgets among production systems and multiple geographies is critical for engaging stakeholders, developing local and national strategies for P reduction, and informing policy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- P Welikhe
- Department of Agronomy, Purdue University
- National Soil Erosion Research Laboratory, USDA-ARS
| | - M R Williams
- National Soil Erosion Research Laboratory, USDA-ARS
| | - K King
- Soil Drainage Research Unit, USDA-ARS
| | - J Bos
- National Soil Erosion Research Laboratory, USDA-ARS
| | - M Akland
- Department of Plant and Soil Sciences, University of Kentucky
| | - C Baffaut
- Cropping Systems and Water Quality Research Unit, USDA-ARS
| | | | - A Bierer
- Northwest Irrigation and Soils Research Lab, USDA-ARS
| | - D D Bosch
- Southeast Watershed Research Laboratory, USDA-ARS
| | - E S Brooks
- Department of Soil and Water Resources, University of Idaho
| | - A R Buda
- Pasture Systems and Watershed Management Research Unit, USDA-ARS
| | - M Cavigelli
- Sustainable Agricultural Systems Lab, USDA-ARS
| | - J Faulkner
- Department of Plant and Soil Science, University of Vermont
| | | | - A Fortuna
- Grazinglands Research Laboratory, USDA-ARS
| | - J Gamble
- Plant Science Research Unit, USDA-ARS
| | | | - M Z Hussain
- W.K. Kellogg Biological Station, Michigan State University
| | - J L Kovar
- National Laboratory for Agriculture and the Environment, USDA-ARS
| | - B Lee
- Department of Plant and Soil Sciences, University of Kentucky
| | - A B Leytem
- Northwest Irrigation and Soils Research Lab, USDA-ARS
| | - M A Liebig
- Northern Great Plains Research Laboratory, USDA-ARS
| | - D Line
- Department of Crop and Soil Sciences, North Carolina State University
| | - M L Macrae
- Department of Geography and Environmental Management, University of Waterloo
| | - T B Moorman
- National Laboratory for Agriculture and the Environment, USDA-ARS
| | - D Moriasi
- Grazinglands Research Laboratory, USDA-ARS
| | - R Mumbi
- Department of Agronomy, Purdue University
- National Soil Erosion Research Laboratory, USDA-ARS
| | - N Nelson
- Department of Agronomy, Kansas State University
| | - A Ortega-Pieck
- Department of Soil and Water Resources, University of Idaho
| | - D Osmond
- Department of Crop and Soil Sciences, North Carolina State University
| | - C Penn
- National Soil Erosion Research Laboratory, USDA-ARS
| | - O Pisani
- Southeast Watershed Research Laboratory, USDA-ARS
| | - M L Reba
- Delta Water Management Research Unit, USDA-ARS
| | - D R Smith
- Grassland, Soil and Water Research Laboratory, USDA-ARS
| | - J Unrine
- Department of Plant and Soil Sciences, University of Kentucky
- Kentucky Water Resources Research Institute
| | - P Webb
- Department of Crop, Soil, and Environmental Sciences, University of Arkansas
| | - K E White
- Sustainable Agricultural Systems Lab, USDA-ARS
| | - H Wilson
- Agriculture and Agri-Food Canada, Science and Technology Branch, Brandon Research and Development Centre
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3
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Williams MR, Welikhe P, Bos J, King K, Akland M, Augustine D, Baffaut C, Beck EG, Bierer A, Bosch DD, Boughton E, Brandani C, Brooks E, Buda A, Cavigelli M, Faulkner J, Feyereisen G, Fortuna A, Gamble J, Hanrahan B, Hussain M, Kohmann M, Kovar J, Lee B, Leytem A, Liebig M, Line D, Macrae M, Moorman T, Moriasi D, Nelson N, Ortega-Pieck A, Osmond D, Pisani O, Ragosta J, Reba M, Saha A, Sanchez J, Silveira M, Smith D, Spiegal S, Swain H, Unrine J, Webb P, White K, Wilson H, Yasarer L. P-FLUX: A phosphorus budget dataset spanning diverse agricultural production systems in the United States and Canada. J Environ Qual 2022; 51:451-461. [PMID: 35373848 DOI: 10.1002/jeq2.20351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Quantifying spatial and temporal fluxes of phosphorus (P) within and among agricultural production systems is critical for sustaining agricultural production while minimizing environmental impacts. To better understand P fluxes in agricultural landscapes, P-FLUX, a detailed and harmonized dataset of P inputs, outputs, and budgets, as well as estimated uncertainties for each P flux and budget, was developed. Data were collected from 24 research sites and 61 production systems through the Long-term Agroecosystem Research (LTAR) network and partner organizations spanning 22 U.S. states and 2 Canadian provinces. The objectives of this paper are to (a) present and provide a description of the P-FLUX dataset, (b) provide summary analyses of the agricultural production systems included in the dataset and the variability in P inputs and outputs across systems, and (c) provide details for accessing the dataset, dataset limitations, and an example of future use. P-FLUX includes information on select site characteristics (area, soil series), crop rotation, P inputs (P application rate, source, timing, placement, P in irrigation water, atmospheric deposition), P outputs (crop removal, hydrologic losses), P budgets (agronomic budget, overall budget), uncertainties associated with each flux and budget, and data sources. Phosphorus fluxes and budgets vary across agricultural production systems and are useful resources to improve P use efficiency and develop management strategies to mitigate environmental impacts of agricultural systems. P-FLUX is available for download through the USDA Ag Data Commons (https://doi.org/10.15482/USDA.ADC/1523365).
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Affiliation(s)
- M R Williams
- National Soil Erosion Research Laboratory, USDA-ARS, West Lafayette, IN, USA
| | - P Welikhe
- National Soil Erosion Research Laboratory, USDA-ARS, West Lafayette, IN, USA
- Dep. of Agronomy, Purdue Univ., West Lafayette, IN, USA
| | - J Bos
- National Soil Erosion Research Laboratory, USDA-ARS, West Lafayette, IN, USA
| | - K King
- Soil Drainage Research Unit, USDA-ARS, Columbus, OH, USA
| | - M Akland
- Dep. of Plant and Soil Sciences, Univ. of Kentucky, Lexington, KY, USA
| | - D Augustine
- Rangeland Resources Research Unit, USDA-ARS, Fort Collins, CO, USA
| | - C Baffaut
- Cropping Systems and Water Quality Research Unit, USDA-ARS, Columbia, MO, USA
| | - E G Beck
- Kentucky Geological Survey, Univ. of Kentucky, Henderson, KY, USA
| | - A Bierer
- Northwest Irrigation and Soils Research Lab, USDA-ARS, Kimberly, ID, USA
| | - D D Bosch
- Southeast Watershed Research Laboratory, USDA-ARS, Tifton, GA, USA
| | - E Boughton
- Buck Island Ranch, Archbold Biological Station, Lake Placid, FL, USA
| | - C Brandani
- Dep. of Animal and Range Science, New Mexico State Univ., Las Cruces, NM, USA
| | - E Brooks
- Dep. of Soil and Water Resources, Univ. of Idaho, Moscow, ID, USA
| | - A Buda
- Systems and Watershed Management Research Unit, USDA-ARS, University Park, PA, USA
| | - M Cavigelli
- Sustainable Agricultural Systems Laboratory, USDA-ARS, Beltsville, MD, USA
| | - J Faulkner
- Dep. of Plant and Soil Science, Univ. of Vermont, Burlington, VT, USA
| | - G Feyereisen
- Soil and Water Management Unit, USDA-ARS, St. Paul, MN, USA
| | - A Fortuna
- Grazinglands Research Laboratory, USDA-ARS, El Reno, OK, USA
| | - J Gamble
- Soil and Water Management Unit, USDA-ARS, St. Paul, MN, USA
| | - B Hanrahan
- Soil Drainage Research Unit, USDA-ARS, Columbus, OH, USA
| | - M Hussain
- W.K. Kellogg Biological Station, Michigan State Univ., Hickory Corners, MI, USA
| | - M Kohmann
- Range Cattle Research and Education Center, Univ. of Florida, Ona, FL, USA
| | - J Kovar
- Agroecosystems Management Research, USDA-ARS, Ames, IA, USA
| | - B Lee
- Dep. of Plant and Soil Sciences, Univ. of Kentucky, Lexington, KY, USA
| | - A Leytem
- Northwest Irrigation and Soils Research Lab, USDA-ARS, Kimberly, ID, USA
| | - M Liebig
- Northern Great Plains Research Laboratory, USDA-ARS, Mandan, ND, USA
| | - D Line
- Dep. of Crop and Soil Sciences, North Carolina State Univ., Raleigh, NC, USA
| | - M Macrae
- Dep. of Geography and Environmental Management, Univ. of Waterloo, Waterloo, ON, Canada
| | - T Moorman
- Agroecosystems Management Research, USDA-ARS, Ames, IA, USA
| | - D Moriasi
- Grazinglands Research Laboratory, USDA-ARS, El Reno, OK, USA
| | - N Nelson
- Dep. of Agronomy, Kansas State Univ., Manhattan, KS, USA
| | - A Ortega-Pieck
- Dep. of Soil and Water Resources, Univ. of Idaho, Moscow, ID, USA
| | - D Osmond
- Dep. of Crop and Soil Sciences, North Carolina State Univ., Raleigh, NC, USA
| | - O Pisani
- Southeast Watershed Research Laboratory, USDA-ARS, Tifton, GA, USA
| | - J Ragosta
- USDA-ARS, Jornada Experimental Range, Las Cruces, NM, USA
| | - M Reba
- USDA-ARS, Delta Water Management Research Unit, Arkansas State Univ., Jonesboro, AR, USA
| | - A Saha
- Buck Island Ranch, Archbold Biological Station, Lake Placid, FL, USA
| | - J Sanchez
- Range Cattle Research and Education Center, Univ. of Florida, Ona, FL, USA
| | - M Silveira
- Range Cattle Research and Education Center, Univ. of Florida, Ona, FL, USA
| | - D Smith
- Grassland, Soil and Water Research Laboratory, USDA-ARS, Temple, TX, USA
| | - S Spiegal
- USDA-ARS, Jornada Experimental Range, Las Cruces, NM, USA
| | - H Swain
- Buck Island Ranch, Archbold Biological Station, Lake Placid, FL, USA
| | - J Unrine
- Dep. of Plant and Soil Sciences, Univ. of Kentucky, Lexington, KY, USA
| | - P Webb
- Dep. of Crop, Soil, and Environmental Sciences, Univ. of Arkansas, Fayetteville, AR, USA
| | - K White
- Sustainable Agricultural Systems Laboratory, USDA-ARS, Beltsville, MD, USA
| | - H Wilson
- Science and Technology Branch, Brandon Research and Development Centre, Agriculture and Agri-Food Canada, Brandon, MB, Canada
| | - L Yasarer
- National Sedimentation Laboratory, USDA-ARS, Oxford, MS, USA
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Mohammad KI, Al-Reda AN, Aldalaykeh M, Hayajneh W, Alafi KK, Creedy DK, Gamble J. Personal, professional and workplace factors associated with burnout in Jordanian midwives: A national study. Midwifery 2020; 89:102786. [PMID: 32619851 DOI: 10.1016/j.midw.2020.102786] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the prevalence of burnout and explore associated socio-demographic and work-related factors among Jordanian midwives. DESIGN A cross-sectional survey design. The survey tool included the Copenhagen Burnout Inventory (CBI) and socio-demographic and work-related data forms. SETTING All government-funded hospitals in Jordan (18 hospitals) that provide antenatal, labour and birth, or postnatal care for women. PARTICIPANTS A sample of 321 midwives participated. DATA ANALYSIS Frequencies, means, and standard deviations were calculated as appropriate on the demographic variables and scale scores. The CBI was assessed for internal consistency using Cronbach's alpha. Multiple regression analyses using backward elimination were undertaken to determine associations between variables and CBI subscales. An alpha level of 0.05 was used for all statistical tests. FINDINGS Over three-quarters of midwives reported personal (78.1%), work-related (82.2%), and client-related (71.3%) burnout (scored >50 on CBI). Compared to midwives aged between 21 - 30 years, those between 31 - 40 years of age scored on average a 11.75 (95% CI = 7.05 - 16.45) points lower personal burnout score. Married midwives had on average a 6.44 (95% CI = 1.57 - 11.31) points higher personal burnout score compared to single midwives. Midwives with ≥ 10 years' experience had on average a 4.29 (95% CI = 1.93 - 6.64), 5.27 (95% CI = 3.17 - 7.36), and 7.31 (95% CI = 4.84 - 9.78) points lower personal, work-related, and client-related burnout scores respectively compared to midwives with < 10 years' experience.Compared to midwives providing care for 1 - 5 women per shift, those providing care for > 10 women per shift reported 9.98 (95% CI = 6.06 - 13.90) and 5.35 (95% CI = 0.71 - 9.99) points higher work-related and client-related burnout scores respectively. Midwives who rotated between shifts had on average a 5.87 (95% CI = 1.27 - 10.48) and 11.2 (95% CI = 5.78 - 16.66) points higher work-related and client-related burnout scores respectively than those who did not rotate. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The high prevalence of burnout identifies the urgent need for a national plan to address midwives' psychological health in Jordan. Midwives should be appropriately trained to recognize the signs and symptoms of burnout in a timely way, and for support services to be offered. The government could consider implementing continuity of midwifery care models, reducing the administrative burden on midwives, and empowering them to work to their full scope of practice.
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Affiliation(s)
- K I Mohammad
- Maternal and Child Health and Midwifery Department, Faculty of Nursing, Jordan University of Science & Technology, Irbid, Jordan.
| | - A N Al-Reda
- Maternal and Child Health and Midwifery Department, Faculty of Nursing, Jordan University of Science & Technology, Irbid, Jordan.
| | - M Aldalaykeh
- Community and Mental Health Nursing Department, Faculty of Nursing, Jordan University of Science & Technology, Irbid, Jordan.
| | - W Hayajneh
- Educational Science Department, Irbid University College, Al-Balqa Applied University.
| | - K K Alafi
- Department of Management, The World Islamic Sciences and Education University, Amman, Jordan.
| | - D K Creedy
- Maternal, Newborn and Families Research Collaborative, Menzies Institute of Health Queensland, Griffith University, Brisbane, Australia.
| | - J Gamble
- Maternal, Newborn and Families Research Collaborative, Menzies Institute of Health Queensland, Griffith University, Brisbane, Australia.
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Monteiro C, Cojoianu A, Savage R, Bone R, Hammond C, Gamble J, Newton J. P214 Clinical audit of in-patient echocardiography in acute heart failure: real world data from a tertiary hospital. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.081] [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: 11/15/2022] Open
Abstract
Abstract
Background
Over the last ten years, an increase in admission rates for acute heart failure (HF) has been noted in England and Wales, with one year mortality rates varying between 30% and 60%. Transthoracic echocardiography (TTE) is recommended within 48 hours of admission for suspected acute heart failure, so to guide treatment accordingly.
Our centre has a specialist team who assesses patients with suspected HF on admission, and refers them for urgent in-patient TTE, using two priority in-patient echo slots per day. Patients are initially referred for HF assessment by general medics and geriatricians, across non-specialist medical wards. We audited the referrals and results of those who received TTE in this context.
Methods and results
We screened the medical notes of 252 patients admitted with suspected HF between January and December 2017, and reviewed the echocardiography results of those who received it during their admission.
50% of these patients were female and 59% were elderly (over 80 years old). 245 of these patients (97.2%) had in-patient echocardiography performed during their hospital stay. The mean wait for echocardiography was 0.58 days, with 92% of the scans being performed within 24 hours. The mean admission duration was 8.6 days (SD 10.9). 17.9% of patients were readmitted with suspected heart failure within six months, 69% of which were elderly.
The majority of this cohort presented with heart failure with preserved ejection fraction (HFpEF), 50%), followed by heart failure with reduced ejection fraction (HFrEF, 29%) and heart failure with mid-range ejection fraction (HFmrEF, 16%). 41% of the patients who received an echocardiogram were in atrial fibrillation, 51% of which were diagnosed with HFpEF.
All patients had their HF medical treatment optimised post-echocardiography and only 18.4% were readmitted within 6 months of the first admission. The majority of these patients was elderly (68.9%). 38.8% of patients who received echocardiography were referred for specialist clinic follow-up, with HFrEF patients more likely to be seen in this setting (42%).
Six-month mortality occurred in 19.8% of patients; cause of death (COD) was undocumented in 25.8% of cases. In those where a post-mortem was conducted, the main COD was HF (16.7%), followed by sepsis (13.6%), cardiac (6.1%) and respiratory arrest (6.1%). 66% of the deceased patients were elderly and 48% presented with HFpEF.
Conclusion
Our cohort is an accurate representation of the current HF statistics seen nationwide. Appropriate treatment was offered to the large majority of patients who received in-patient echocardiography within the first 24 hours of their admission, with low six-month readmission rates. This approach also allowed for the inclusion of these patients on a systematic review plan, including specialist cardiology follow-up. Our numbers are consistent with the higher awareness about HFpEF currently seen in the medical community.
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Affiliation(s)
- C Monteiro
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | | | - R Savage
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - R Bone
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - C Hammond
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J Gamble
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J Newton
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
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Toohill J, Fenwick J, Sidebotham M, Gamble J, Creedy DK. Trauma and fear in Australian midwives. Women Birth 2018; 32:64-71. [PMID: 29759933 DOI: 10.1016/j.wombi.2018.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 01/25/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Relatively little is known about the extent of trauma and birth-related fear in midwives and how this might affect practice. AIM (1) Determine prevalence of birth related trauma and fear in midwives and associations with midwives' confidence to advise women during pregnancy of their birth options and to provide care in labour. (2) Describe midwives' experiences of birth related trauma and/or fear. METHOD A mixed methods design. A convenience sample of midwives (n=249) completed an anonymous online survey. Descriptive and inferential statistics were used to analyse the quantitative data. Latent content analysis was used to extrapolate meaning from the 170 midwives who wrote about their experiences of personal and/or professional trauma. RESULTS The majority of midwives (93.6%) reported professional (n=199, 85.4%) and/or personal (n=97, 41.6%) traumatic birth experiences. Eight percent (n=20) reported being highly fearful of birth. Trauma was not associated with practice concerns but fear was. Midwives categorised as having 'high fear' reported more practice concerns (Med 23.5, n=20) than midwives with 'low fear' (Med 8, n=212) (U=1396, z=-3.79, p<0.001, r=0.24). Reasons for personal trauma included experiencing assault, intervention and stillbirth. Professional trauma related to both witnessing and experiencing disrespectful care and subsequently feeling complicit in the provision of poor care. Feeling unsupported in the workplace and fearing litigation intensified trauma. CONCLUSION High fear was associated with lower confidence to support childbearing women. Fear and trauma in midwives warrants further investigation to better understand the impact on professional practice.
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Affiliation(s)
- J Toohill
- School of Nursing and Midwifery, Griffith University, Australia.
| | - J Fenwick
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia; Clinical Chair, Gold Coast University Hospital, Australia.
| | - M Sidebotham
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | - J Gamble
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | - D K Creedy
- Menzies Health Institute Queensland, Griffith University, Australia.
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7
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Sieniewicz B, Behar J, Sohal M, Claridge S, Porter B, Niederer S, Gamble J, Betts TR, Jais P, Derval N, Spragg D, Steendijk P, Van Gelder B, Bracke FA, Rinaldi CA. 533Does targeting the site of maximal electrical delay result in the optimal haemodynamic improvement; results from an international multi-centre registry. Europace 2018. [DOI: 10.1093/europace/euy015.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Sieniewicz
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Behar
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - M Sohal
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - S Claridge
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - B Porter
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - S Niederer
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Gamble
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - T R Betts
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - P Jais
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - N Derval
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - D Spragg
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | - P Steendijk
- Leiden University Medical Center, Leiden, Netherlands
| | | | - F A Bracke
- Catharina Hospital, Eindhoven, Netherlands
| | - C A Rinaldi
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
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Sieniewicz B, Behar J, Sohal M, Porter B, Claridge S, Niederer S, Gamble J, Betts TR, Jais P, Derval N, Spragg D, Steendijk P, Van Gelder BERRY, Bracke FA, Rinaldi CA. 687Cardiomyoapthic aetiology affects the distribution of endocardial electrical latency; results from a multi-centre registry. Europace 2018. [DOI: 10.1093/europace/euy015.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Sieniewicz
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Behar
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - M Sohal
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - B Porter
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - S Claridge
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - S Niederer
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Gamble
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - T R Betts
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - P Jais
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - N Derval
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - D Spragg
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | - P Steendijk
- Leiden University Medical Center, Leiden, Netherlands
| | | | - F A Bracke
- Catharina Hospital, Eindhoven, Netherlands
| | - C A Rinaldi
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
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Gamble J, Pearce M, Kopparapu P, Jang HS, Tanguay R, Greenwood J, Kolluri S. Abstract P3-06-04: Bcl-2 functional converters inhibit tumor growth and metastatic potential in zebrafish xenografts. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-06-04] [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: 11/16/2022]
Abstract
Abstract
While potential therapies might have pronounced success in the simplified settings in cell culture medium, many drugs fail or underperform when cancer cells are encased in a complex 3D microenvironment. Although, rat and mouse models will continue to be the gold standard for in vivo data in drug discovery, zebrafish xenograft models have emerged as a powerful model that can quickly and efficiently deliver in vivo drug efficacy data before commitment to expensive and time consuming rodent models. We have discovered several compounds that work as B-cell lymphoma 2 (Bcl-2) functional converters and activate Bcl-2 into a killer instead of its native anti-apoptotic role. In this study, we use a zebrafish xenograft model to evaluate the ability of these compounds to inhibit xenograft tumor growth of Bcl-2 expressing cancer cells, including triple negative breast cancers. Live fluorescent imaging of cancer cells within zebrafish embryos revealed a decrease in cancer cell growth while under treatment of compounds. Furthermore, the agents that converted Bcl-2 into pro-apoptotic protein also inhibited the metastatic potential of the cancer cells. Therefore, this study demonstrates zebrafish xenograft techniques that can be used to quickly and efficiently obtain in vivo drug discovery data. Moreover, we report novel Bcl-2 functional converter compounds that can effectively reduce xenograft tumor growth and its ability to invade tissue in a living 3D environment and establish the role of Bcl-2 in cancer progression.
Citation Format: Gamble J, Pearce M, Kopparapu P, Jang HS, Tanguay R, Greenwood J, Kolluri S. Bcl-2 functional converters inhibit tumor growth and metastatic potential in zebrafish xenografts [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-06-04.
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Affiliation(s)
- J Gamble
- Oregon State University, Corvallis, OR
| | - M Pearce
- Oregon State University, Corvallis, OR
| | | | - HS Jang
- Oregon State University, Corvallis, OR
| | - R Tanguay
- Oregon State University, Corvallis, OR
| | | | - S Kolluri
- Oregon State University, Corvallis, OR
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Sawhney V, Domenichini G, Baker V, John S, Gamble J, FurnIss G, Panagopoulos D, Campbell N, Rajappan K, Lambiase P, Sporton S, Earley MJ, Dhinoja M, Haywood G, Hunter RJ, Schilling RJ. 21Thromboembolic events in left ventricular endocardial pacing: long-term outcomes from a Multicentre UK registry. Europace 2017. [DOI: 10.1093/europace/eux283.030] [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: 11/12/2022] Open
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Toohill J, Callander E, Gamble J, Creedy DK, Fenwick J. A cost effectiveness analysis of midwife psycho-education for fearful pregnant women - a health system perspective for the antenatal period. BMC Pregnancy Childbirth 2017; 17:217. [PMID: 28693447 PMCID: PMC5504805 DOI: 10.1186/s12884-017-1404-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Psycho-education can reduce childbirth fear and caesarean section numbers. This study determines the cost-effectiveness of a midwife-led psycho-education intervention for women fearful of birth. Method One thousand four hundred ten pregnant women in south-east Queensland, Australia were screened for childbirth fear (W-DEQ A ≥ 66). Women with high scores (n = 339) were randomised to the BELIEF Study (Birth Emotions and Looking to Improve Expectant Fear) to receive psycho-education (n = 170) at 24 and 34 weeks of pregnancy or to the control group (n = 169). Women in both groups were surveyed 6 weeks postpartum with total cost for health service use during pregnancy calculated. Logistic regression models assessed the odds ratio of having vaginal birth or caesarean section in the study groups. Result Of 339 women randomised, 184 (54%) women returned data at 6 weeks postpartum (Intervention Group n = 91; Control Group n = 93). Women receiving psycho-education had a higher likelihood of vaginal birth compared to controls (n = 60, 66% vs. n = 54, 58%; OR 2.34). Mean ‘treatment’ cost for women receiving psycho-education was AUS$72. Mean cost for health services excluding the cost of psycho-education, was less in the intervention group (AUS$1193 vs. AUS$1236), but not significant (p = 0.78). For every five women who received midwife counselling, one caesarean section was averted. The incremental healthcare cost to prevent one caesarean section using this intervention was AUS$145. Conclusion Costs of delivering midwife psycho-education to women with childbirth fear during pregnancy are offset by improved vaginal birth rates and reduction in caesarean section numbers. Trial registration Australian New Zealand Controlled Trials Registry ACTRN12612000526875, 17th May 2012 (retrospectively registered one week after enrolment of first participant).
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Affiliation(s)
- J Toohill
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia. .,Office of the Chief Nursing and Midwifery Officer, Queensland Department of Health, Brisbane, 4001, Australia.
| | - E Callander
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, 4812, Australia
| | - J Gamble
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia
| | - D K Creedy
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia
| | - J Fenwick
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia.,Gold Coast University Hospital, Southport, 4215, Australia
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12
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Sawhney V, Domenichini G, Gamble J, Furniss G, Panagopoulos D, Campbell N, Lowe M, Lambiase P, Haywood G, Sporton S, Earley MJ, Dhinoja M, Hunter R, Betts T, Schilling RJ. 239Long-Term follow-up of thromboembolic complications in left ventricular endocardial pacing: outcomes from a multi centre uk registry. Europace 2017. [DOI: 10.1093/ehjci/eux139.006] [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: 11/13/2022] Open
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13
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Sieniewicz B, Behar J, Sohal M, Gamble J, Betts TR, Jais P, Derval N, Spragg D, Steendijk P, Van Gelder B, Bracke F, Rinaldi A. 807Identifying the optimal location for LV endocardial pacing: results from a multicentre international registry. Europace 2017. [DOI: 10.1093/ehjci/eux149.002] [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: 11/12/2022] Open
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14
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Sieniewicz B, Behar J, Sohal M, Gamble J, Betts TR, Jais P, Derval N, Spragg D, Steendijk P, Van Gleder B, Bracke F, Rinaldi CA. P260Electrical latency (Q-LV) predicts the optimal LV endocardial pacing site; results from a multi-centre registry. Europace 2017. [DOI: 10.1093/ehjci/eux171.015] [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: 11/12/2022] Open
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15
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Sieniewicz B, Behar J, Sohal M, Gamble J, Betts TR, Jais P, Derval N, Spragg D, Steendijk P, Van Gelder B, Bracke F, Rinaldi CA. P998Paced QRS duration predicts the optimal LV endocardial pacing site; results from a multi-centre registry. Europace 2017. [DOI: 10.1093/ehjci/eux151.179] [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: 11/13/2022] Open
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Fenwick J, Brittain H, Gamble J. Australian private midwives with hospital visiting rights in Queensland: Structures and processes impacting clinical outcomes. Women Birth 2017; 30:497-505. [PMID: 28522387 DOI: 10.1016/j.wombi.2017.05.001] [Citation(s) in RCA: 7] [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: 02/09/2017] [Revised: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Reporting the outcomes for women and newborns accessing private midwives with visiting rights in Australia is important, especially since this data cannot currently be disaggregated from routinely collected perinatal data. AIM 1) Evaluate the outcomes of women and newborns cared for by midwives with visiting access at one Queensland facility and 2) explore private midwives views about the structures and processes contributing to clinical outcomes. METHODS Mixed methods. An audit of the 'all risk' 529 women receiving private midwifery care. Data were compared with national core maternity variables using Chi square statistics. Telephone interviews were conducted with six private midwives and data analysed using thematic analysis. FINDINGS Compared to national data, women with a private midwife were significantly more likely to be having a first baby (49.5% vs 43.6% p=0.007), to commence labour spontaneously (84.7% vs 52.7%, p<0.001), experience a spontaneous vaginal birth (79% vs 54%, p<0.001) and not require pharmacological pain relief (52.9% vs 23.1%, p<0.001). The caesarean section rate was significantly lower than the national rate (13% vs 32.8%, p<0.001). In addition fewer babies required admission to the Newborn Care Unit (5.1% vs 16%, p<0.001). Midwives were proud of their achievements. Continuity of care was considered fundamental to achieving quality outcomes. Midwives valued the governance processes embedded around the model. CONCLUSIONS Private midwives with access to the public system is safe. Ensuring national data collection accurately captures outcomes relative to model of care in both the public and private sector should be prioritised.
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Affiliation(s)
- J Fenwick
- Menzies Health Institute Queensland: Maternal, Newborn and Families Research Group, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Australia; Women-Newborn-Children Services Gold Coast University Hospital, Maternal, Newborn and Families Research Group, Australia.
| | - H Brittain
- Women-Newborn-Children Services Gold Coast University Hospital, Maternal, Newborn and Families Research Group, Australia.
| | - J Gamble
- Menzies Health Institute Queensland: Maternal, Newborn and Families Research Group, School of Nursing & Midwifery, Griffith University, Australia.
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Fitzsimons D, Mullan D, Wilson J, Chew E, Conway B, Corcoran B, Gamble J, Hanna L, Mcmullan G, Mcma-Hon M, Mulholland P, Stewart C, Stockdale P. 1375: The palliative care needs of patients with heart failure from the perspective of the patient, carer and clinical team. Eur J Cardiovasc Nurs 2017. [DOI: 10.1177/14745151060050s163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D. Fitzsimons
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
- Institute of Nursing Research, University of Ulster
| | - D. Mullan
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - J. Wilson
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - E. Chew
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - B. Conway
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - B. Corcoran
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - J. Gamble
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - L. Hanna
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - G. Mcmullan
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - M. Mcma-Hon
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - P. Mulholland
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - C. Stewart
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - P. Stockdale
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
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Creedy DK, Sidebotham M, Gamble J, Pallant J, Fenwick J. Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey. BMC Pregnancy Childbirth 2017; 17:13. [PMID: 28068942 PMCID: PMC5223536 DOI: 10.1186/s12884-016-1212-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 12/29/2016] [Indexed: 11/24/2022] Open
Abstract
Background The health and wellbeing of midwives are important considerations for workforce retention and quality care. The occurrence and relationships among mental health conditions such as burnout and depression have received little attention. We investigated the prevalence of burnout, depression, anxiety and stress in Australian midwives. Methods An online survey was conducted in September 2014. Participants were recruited through the Australian College of Midwives and professional networks. The survey sought personal and professional details. Standard measures included the Copenhagen Burnout Inventory (CBI) (Personal, Work and Client subscales), and Depression, Anxiety, and Stress Scale (DASS). The sample was collapsed into two groups according to DASS clinical cut-offs (normal/mild versus moderate/severe/extreme). Effect size statistics were calculated and judged according to Cohen’s guidelines. Results One thousand thirty-seven surveys were received. Respondents were predominantly female (98%), with an average age of 46.43 years, and 16.51 years of practice. Using a CBI subscale cut-off score of 50 and above (moderate and higher), 64.9% (n = 643) reported personal burnout; 43.8% (n = 428) reported work-related burnout; and 10.4% (n = 102) reported client-related burnout. All burnout subscales were significantly correlated with depression, anxiety and stress, particularly personal and work-related burnout with Spearman’s rho correlations ranging from .51 to .63 (p < .001). Around 20% of midwives reported moderate/ severe/ extreme levels of depression (17.3%); anxiety (20.4%), and stress (22.1%) symptoms. Mann-Whitney U tests revealed significant differences between groups with depression (r = .43), anxiety (r = .41) and stress (r = 48) having a medium size effect on burnout. Conclusion Prevalence of personal and work-related burnout in Australian midwives was high. The physical and psychological exhaustion associated with the different types of burnout were reflected in symptoms of depression, anxiety and stress symptoms. Further research is needed to support the personal well-being of midwives and minimize workplace burnout by developing short and long term strategies. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1212-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D K Creedy
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia.
| | - M Sidebotham
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia
| | - J Gamble
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia
| | - Julie Pallant
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia
| | - J Fenwick
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia.,Gold Coast University Hospital, Southport, Australia
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West R, Gamble J, Kelly J, Milne T, Duffy E, Sidebotham M. Culturally capable and culturally safe: Caseload care for Indigenous women by Indigenous midwifery students. Women Birth 2016; 29:524-530. [DOI: 10.1016/j.wombi.2016.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/29/2016] [Accepted: 05/09/2016] [Indexed: 11/16/2022]
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Pallant JF, Haines HM, Green P, Toohill J, Gamble J, Creedy DK, Fenwick J. Assessment of the dimensionality of the Wijma delivery expectancy/experience questionnaire using factor analysis and Rasch analysis. BMC Pregnancy Childbirth 2016; 16:361. [PMID: 27871320 PMCID: PMC5117613 DOI: 10.1186/s12884-016-1157-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/14/2016] [Indexed: 12/04/2022] Open
Abstract
Background Fear of childbirth has negative consequences for a woman's physical and emotional wellbeing. The most commonly used measurement tool for childbirth fear is the Wijma Delivery Expectancy Questionnaire (WDEQ-A). Although originally conceptualized as unidimensional, subsequent investigations have suggested it is multidimensional. This study aimed to undertake a detailed psychometric assessment of the WDEQ-A; exploring the dimensionality and identifying possible subscales that may have clinical and research utility. Methods WDEQ-A was administered to a sample of 1410 Australian women in mid-pregnancy. The dimensionality of WDEQ-A was explored using exploratory (EFA) and confirmatory factor analysis (CFA), and Rasch analysis. Results EFA identified a four factor solution. CFA failed to support the unidimensional structure of the original WDEQ-A, but confirmed the four factor solution identified by EFA. Rasch analysis was used to refine the four subscales (Negative emotions: five items; Lack of positive emotions: five items; Social isolation: four items; Moment of birth: three items). Each WDEQ-A Revised subscale showed good fit to the Rasch model and adequate internal consistency reliability. The correlation between Negative emotions and Lack of positive emotions was strong, however Moment of birth and Social isolation showed much lower intercorrelations, suggesting they should not be added to create a total score. Conclusion This study supports the findings of other investigations that suggest the WDEQ-A is multidimensional and should not be used in its original form. The WDEQ-A Revised may provide researchers with a more refined, psychometrically sound tool to explore the differential impact of aspects of childbirth fear. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1157-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J F Pallant
- Department of Rural Health, The University of Melbourne, Graham St, Shepparton, Australia
| | - H M Haines
- Department of Rural Health, The University of Melbourne, Graham St, Shepparton, Australia.
| | - P Green
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - J Toohill
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - J Gamble
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - D K Creedy
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - J Fenwick
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia.,Gold Coast University Hospital Southport, Queensland, 4215, Australia
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Cullen D, Sidebotham M, Gamble J, Fenwick J. Young student's motivations to choose an undergraduate midwifery program. Women Birth 2016; 29:234-9. [DOI: 10.1016/j.wombi.2015.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/25/2015] [Accepted: 10/28/2015] [Indexed: 11/30/2022]
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Tickle N, Sidebotham M, Fenwick J, Gamble J. Women's experiences of having a Bachelor of Midwifery student provide continuity of care. Women Birth 2016; 29:245-51. [DOI: 10.1016/j.wombi.2015.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 10/26/2015] [Accepted: 11/02/2015] [Indexed: 11/25/2022]
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Fenwick J, Cullen D, Gamble J, Sidebotham M. Being a young midwifery student: A qualitative exploration. Midwifery 2016; 39:27-34. [PMID: 27321717 DOI: 10.1016/j.midw.2016.04.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 02/21/2016] [Accepted: 04/24/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND undergraduate midwifery programmes offer opportunities for school leavers and young people (aged less than 21 years) to enter the profession. There is limited research exploring this age groups experience of their Bachelor of Midwifery programme. In order to retain these students we need to ensure that their experiences of undertaking a Bachelor of Midwifery program are positive and barriers and challenges are minimised. AIM this study explored young midwifery students' experience of their Bachelor of Midwifery program. METHOD a descriptive exploratory qualitative approach was used to explore the experiences of eleven students aged 20 years or less on enrolment. Data was collected using face-to-face or telephone-recorded interviews. Thematic analysis was used to analysis the data set. FINDINGS three major themes described the young students' experiences. The first labelled 'The challenges of being young' presented a number of age related challenges including transport issues with on-call commitments as some students had not gained a driver's license. Students experienced some degree of prejudice relating to their age from their older student peers and some clinical staff during placements. 'Finding your way' was the second theme and described the strategies students used to build confidence and competence both in the university and clinical environment. The young students reported a strong commitment to the profession. They demonstrated high levels of connection with women and found the continuity of care experiences invaluable to their learning. The final theme 'Making the transition from teenager to midwife' demonstrated some unique insights into how studying to become a midwife impacted upon their personal and professional growth. CONCLUSION the young students in this study encountered some unique issues related to their age. However as they progressed through the program they developed confidence in themselves and visualised themselves as having a long midwifery career. They were strongly motivated towards providing woman-centred maternity care and considered their continuity of care experiences fundamental to them developing a strong sense of themselves as midwives. Attracting and retaining young students is essential if the profession is to realise its goal of ensuring all women have access to a known midwife.
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Affiliation(s)
- J Fenwick
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Australia.
| | - D Cullen
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Australia
| | - J Gamble
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | - M Sidebotham
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
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Riley BL, Robinson KL, Gamble J, Finegood DT, Sheppard D, Penney TL, Best A. Knowledge to action for solving complex problems: insights from a review of nine international cases. Health Promot Chronic Dis Prev Can 2016; 35:47-53. [PMID: 25970804 DOI: 10.24095/hpcdp.35.3.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Solving complex problems such as preventing chronic diseases introduces unique challenges for the creation and application of knowledge, or knowledge to action (KTA). KTA approaches that apply principles of systems thinking are thought to hold promise, but practical strategies for their application are not well understood. In this paper we report the results of a scan of systems approaches to KTA with a goal to identify how to optimize their implementation and impact. METHODS A 5-person advisory group purposefully selected 9 initiatives to achieve diversity on issues addressed and organizational forms. Information on each case was gathered from documents and through telephone interviews with primary contacts within each organization. Following verification of case descriptions, an inductive analysis was conducted within and across cases. RESULTS The cases revealed 5 guidelines for moving from conceiving KTA systems to implementing them: (1) establish and nurture relationships, (2) co-produce and curate knowledge, (3) create feedback loops, (4) frame as systems interventions rather than projects, and (5) consider variations across time and place. CONCLUSION Results from the environmental scan are a modest start to translating systems concepts for KTA into practice. Use of the strategies revealed in the scan may improve KTA for solving complex public health problems. The strategies themselves will benefit from the development of a science that aims to understand adaptation and ongoing learning from policy and practice interventions, strengthens enduring relationships, and fills system gaps in addition to evidence gaps. Systems approaches to KTA will also benefit from robust evaluations.
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Affiliation(s)
- B L Riley
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada
| | - K L Robinson
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - J Gamble
- Imprint Consulting, Hampton, New Brunswick, Canada
| | - D T Finegood
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - D Sheppard
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - T L Penney
- Cambridge University, Cambridge, United Kingdom
| | - A Best
- InSource Research Group, Vancouver, British Columbia, Canada
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Turkstra E, Creedy DK, Fenwick J, Buist A, Scuffham PA, Gamble J. Health services utilization of women following a traumatic birth. Arch Womens Ment Health 2015; 18:829-32. [PMID: 25577338 DOI: 10.1007/s00737-014-0495-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 09/29/2014] [Accepted: 12/24/2014] [Indexed: 10/24/2022]
Abstract
This cohort study compared 262 women with high childbirth distress to 138 non-distressed women. At 12 months, high distress women had lower health-related quality of life compared to non-distressed women (EuroQol five-dimensional (EQ-5D) scale 0.90 vs. 0.93, p = 0.008), more visits to general practitioners (3.5 vs. 2.6, p = 0.002) and utilized more additional services (e.g. maternal health clinics), with no differences for infants. Childbirth distress has lasting adverse health effects for mothers and increases health-care utilization.
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Affiliation(s)
- E Turkstra
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia. .,Griffith Health Institute, Griffith University, Queensland, Australia.
| | - D K Creedy
- Griffith Health Institute, Griffith University, Queensland, Australia.
| | - J Fenwick
- Griffith Health Institute, Griffith University and Gold Coast Hospital, Queensland, Australia.
| | - A Buist
- University of Melbourne, Melbourne, Australia.
| | - P A Scuffham
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia. .,Griffith Health Institute, Griffith University, Queensland, Australia.
| | - J Gamble
- Griffith Health Institute, Griffith University, Queensland, Australia.
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Behar J, Behar J, Providência R, Cronbach P, Siddiqui S, Brough C, Ara F, Newham W, Ng F, Ayala-Paredes F, Withers K, Hayward C, Chin H, Fearn S, Omerod J, Gamble J, Foley P, Bostock J, Claridge S, Jackson T, Sohal M, Razavi R, Betts T, Herring N, Rinaldi C, Pourmorteza A, McVeigh E, Niederer S, Claridge S, Jackson T, Sohal M, Preston R, Carr-White G, Razavi R, Rajani R, Rinaldi C, Boveda S, Defaye P, Barra S, Babu G, Ang R, Algalarrondo V, Bouzeman A, Ahsan S, Deharo JC, Sporton S, Segal O, Klug D, Lambiase P, Sadoul N, Agarwal S, Piot O, Chow A, Périer M, Fauchier L, Babuty D, Lowe M, Leclercq C, Bordachar P, Marijon E, Wilson D, Panfilo D, Greenhut S, Stegemann B, Morgan J, Nicolson W, Li A, Behr E, Ng G, Raman G, Belchambers S, Rao A, Wright D, John I, Crockford C, Kaba R, Begg G, Tayebjee M, Leong K, Hu M, Kanapeckaite L, Roney C, Lim P, Harding S, Peters N, Varnava A, Kanagaratnam P, Roux JF, Badra M, White J, Lencioni M, Carolan-Rees G, Patrick H, Griffith M, Patel H, Spiesshoefer J, Morley-Smith A, Patel K, Rosen S, DiMario C, Lyon A, Cowie M. Devices & Sudden death. Europace 2015; 17:v10-v13. [PMCID: PMC4892105 DOI: 10.1093/europace/euv331] [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: 09/05/2023] Open
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Haines HM, Pallant JF, Fenwick J, Gamble J, Creedy DK, Toohill J, Hildingsson I. Identifying women who are afraid of giving birth: A comparison of the fear of birth scale with the WDEQ-A in a large Australian cohort. Sex Reprod Healthc 2015; 6:204-10. [PMID: 26614602 DOI: 10.1016/j.srhc.2015.05.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/01/2015] [Accepted: 05/11/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND The WDEQ-A is the most widely used measure of childbirth fear in pregnant women; however there is increasing discussion in the literature that simpler, more culturally transferrable tools may offer a better solution to identifying fearful women in clinical practice. AIM To compare the two item Fear of Birth Scale (FOBS) with the 33 item WDEQ-A in a large cohort of Australian pregnant women. METHOD Self-report questionnaires during second trimester including Wijma Delivery Expectancy Questionnaire (WDEQ-A) and Fear of Birth Scale (FOBS). Correlation of FOBS and WDEQ-A was tested using Spearman's correlation coefficients. Receiver operating characteristic (ROC) curve assessed the sensitivity and specificity of possible cut-points on the FOBS against WDEQ-A cut-point of ≥85. Sensitivity, specificity, positive and negative predictive values were determined. Fearful and non-fearful women as classified by both instruments were compared for differences in demographic, psycho-social and obstetric characteristics. RESULTS 1410 women participated. The correlation between the instruments was strong (Spearman's Rho = 0.66, p < 0.001). The area under the ROC was 0.89 indicating high sensitivity with a FOBS cut-point of 54. Sensitivity was 89%, specificity 79% and Youden index 0.68. Positive predictive value was 85% and negative predictive value 79%. Both instruments identified high fear as significantly associated with first time mothers, previous emergency caesarean and women with self-reported anxiety and/or depression. Additionally FOBS identified a significant association between fearful women and preference for caesarean. CONCLUSION This study supports the use of the FOBS in clinical practice to identify childbirth fear in pregnant women.
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Affiliation(s)
- H M Haines
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Rural Health Academic Centre, The University of Melbourne, 49 Graham St, Shepparton, Victoria, Australia; Northeast Health, Green St, Wangaratta, Victoria, Australia.
| | - J F Pallant
- Rural Health Academic Centre, The University of Melbourne, 49 Graham St, Shepparton, Victoria, Australia
| | - J Fenwick
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia; Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland 4215, Australia
| | - J Gamble
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - D K Creedy
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - J Toohill
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - I Hildingsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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McNair E, Marcoux JA, Bally C, Gamble J, Thomson D. Bivalirudin as an adjunctive anticoagulant to heparin in the treatment of heparin resistance during cardiopulmonary bypass-assisted cardiac surgery. Perfusion 2015; 31:189-99. [PMID: 25934498 DOI: 10.1177/0267659115583525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 01/08/2023]
Abstract
Heparin resistance (unresponsiveness to heparin) is characterized by the inability to reach acceptable activated clotting time values following a calculated dose of heparin. Up to 20% of the patients undergoing cardiothoracic surgery with cardiopulmonary bypass using unfractionated heparin (UFH) for anticoagulation experience heparin resistance. Although UFH has been the "gold standard" for anticoagulation, it is not without its limitations. It is contraindicated in patients with confirmed heparin-induced thrombocytopenia (HIT) and heparin or protamine allergy. The safety and efficacy of the use of the direct thrombin inhibitor bivalirudin for anticoagulation during cardiac surgery has been reported. However, there have been no reports on the treatment of heparin resistance with bivalirudin during CPB. In this review, we report the favorable outcome of our single-center experience with the alternative use of bivalirudin in the management of anticoagulation of heparin unresponsive patients undergoing coronary artery bypass graft surgery.
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Affiliation(s)
- E McNair
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, Saskatoon, SK, Canada
| | - J-A Marcoux
- Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, Saskatoon, SK, Canada
| | - C Bally
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - J Gamble
- Department of Anesthesiology and Pain Management, College of Medicine and Saskatoon Health Region, Saskatoon, SK, Canada
| | - D Thomson
- Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, Saskatoon, SK, Canada
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Fenwick J, Toohill J, Creedy D, Smith J, Gamble J. Sources, responses and moderators of childbirth fear in Australian women: A qualitative investigation. Midwifery 2015; 31:239-46. [DOI: 10.1016/j.midw.2014.09.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/29/2014] [Accepted: 09/04/2014] [Indexed: 11/29/2022]
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Herring N, Gamble J, Jubb S, Lent E, Foley PWX, Khiani R, Ginks MR, Rajappan K, Bashir Y, Betts TR. 11 * Real world performance of quadripolar compared to bipolar left ventricular pacing leads. Europace 2014. [DOI: 10.1093/europace/euu237.5] [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: 11/13/2022] Open
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Abstract
BACKGROUND Birth weight is a good indicator of mothers' and neonates' nutritional status, and it contributes to the newborn baby's survival, health, growth and development. AIM This study identified social factors associated with differences in the mean birth weight of newborn babies in Jordan. METHODS This retrospective study analysed medical records to determine possible risk factors associated with differences in newborn BW in the Irbid governorate of Jordan. All full-term singleton births during the year 2010 were reviewed. Abstracted data included mother's age, educational level, and monthly family income. Newborn information included birth weight, gender and birth order. RESULTS A total of 5414 full-term singleton births were included. Of these, 15.1% were low birth weight, 73.6% were normal birth weight, and 11.3% were high birth weight. Bivariate analysis of variance revealed that low mean birth weight was associated with female gender, first-born babies, higher maternal age (>35 years), lower educational level and lower income (<500 JD). Multivariate analysis of variance revealed that mean birth weight was lower in female infants, first-born infants, infants of less educated mothers, higher age and low monthly income. LIMITATIONS The findings can be generalized to full-term singleton pregnancies in countries who share similar cultural and traditional values. CONCLUSION Education of mothers is a modifiable variable that can positively influence birth weight, particularly in the case of female and first-born infants. IMPLICATION FOR NURSING AND HEALTH POLICY The findings inform our understanding of some social factors affecting birth weights of neonates in Jordan and development of effective public health interventions that could reduce the adverse effects of such factors on newborn birth weight. Preconception and antenatal care is also important for early detection of such possible risk and targeting mothers who require early interventions and support.
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Affiliation(s)
- K Mohammad
- Maternal and Child Health and Midwifery Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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Abstract
BACKGROUND Dissatisfaction with childbirth care can have a negative impact on a woman's health and well-being, as well as her relationships with her infant. AIM To investigate the prevalence and associated factors of dissatisfaction with intrapartum care by Jordanian women. METHOD A descriptive cross-sectional study was used. Participants (n = 320) who were 7 weeks post-partum were recruited from five maternal and child health centres in Irbid city in northern Jordan. Participants provided personal and obstetric information, and completed the Satisfaction with Childbirth Care Scale. RESULTS The majority of women (75.6%) were dissatisfied with their intrapartum care. Dissatisfaction was associated with the attendance of unknown and unwanted persons during childbirth, experiencing labour as more painful than expected, and perceptions of inadequate help from healthcare providers to manage pain during labour. LIMITATIONS Findings are limited to Jordanian women accessing public sector perinatal health services. CONCLUSION The high percentage of women reporting dissatisfaction with intrapartum care in this study is of concern. Women's perception of pain and expectations of staff during labour and birth need to be addressed through education and improved communication by staff. IMPLICATIONS FOR NURSING AND HEALTH POLICY Development of national evidence-based policies and quality assurance systems would help reduce the rate of obstetric interventions and give greater emphasis to respect for women's preferences during labour and birth.
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Affiliation(s)
- K I Mohammad
- Department of Maternal & Child Health, Jordan University of Science and Technology (JUST), Irbid, Jordan
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Turkstra E, Gamble J, Creedy DK, Fenwick J, Barclay L, Buist A, Ryding EL, Scuffham PA. PRIME: impact of previous mental health problems on health-related quality of life in women with childbirth trauma. Arch Womens Ment Health 2013; 16:561-4. [PMID: 24091921 DOI: 10.1007/s00737-013-0384-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 05/15/2013] [Accepted: 09/15/2013] [Indexed: 11/27/2022]
Abstract
We investigated the impact of pre-existing mental ill health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers' Emotions; n = 137) or parenting support (n = 125) at birth and 6 weeks. The EuroQol Five dimensional (EQ-5D)-measured health-related quality of life at 6 weeks, 6 and 12 months. At 12 months, EQ-5D was better for women without mental health problems receiving PRIME (mean difference (MD) 0.06; 95 % confidence interval (CI) 0.02 to 0.10) or parenting support (MD 0.08; 95 % CI 0.01 to 0.14). Pre-existing mental health conditions influence quality of life in women with childbirth trauma.
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Affiliation(s)
- E Turkstra
- Centre for Applied Health Economics, Griffith Health Institute, Griffith University, Brisbane, QLD, Australia,
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Nguyen LS, Jolly L, Shoubridge C, Chan WK, Huang L, Laumonnier F, Raynaud M, Hackett A, Field M, Rodriguez J, Srivastava AK, Lee Y, Long R, Addington AM, Rapoport JL, Suren S, Hahn CN, Gamble J, Wilkinson MF, Corbett MA, Gecz J. Transcriptome profiling of UPF3B/NMD-deficient lymphoblastoid cells from patients with various forms of intellectual disability. Mol Psychiatry 2012; 17:1103-15. [PMID: 22182939 PMCID: PMC4281019 DOI: 10.1038/mp.2011.163] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [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: 08/01/2011] [Revised: 09/27/2011] [Accepted: 10/24/2011] [Indexed: 11/09/2022]
Abstract
The nonsense-mediated mRNA decay (NMD) pathway was originally discovered by virtue of its ability to rapidly degrade aberrant mRNAs with premature termination codons. More recently, it was shown that NMD also directly regulates subsets of normal transcripts, suggesting that NMD has roles in normal biological processes. Indeed, several NMD factors have been shown to regulate neurological events (for example, neurogenesis and synaptic plasticity) in numerous vertebrate species. In man, mutations in the NMD factor gene UPF3B, which disrupts a branch of the NMD pathway, cause various forms of intellectual disability (ID). Using Epstein Barr virus-immortalized B cells, also known as lymphoblastoid cell lines (LCLs), from ID patients that have loss-of-function mutations in UPF3B, we investigated the genome-wide consequences of compromised NMD and the role of NMD in neuronal development and function. We found that ~5% of the human transcriptome is impacted in UPF3B patients. The UPF3B paralog, UPF3A, is stabilized in all UPF3B patients, and partially compensates for the loss of UPF3B function. Interestingly, UPF3A protein, but not mRNA, was stabilised in a quantitative manner that inversely correlated with the severity of patients' phenotype. This suggested that the ability to stabilize the UPF3A protein is a crucial modifier of the neurological symptoms due to loss of UPF3B. We also identified ARHGAP24, which encodes a GTPase-activating protein, as a canonical target of NMD, and we provide evidence that deregulation of this gene inhibits axon and dendrite outgrowth and branching. Our results demonstrate that the UPF3B-dependent NMD pathway is a major regulator of the transcriptome and that its targets have important roles in neuronal cells.
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Affiliation(s)
- LS Nguyen
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Department of Genetic Medicine, SA Pathology, Adelaide, SA, Australia
| | - L Jolly
- Department of Genetic Medicine, SA Pathology, Adelaide, SA, Australia
| | - C Shoubridge
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Department of Genetic Medicine, SA Pathology, Adelaide, SA, Australia
| | - WK Chan
- Department of Bioinformatics and Computational Biology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - L Huang
- Department of Reproductive Medicine, University of California, San Diego, CA, USA
| | - F Laumonnier
- INSERM, U930, Tours, France
- CNRS, ERL3106, Tours, France
- University Francois-Rabelais, UMR ‘Imaging and Brain’, Tours, France
| | - M Raynaud
- INSERM, U930, Tours, France
- University Francois-Rabelais, UMR ‘Imaging and Brain’, Tours, France
- CHRU de Tours, Service de Genetique, Tours, France
| | - A Hackett
- GOLD Service, Hunter Genetics, Newcastle, Australia
| | - M Field
- GOLD Service, Hunter Genetics, Newcastle, Australia
| | - J Rodriguez
- J.C. Self Research Institute, Greenwood Genetic Centre, Greenwood, SC, USA
| | - AK Srivastava
- J.C. Self Research Institute, Greenwood Genetic Centre, Greenwood, SC, USA
| | - Y Lee
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - R Long
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - AM Addington
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - JL Rapoport
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - S Suren
- Human Developmental Biology Resource, Neural Development Unit, UCL Institute of Child Health, London, UK
| | - CN Hahn
- Department of Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia
| | - J Gamble
- Centenary Institute of Cancer Medicine & Cell Biology, University of Sydney, NSW, Australia
| | - MF Wilkinson
- Department of Reproductive Medicine, University of California, San Diego, CA, USA
| | - MA Corbett
- Department of Genetic Medicine, SA Pathology, Adelaide, SA, Australia
| | - J Gecz
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Department of Genetic Medicine, SA Pathology, Adelaide, SA, Australia
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Hausman GJ, Barb CR, Fairchild BD, Gamble J, Lee-Rutherford L. Expression of genes for interleukins, neuropeptides, growth hormone receptor, and leptin receptor in adipose tissue from growing broiler chickens. Domest Anim Endocrinol 2012; 43:260-3. [PMID: 22560177 DOI: 10.1016/j.domaniend.2012.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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: 09/15/2011] [Revised: 03/27/2012] [Accepted: 03/30/2012] [Indexed: 11/30/2022]
Abstract
In this study, total RNA was collected from abdominal adipose tissue samples obtained from 10 broiler chickens at 3, 4, 5, and 6 wk of age and prepared for quantitative real-time PCR analysis. Quantitative real-time PCR analysis was used to examine the influence of age on the expression of the adipose tissue genes for IL-1β, -6, -10, -15, -18; brain-derived neurotropic factor; ciliary neurotropic factor; interferon γ, neuropeptide Y receptor Y1; neuropeptide Y; nucleobindin 2; growth hormone receptor; leptin receptor; and visfatin. Between 3 and 6 wk of age, leptin receptor expression decreased (P=0.013) with age, whereas expression of IL-15 (P=0.015) and growth hormone receptor (P=0.002) increased. Furthermore, IL-18 (P<0.001) and visfatin (P=0.007) expression increased between 4 and 6 wk of age. This is a unique exhibition of age-related changes in cytokine gene expression in chicken adipose tissue. Future studies are needed to elucidate the role of adipose tissue cytokines in growth and, possibly, disease resistance.
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Affiliation(s)
- G J Hausman
- Poultry Processing and Swine Physiology Research, Agricultural Research Service, USDA, Athens, GA 30605, USA.
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Mohammad KI, Gamble J, Creedy DK. Prevalence and factors associated with the development of antenatal and postnatal depression among Jordanian women. Midwifery 2010; 27:e238-45. [PMID: 21130548 DOI: 10.1016/j.midw.2010.10.008] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 10/11/2010] [Accepted: 10/17/2010] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To investigate the prevalence of depression during pregnancy and postpartum period for Jordanian women and identify associated risk factors and maternity service delivery issues. DESIGN A prospective cross-sectional study. Participants were recruited during the last trimester of pregnancy, provided personal, social and obstetric information, and completed the Edinburgh Postnatal Depression Scale (EPDS), Depression Anxiety and Stress Scale (DASS-21), the Maternity Social Support Scale (MSSS), the Cambridge Worry Scale (CWS), Perceived Self-Efficacy Scale (PSES) and Perceived Knowledge Scale (PKS). All participants were contacted again at six-eight weeks and six months post partum to complete a telephone or face-to-face interview. The postnatal questionnaire included the EPDS, MSSS, and DASS-21. SETTING A teaching hospital and five health centres in Irbid city in northern Jordan. PARTICIPANTS Arabic speaking women (n = 353) between the ages of 18 and 45 years, in their last trimester of pregnancy, at low risk for obstetric complications and receiving antenatal care between November 2005 and August 2006. FINDINGS High rates of antenatal (19%) and postnatal depression (22%) were reported. A regression analysis revealed that stress, anxiety, financial problems, perceived lack of parenting knowledge, difficult relationship with the mother-in-law, unplanned pregnancy, and low self-efficacy were associated with antenatal depression. These seven factors accounted for 83% (r(2) = 0.834) of variance in the development of probable antenatal depression. At six-eight weeks post partum, a regression analysis revealed that antenatal depression, unplanned pregnancy, difficult relationship with mother-in-law, dissatisfaction with overall care, stress, lack of social support, giving birth to a female baby, feeling pressured to birth the baby quickly, and perceived low parenting knowledge were associated with postnatal depression. These nine variables accounted for 82% (r(2) = 0.819) of variance in the development of probable PND. Three intrapartum and postpartum variables associated with PND at six-eight weeks (postpartum haemorrhage, unhelpful doctors during labour and birth, and anxiety) were no longer associated with PND at six months. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Jordanian women need support to prepare for labour and birth. Postpartum emotional support and assessment of symptoms of depression needs to be incorporated into routine practice. The opportunity for open discussion along with increased awareness and clarification of common misconceptions about antenatal and postnatal depression are necessary. Quality assurance systems would help reduce the rate of invasive obstetric procedures, and give greater emphasis to emotional care provided to women during the perinatal period.
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Affiliation(s)
- K I Mohammad
- The Department of Maternal & Child Health & Midwifery, Faculty of Nursing, Jordan University of Science & Technology, Jordan
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Vivithanaporn P, Heo G, Gamble J, Krentz HB, Hoke A, Gill MJ, Power C. Neurologic disease burden in treated HIV/AIDS predicts survival: a population-based study. Neurology 2010; 75:1150-8. [PMID: 20739646 DOI: 10.1212/wnl.0b013e3181f4d5bb] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) has improved the survival of patients with HIV/AIDS but its impact remains uncertain on the changing prevalence and incidence of neurologic disorders with ensuing effects on mortality. METHODS The prevalence and incidence of neurologic disorders were examined in patients receiving active care in a regional HIV care program from 1998 to 2008. The mortality hazard ratio (HR) was calculated by Cox proportional hazard models with adjustment for demographic and clinical variables. RESULTS Of 1,651 HIV-infected patients assessed, 404 (24.5%) were identified as having one or more neurologic disorders, while 41% of AIDS-affected persons exhibited neurologic disease. Symptomatic distal sensory polyneuropathy (DSP, 10.0%) and HIV-associated neurocognitive disorder (HAND, 6.2%) represented the most prevalent disorders among 53 recognized neurologic disorders. Patients with at least one neurologic disorder exhibited higher mortality rates (17.6% vs 8.0%, p < 0.0001), particularly AIDS-related deaths (9.7% vs 3.2%, p < 0.0001), compared with those without neurologic disorders. The highest mortality HR was associated with opportunistic infections of CNS (HR 5.3, 95% confidence interval [CI] 2.5-11.2), followed by HAND (HR 3.1, 95% CI 1.8-5.3) and the presence of any neurologic disorder (HR 2.0, 95% CI 1.2-3.2). The risk of AIDS-related death with a neurologic disorder was increased by 13.3% per 100 cells/mm(3) decrement in blood CD4+ T-cell levels or by 39% per 10-fold increment in plasma viral load. CONCLUSIONS The burden and type of HIV-related neurologic disease have evolved over the past decade and despite the availability of cART, neurologic disorders occur frequently and predict an increased risk of death.
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Affiliation(s)
- P Vivithanaporn
- Division of Neurology, University of Alberta, Edmonton, Canada
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Turzyniecka M, Wild SH, Krentz AJ, Chipperfield AJ, Gamble J, Clough GF, Byrne CD. Skeletal muscle microvascular exchange capacity is associated with hyperglycaemia in subjects with central obesity. Diabet Med 2009; 26:1112-9. [PMID: 19929989 DOI: 10.1111/j.1464-5491.2009.02822.x] [Citation(s) in RCA: 9] [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] [Indexed: 01/08/2023]
Abstract
AIMS Poor glycaemic control is associated with increased risk of microvascular disease in various organs including the eye and kidney, but the relationship between glycated haemoglobin (HbA(1c)) and microvascular function in skeletal muscle has not been described. We tested the association between HbA(1c) and a measure of microvascular exchange capacity (K(f)) in skeletal muscle in people with central obesity at risk of developing Type 2 diabetes. METHODS Microvascular function was measured in 28 women and 19 men [mean (+/- sd) age 51 +/- 9 years] with central obesity who did not have diabetes. We estimated insulin sensitivity by hyperinsulinaemic-euglycaemic clamp, visceral and total fatness by magnetic resonance imaging, fitness (VO(2) max by treadmill testing), physical activity energy expenditure [metabolic equivalents of tasks (METS) by use of the SenseWear Pro armband] and skeletal muscle microvascular exchange capacity (K(f)) by venous occlusion plethysmography. RESULTS In regression modelling, age, sex and fasting plasma glucose accounted for 30.5% of the variance in HbA(1c) (r(2) = 0.31, P = 0.001). Adding K(f) to this model explained an additional 26.5% of the variance in HbA(1c) (r(2) = 0.57, P = 0.0001 and K(f) was strongly and independently associated with HbA(1c) (standardized B coefficient -0.45 (95% confidence interval -0.19, -0.06), P = 0.001). CONCLUSIONS We found a strong negative independent association between a measure of skeletal muscle microvascular exchange capacity (K(f)) and HbA(1c). K(f) was associated with almost as much of the variance in HbA(1c) as fasting plasma glucose.
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Affiliation(s)
- M Turzyniecka
- School of Medicine, University of Southampton, Southampton, UK
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Li C, Wu B, Midwinter R, Beck K, Collinson E, Maghzal G, Cassano C, Santiago F, Khachigian L, Gamble J, Stocker R. Abstract: 81 PROTECTION AGAINST ATHEROSCLEROSIS BY HEME OXYGENASE. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70224-7] [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: 10/20/2022]
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Gamble J, Eurich D, Marrie T, Majumdar S. Admission hypoglycaemia portends a substantially increased risk of mortality in patients with community- acquired pneumonia: population-based cohort study. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33015-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fitzsimons D, Mullan D, Wilson JS, Conway B, Corcoran B, Dempster M, Gamble J, Stewart C, Rafferty S, McMahon M, MacMahon J, Mulholland P, Stockdale P, Chew E, Hanna L, Brown J, Ferguson G, Fogarty D. The challenge of patients' unmet palliative care needs in the final stages of chronic illness. Palliat Med 2007; 21:313-22. [PMID: 17656408 DOI: 10.1177/0269216307077711] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is consensus in the literature that the end of life care for patients with chronic illness is suboptimal, but research on the specific needs of this population is limited. AIM This study aimed to use a mixed methodology and case study approach to explore the palliative care needs of patients with a non-cancer diagnosis from the perspectives of the patient, their significant other and the clinical team responsible for their care. Patients (n = 18) had a diagnosis of either end-stage heart failure, renal failure or respiratory disease. METHODS The Short Form 36 and Hospital and Anxiety and Depression Questionnaire were completed by all patients. Unstructured interviews were (n = 35) were conducted separately with each patient and then their significant other. These were followed by a focus group discussion (n = 18) with the multiprofessional clinical team. Quantitative data were analysed using simple descriptive statistics and simple descriptive statistics. All qualitative data were taped, transcribed and analysed using Colaizzi's approach to qualitative analysis. FINDINGS Deteriorating health status was the central theme derived from this analysis. It led to decreased independence, social isolation and family burden. These problems were mitigated by the limited resources at the individual's disposal and the availability of support from hospital and community services. Generally resources and support were perceived as lacking. All participants in this study expressed concerns regarding the patients' future and some patients described feelings of depression or acceptance of the inevitability of imminent death. CONCLUSION Patients dying from chronic illness in this study had many concerns and unmet clinical needs. Care teams were frustrated by the lack of resources available to them and admitted they were ill-equipped to provide for the individual's holistic needs. Some clinicians described difficulty in talking openly with the patient and family regarding the palliative nature of their treatment. An earlier and more effective implementation of the palliative care approach is necessary if the needs of patients in the final stages of chronic illness are to be adequately addressed.
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Affiliation(s)
- D Fitzsimons
- Nursing Research and Development, Belfast City Hospital, Belfast, Northern Ireland.
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Aburuz S, Heaney LG, Millership J, Gamble J, McElnay J. A cross-sectional study evaluating the relationship between cortisol suppression and asthma control in patients with difficult asthma. Br J Clin Pharmacol 2007; 63:110-5. [PMID: 17229041 PMCID: PMC2000719 DOI: 10.1111/j.1365-2125.2006.02745.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 06/22/2005] [Accepted: 06/12/2006] [Indexed: 12/01/2022] Open
Abstract
AIM To examine the relationship between cortisol suppression and asthma symptoms in patients with difficult asthma. METHODS Patients, referred to a specialist difficult asthma service and who fulfilled the criteria for difficult asthma, were recruited to the study in a sequential, unselected manner. At each clinic visit, all patients completed a validated asthma control questionnaire. For measuring cortisol suppression, early morning urinary cortisol [corrected for creatinine to give urinary cortisol creatinine ratio (UCC ratio)] was used. The urine samples were collected and stored at -70 degrees C until ready for analysis. Urinary cortisol was extracted (solid-phase extraction) and analysed using high-performance liquid chromatography. The Pearson correlation coefficient was used for correlation analysis while t-tests were used for between-group differences for normally distributed data. If the data were not normally distributed, nonparametric statistics were used. A P-value < 0.05 was considered statistically significant. RESULTS During the study period all the patients who attended the difficult asthma clinic and fulfilled the criteria for difficult asthma (n = 66) agreed to take part in the study. There were moderate to strong and significant associations between several measures of asthma control and UCC ratio. The correlation coefficient with five indicators of asthma control ranged between 0.3 and 0.5 (P < 0.05). CONCLUSIONS We have demonstrated a relationship between cortisol suppression and asthma control in difficult asthmatics on high-dose steroid therapy. We have proposed a model based on the relationship between symptom control and cortisol suppression, whereby both adherence and therapeutic adjustments could potentially be made. A properly controlled prospective clinical trial should examine the utility of this approach in clinical practice.
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Affiliation(s)
- S Aburuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan.
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Aburuz S, McElnay J, Gamble J, Millership J, Heaney L. Relationship between lung function and asthma symptoms in patients with difficult to control asthma. J Asthma 2006; 42:859-64. [PMID: 16393725 DOI: 10.1080/02770900500371187] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Several studies have demonstrated a poor relationship between measures of asthma control and lung function in patients with asthma. We sought to examine this relationship in a cohort of difficult to control asthmatics attending a hospital outpatient clinic. FEV1 % and asthma control scores (ACSs) were measured at the first clinic visit and at a follow-up visit. A total of 59 patients took part in the study. At the initial visit, FEV1 % correlated with limitation of activity (p = 0.002), shortness of breath (p = 0.02), wheezing (p = 0.029), and ACS (p = 0.014). However, at follow-up, there was no correlation between FEV1 % and any measured index of asthma control. When patients with severe fixed airflow obstruction were excluded from the analysis (n = 16), FEV1 % at follow-up became significantly correlated with night waking (p = 0.02), wheezing (p = 0.05), and ACS (p = 0.036). The improvement in asthma control score at follow-up was significantly and strongly associated (r = 0.51 for total asthma control, p < 0.001) with the improvement in lung function in patients without severe fixed airflow obstruction. Lung function was not associated with any measure of asthma control in patients with severe fixed airflow obstruction. FEV1 % correlates well with asthma symptoms in difficult asthma patients with poor control but not when control improves. This loss of relationship is due to subjects with severe fixed airflow obstruction where good subjective control does not exclude the presence of significant obstruction. How severe fixed airflow obstruction should be prevented, delayed, or managed in asthma requires further research.
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Affiliation(s)
- S Aburuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Jordan.
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Zannettino ACW, Holding CA, Diamond P, Atkins GJ, Kostakis P, Farrugia A, Gamble J, To LB, Findlay DM, Haynes DR. Osteoprotegerin (OPG) is localized to the Weibel-Palade bodies of human vascular endothelial cells and is physically associated with von Willebrand factor. J Cell Physiol 2005; 204:714-23. [PMID: 15799029 DOI: 10.1002/jcp.20354] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [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: 01/06/2023]
Abstract
Recent studies demonstrate roles for osteoprotegerin (OPG) in both skeletal and extra-skeletal tissues. Although its role in preventing osteoclast (OC) formation and activity is well documented, emerging evidence suggests a role of OPG in endothelial cell survival and the prevention of arterial calcification. In this communication, we show that vascular endothelial cells in situ, and human umbilical vein endothelial cells (HUVEC) in vitro, express abundant OPG. In HUVEC, OPG co-localizes with P-selectin and von Willebrand factor (vWF), within the Weibel-Palade bodies (WPB). Treatment of HUVEC with the pro-inflammatory cytokines, tumor necrosis factor (TNF)-alpha and IL-1beta, resulted in mobilization from the WPBs and subsequent secretion of OPG protein into the culture supernatant. Furthermore, TNF-alpha treatment of HUVEC resulted in a sustained increase in OPG mRNA levels and protein secretion over the 24-h treatment period. Reciprocal immunoprecipitation experiments revealed that while not associated with P-Selectin, OPG is physically complexed with vWF both within the WPB and following secretion from endothelial cells. Interestingly, this association was also identified in human peripheral blood plasma. In addition to its interaction with vWF, we show that OPG also binds with high avidity to the vWF reductase, thrombospondin (TSP-1), raising the intriguing possibility that OPG may provide a link between TSP-1 and vWF. In summary, the intracellular localization of OPG in HUVEC, in association with vWF, together with its rapid and sustained secretory response to inflammatory stimuli, strongly support a modulatory role in vascular injury, inflammation and hemostasis.
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Affiliation(s)
- A C W Zannettino
- Myeloma and Mesenchymal Research Laboratory, Division of Haematology, Institute of Medical and Veterinary Science, and Hanson Institute, Adelaide, South Australia, Australia.
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Anim-Nyame N, Sooranna SR, Johnson MR, Sullivan MH, Gamble J, Steer PJ. Impaired retrograde transmission of vasodilatory signals via the endothelium in pre-eclampsia: a cause of reduced tissue blood flow? Clin Sci (Lond) 2004; 106:19-25. [PMID: 12889986 DOI: 10.1042/cs20030045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2003] [Revised: 06/19/2003] [Accepted: 07/30/2003] [Indexed: 11/17/2022]
Abstract
There is evidence that tissue blood flow is regulated by retrograde transmission of signals initiated at capillary and post-capillary sites, and transmitted via the endothelium to modulate pre-capillary resistance. We have used pre-eclampsia as a model to test the hypothesis that normal endothelium is required to enable adjustment of blood flow to match tissue requirements. Integrity of the endothelial pathway was assessed by measuring calf blood flow at increasing venous pressures, using an established small cumulative-step venous-congestion plethysmography protocol in ten women with pre-eclampsia, 17 normal pregnant controls and ten non-pregnant women. Endothelial cell activation was assessed by measuring plasma levels of the cell adhesion molecules, intercellular cell-adhesion molecule-1 (ICAM-1), vascular cell-adhesion molecule-1 (VCAM-1) and E-selectin. Baseline calf blood flow was significantly lower in pre-eclampsia than in the other two groups (P<0.0001; ANOVA). In the pre-eclampsia group, there was a fall in blood flow as venous congestion pressure was raised (P<0.0001; ANOVA). No such change was observed in the other two groups. A significant inverse correlation was observed between the reduction in blood flow in pre-eclampsia and the levels of E-selectin (r=-0.92, P=0.0002), VCAM-1 (r=-0.93, P=0.0008) and ICAM-1 (r=-0.86, P=0.001). The differences between the pre-eclamptic women and the other two groups support the notion that the failure to sustain blood flow during a cumulative pressure step protocol in the pre-eclamptic group might be influenced by interference with the retrograde transmission of signals via the endothelium in these patients.
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Affiliation(s)
- N Anim-Nyame
- Academic Department of Obstetrics and Gynaecology, Faculty of Medicine, Imperial College of Science, Technology and Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
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Heaney LG, Conway E, Kelly C, Johnston BT, English C, Stevenson M, Gamble J. Predictors of therapy resistant asthma: outcome of a systematic evaluation protocol. Thorax 2003; 58:561-6. [PMID: 12832665 PMCID: PMC1746731 DOI: 10.1136/thorax.58.7.561] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.2] [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: 11/04/2022]
Abstract
BACKGROUND It has been suggested that asthmatic subjects with persisting symptoms despite adequate maintenance therapy should be systematically evaluated to identify factors contributing to poor control. The aims of this study were to examine the prevalence of these factors in a cohort of sequentially referred poorly controlled asthmatics, and to determine if any factor or combination of factors predicted true therapy resistant asthma (TRA). METHODS Patients were evaluated using a systematic evaluation protocol including induced sputum analysis, psychiatric assessment, ear, nose and throat examination, pulmonary function testing, high resolution CT scan of the thorax, and 24 hour dual probe ambulatory oesophageal pH monitoring; any identified provoking factor was treated. Asthma was managed according to BTS guidelines. RESULTS Of 73 subjects who completed the assessment, 39 responded to intervention and 34 had TRA. Subjects with TRA had a greater period of instability, a higher dose of inhaled steroids at referral, more rescue steroid use, and a lower best percentage forced expiratory volume in 1 second (FEV(1)%). Oesophageal reflux, upper airway disease, and psychiatric morbidity were common (57%, 95%, 49%, respectively) but were not more prevalent in either group. Using multivariate logistic regression analysis, inhaled steroid dose >2000 micro g BDP, previous assessment by a respiratory specialist, and initial FEV(1)% of <70% at referral predicted a final diagnosis of TRA. CONCLUSIONS In poorly controlled asthmatics there is a high prevalence of co-morbidity, identified by detailed systematic assessment, but no difference in prevalence between those who respond to intervention and those with TRA. Targeted treatment of identified co-morbidities has minimal impact on asthma related quality of life in those with therapy resistant disease.
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Affiliation(s)
- L G Heaney
- Regional Respiratory Centre, Belfast City Hospital, Belfast, UK.
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Anim-Nyame N, Gamble J, Sooranna SR, Johnson MR, Sullivan MH, Steer PJ. Evidence of impaired microvascular function in pre-eclampsia: a non-invasive study. Clin Sci (Lond) 2003; 104:405-412. [PMID: 12653685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The clinical presentation of pre-eclampsia suggests that microvascular dysfunction may play a role in the maternal manifestations of the disease. Isovolumetric venous pressure ( P V(i)) is an index of microvascular function, reflecting local plasma colloid osmotic (oncotic) pressure, and is abnormal in clinical conditions with microvascular dysfunction. We hypothesized that, in pre-eclampsia, post-capillary margination of neutrophils would increase post-capillary resistance, and therefore P V(i). A small cumulative step strain-gauge plethysmography protocol was used to compare P V(i) in 18 women with pre-eclampsia, 16 normal pregnant women and 17 non-pregnant controls. Circulating levels of vascular cell-adhesion molecule-1 (VCAM-1), intercellular cell-adhesion molecule-1 (ICAM-1) and E-selectin, and neutrophil elastase, were measured to assess endothelial and neutrophil activation respectively. P V(i) was significantly greater in the pre-eclampsia group, relative to the normal pregnant and non-pregnant controls ( P <0.001, ANOVA, for both comparisons). P V(i) was significantly lower during normal pregnancy compared with the non-pregnant controls ( P =0.001). Plasma levels of neutrophil elastase, VCAM-1, ICAM-1 and E-selectin ( P =0.001) were significantly greater in the pre-eclamptics than the controls. Significant positive correlations were observed between P V(i) and neutrophil elastase ( r =0.71, P =0.001), VCAM-1 ( r =0.52, P =0.03), ICAM-1 ( r =0.67, P =0.002), E-selectin ( r =0.69, P =0.001), uric acid levels ( r =0.54, P =0.02) and haematocrit ( r =0.64, P =0.004) in pre-eclampsia. The relationship with the platelet count was negative ( r =-0.65, P =0.003). No significant correlations were observed between P V(i) and maternal age, gestational age, total protein, albumin, diastolic blood pressures, age, body mass index and infant birth mass in the normal pregnant and non-pregnant controls. These data suggest that microvascular dysfunction occurs in pre-eclampsia, and that it is related to alterations in endothelial cell and neutrophil activation.
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Affiliation(s)
- N Anim-Nyame
- Department of Maternal and Fetal Medicine, Imperial College School of Medicine at Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, U.K.
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Bauer A, Bruegger D, Gamble J, Christ F. Influence of different cuff inflation protocols on capillary filtration capacity in human calves -- a congestion plethysmography study. J Physiol 2002; 543:1025-31. [PMID: 12231656 PMCID: PMC2290538 DOI: 10.1113/jphysiol.2002.018291] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
It has been suggested that venous congestion plethysmography (VCP) substantially underestimates microvascular permeability by activation of a veni-arteriolar constrictor mechanism, even when using small (< 25 mmHg) congestion pressure steps. We studied human lower limbs of 18 young healthy volunteers to test whether the congestion pressure step size of the VCP protocol has an influence on the values of the capillary filtration capacity (CFC) and isovolumetric venous pressure (P(vi)). Two different dual stage VCP pressure step protocols, with 3 and 10 mmHg steps, were used in randomised order and separated by a transient reduction in congestion pressure. Since lymph flow is known to increase after venous congestion, we also looked to see if changes in the estimated lymph flow (J(v)L) occur as a result of these VCP protocols. The measured CFC (median [25th; 75th percentile]) was 2.6 [2.5; 3.2] x 10(-3) ml (100 ml)(-1) min(-1) mmHg(-1) with the 3 mmHg pressure step protocol, which was not different from the value of 2.9 [2.7; 3.4] x 10(-3) ml (100 ml)(-1) min(-1) mmHg(-1) obtained with 10 mmHg pressure steps. However, when either of these step sizes was applied after a transient venous decongestion, significantly higher values of CFC, 4.0 [3.4; 4.1] x 10(-3) and 3.5 [3.1; 4.5] x 10(-3) ml (100 ml)(-1) min(-1) mmHg(-1), respectively, were obtained (P < 0.05). The assessment of P(vi) was also independent of the pressure protocol (10 mmHg: 8.0 [5.7; 13.2] mmHg and 3 mmHg: 15.7 [12.5; 18.5] mmHg), but when P(vi) was measured after the transient deflation, significantly higher values were found with both 10 and 3 mmHg steps (24.1 [20.9; 27.3] and 30.4 [28.9; 30.9] mmHg, respectively; P < 0.01). The transient pressure reduction was associated with a rise in estimated J(v)L from 0.04 [0.03; 0.05] to 0.12 [0.08; 0.18] and 0.04 [0.04; 0.05] to 0.09 [0.07; 0.10] ml (100 ml)(-1) min(-1), respectively (P < 0.01). The first stage data from these protocols shows that the value of CFC is not influenced by the size of the cumulative venous pressure steps, providing they are of 10 mmHg or less. The data also show that J(v)L can be estimated with small step VCP protocols. We hypothesise that the sudden reduction in cuff pressure after venous congestion is associated with a temporary upregulation of lymph flow. As the congestion pressure is raised again, there is a modulation of the enhanced lymph flow, such that the resulting CFC slope appears greater than that obtained in the first stage of the protocol.
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Affiliation(s)
- A Bauer
- Clinic for Anaesthesiology, Ludwig-Maximilians University Munich, 81377 Munich, Germany
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Abstract
OBJECTIVE Pelvic venous congestion is a common finding in women with chronic pelvic pain. While the pathophysiology of this condition is poorly understood, there are clear indications that it involves vascular dysfunction. The present studies sought abnormalities in microvascular function in these patients. DESIGN Prospective longitudinal study. SETTING A teaching hospital tertiary referral. POPULATION Eighteen women with pelvic congestion and 13 normal women. METHODS Parameters of microcirculatory function were measured in the calves of women using venous congestion plethysmography during the midfollicular and midluteal phases of the menstrual cycle. The women with pelvic congestion were studied again after treatment for the condition. MAIN OUTCOME MEASURES Isovolumetric venous pressure, microvascular filtration capacity and limb blood flow. RESULTS Of the measured parameters of microvascular function, only isovolumetric venous pressure (Pvi) was significantly higher in women with congestion when compared to the controls during the same phase of the cycle. There were no menstrual cycle related differences in any of the other measured parameters in either patients or controls. Following successful treatment for the condition, values of Pvi in women with pelvic congestion were significantly reduced, achieving a level similar to that observed in the controls. CONCLUSION The observed changes in Pvi suggest that this parameter is intimately associated with the pathophysiology of pelvic congestion. The increase in Pvi, without alterations in other measured microvascular parameters, may be attributable to systemic increases in postcapillary resistance secondary to neutrophil activation. These findings support the notion of systemic microvascular dysfunction in these women.
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Affiliation(s)
- L C Foong
- Department of Obstetrics and Gynaecology, St Mary's Hospital Medical School, London, UK
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