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Lang AE, Patel U, Fitzpatrick J, Lee T, McFarland M, Good CB. Association of the Chantix Recall With US Prescribing of Varenicline and Other Medications for Nicotine Dependence. JAMA Netw Open 2023; 6:e2254655. [PMID: 36745457 DOI: 10.1001/jamanetworkopen.2022.54655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This cross-sectional study evaluates the association between the 2021 varenicline tartrate recall and prescribing of varenicline and other medications for nicotine dependence in a large US national patient cohort.
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Affiliation(s)
- Adam Edward Lang
- Department of Primary Care, McDonald Army Health Center, Ft Eustis, Virginia
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond
| | - Urvashi Patel
- Research Institute Department, Evernorth Health Services, St Louis, Missouri
| | - Jonathan Fitzpatrick
- Department of Client Solution Product Strategy, Evernorth Health Services, St Louis, Missouri
| | - Tiffany Lee
- Research Institute Department, Evernorth Health Services, St Louis, Missouri
| | - Margo McFarland
- Pharmacy Services, Insurance Services Division, UPMC Health Plan, Pittsburgh, Pennsylvania
| | - Chester B Good
- Centers for High Value Health Care and Value Based Pharmacy Initiatives, Insurance Services Division, UPMC Health Plan, Pittsburgh, Pennsylvania
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Butler E, Walsh JE, Grogan S, Lyons C, Whalley D, Fitzpatrick J, Gallagher L, Dockery F. 348 WHAT IS THE OLDER PATIENT’S VIEW ON RECEIVING DETAILED MEDICAL LETTERS? Age Ageing 2022. [DOI: 10.1093/ageing/afac218.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sending copies of clinic letters to patients involves additional work for medical staff in formatting letters, administrative staff in printing and posting and is an added cost to the healthcare service. Though seen largely as good practice in some specialities, it is not done routinely in Geriatric medical services. We introduced this practice as standard in our service and wished to evaluate whether from the patient perspective, it is worthwhile.
Methods
We sent a questionnaire to n=80 older patients who were evaluated in the home setting (by the Integrated Care Team for Older People – ICTOP) or recently attended CGA (Comprehensive Geriatric Assessment) clinic or FLS (Fracture Liaison Service) clinic. We asked their opinion on the detailed medical letter sent to their General Practitioner (GP), which they received a copy of. The questionnaire could be completed by patient/carer/relative, and returned anonymously.
Results
N=30/80 were returned. Two said they found the letter difficult to understand; 1/30 said the letter caused them to worry but all said they still preferred that they had received it. N= 2 said they would like to have contributed to the letter for accuracy. All said they felt they should receive copies of all their medical correspondence. Free text comments showed overwhelming support for the process, in allowing them to self-manage their health, enhance communication with other healthcare professionals and was a useful document to refer back to when they are trying to process information during short consultations.
Conclusion
Though a small survey and limited by low response rate, older people expressed high levels of satisfaction in receiving copies of medical letters about their health. It supports the ongoing practice and should be adopted widely.
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Affiliation(s)
- E Butler
- Beaumont Hospital , Dublin, Ireland
| | - JE Walsh
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
| | - S Grogan
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
| | - C Lyons
- Beaumont Hospital , Dublin, Ireland
| | - D Whalley
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
| | | | | | - F Dockery
- Beaumont Hospital , Dublin, Ireland
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
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Iyengar KP, Azzopardi CA, Fitzpatrick J, Hill T, Haleem S, Panchal H, Botchu R. Calcaneal offset index to measure hindfoot alignment in pes planus. Skeletal Radiol 2022; 51:1631-1637. [PMID: 35146553 DOI: 10.1007/s00256-022-04011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pes planus is a common three-dimensional (3D) deformity characterised by forefoot abduction, the collapse of the medial longitudinal arch, and hindfoot valgus. Several radiological measurements such as anteroposterior talocalcaneal angle (Kite's) and 'Calcaneal pitch angle' (CPA) exist to calculate the degree of hindfoot alignment in these patients with variable intra- and interobserver reliability. OBJECTIVE To describe a new radiological ancillary method of measuring hindfoot alignment, the calcaneal offset index (COI). MATERIAL AND METHODS Anteroposterior (mortise) and lateral view weight-bearing (WB) ankle radiographs of 200 consecutive patients referred for foot and ankle pain were reviewed. Demographic details, clinical indication, and COI calculation were undertaken on the mortise view along with the measurement of CPA for each patient. A one-way analysis of variance (ANOVA) was performed. Intraclass correlation coefficient (ICC) analysis was evaluated to assess the intraclass reliability between observers. RESULTS There was a female preponderance of 2:1 in the study population with a mean age of 51.21 years (13-86 years). The calcaneal offset was increased in pes planus (hindfoot valgus). The p-value was 0.00023 on ANOVA. The COI gave an excellent interobserver correlation with ICC of 0.9 and moderate intraobserver reliability on the ICC analysis of 0.55. CONCLUSION The COI can be an additional index of measuring hindfoot alignment in patients with pes planus. Contrary to the traditional angular measurements, this linear transverse plane measure is easier to calculate and reproducible. COI measurement has shown moderate intraobserver reliability but excellent interobserver reliability.
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Affiliation(s)
- K P Iyengar
- Departments of Orthopaedics, Southport and Ormskirk NHS Trust, Southport, UK
| | - C A Azzopardi
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK
| | - J Fitzpatrick
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK
| | - T Hill
- Departments of Orthopaedics, Southport and Ormskirk NHS Trust, Southport, UK
| | - S Haleem
- Departments of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - H Panchal
- Sanyapixel Diagnostics, Ahmedabad, India
| | - R Botchu
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK.
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Fitzpatrick J. 1. Livestock Science Matters for Human and Planetary Health. Animal - science proceedings 2022. [PMCID: PMC9090130 DOI: 10.1016/j.anscip.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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5
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Lomas J, Brown N, Fitzpatrick J, Fryers P, Barnard S. Comparison of all-cause mortality in England with Europe and the USA: January 2020 to February 2021. Eur J Public Health 2021. [PMCID: PMC8574263 DOI: 10.1093/eurpub/ckab165.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Assessing mortality during the COVID-19 pandemic is vital for informing public health strategies and policy decision making. All-cause excess mortality provides an objective measure of the impact of the pandemic including both the direct and indirect effects. Our study considers the burden of mortality in the UK, Europe and the USA. We examine variation between countries, by age and sex. We explore the extent to which this variation is associated with COVID-19 case rates and other population characteristics. Methods The study is a secondary analysis of routine administrative population and mortality data. Weekly death occurrences and population estimates were obtained from Eurostat and national statistical agencies. Contextual information on COVID-19 case rates, population-level risk factors and healthcare were obtained from various open-source databases. Weekly age-standardised mortality rates (ASMRs) were calculated and presented relative to a baseline average from the preceding 5-year period. Relative cumulative (rc) ASMRs were then calculated to provide a comparable assessment of excess mortality at a point in time. Results Preliminary results show that, by end of the analysis period, England had an overall rcASMR of 10.09%. Higher excess mortality was identified for some countries (eg USA 14.58%) and lower - even below average mortality - for others (eg Norway -6.8%). Under 65 rcASMR showed substantial variation between countries. Cumulative COVID-19 case rates showed a moderate effect size (R2 = 0.51) when used to explain the proportion of variation observed between rcASMRs. Other population factors showed a smaller effect. Conclusions The burden of mortality experienced between countries and populations over the COVID-19 pandemic period has shown significant variation. Factors which may have contributed to the position of some countries should be further explored in order to inform ongoing management of Covid-19 and future pandemic events. Key messages Significant variation in all-cause excess mortality has been identified across the COVID-19 pandemic period between nations and particularly in younger age groups. COVID-19 case rates are associated with relative cumulative all-cause excess mortality among the nations assessed.
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Affiliation(s)
- J Lomas
- Public Health England, London, UK
| | - N Brown
- Public Health England, London, UK
| | | | - P Fryers
- Public Health England, London, UK
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Fryers PT, Barnard S, Burton PR, Fox S, Waller Z, Fitzpatrick J. Excess mortality in England during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574561 DOI: 10.1093/eurpub/ckab164.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Excess mortality monitoring is not dependent on completeness or consistency of coding of causes of death and captures deaths caused directly and indirectly by COVID-19. It takes account of existing inequalities in the baseline rates and shows the additional impact of COVID-19. We report weekly on excess mortality by age, gender, geographical area, deprivation, and ethnicity.
Methods
A quasi-Poisson model was fitted to deaths data for 2015-2019 to estimate expected mortality in population sub-groups each week during the COVID-19 pandemic. This was compared with observed mortality reported each week. Information on deaths registered was obtained from death certificates. Ethnicity was obtained from hospital records linked to deaths data.
Results
Early in the pandemic, excess deaths exceeded official reported COVID-19 deaths every week. Throughout the pandemic there were stark inequalities in excess death rates. Based on data from 21 March 2020 to 9 April 2021, people living in the most deprived areas in England experienced more excess (1.21 times; 95% CI 1.21-1.22) compared with people living in the least deprived areas (1.17; 1.16-1.18). Black (1.56; 1.53-1.58) and Asian groups (1.55; 1.53-1.56) experienced more excess than the White group (1.16; 1.16-1.17). There was wide variation between English regions.
Conclusions
Reporting overall excess mortality early in the pandemic is important to inform policy makers and public about the true scale of the death toll when coding is inconsistent and developing. This approach has highlighted the large increases in already established inequalities in mortality. It provides rapid surveillance of developing disparities for national and local decision makers. It has been used to inform policy around reducing disparities and to revise messaging to encourage hospital attendance for non- COVID-19 health problems.
Key messages
Excess deaths from all causes is a robust measure of overall impact, unaffected by coding consistency. COVID-19 has dramatically worsened established inequalities between ethnic groups and deprivation groups.
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Affiliation(s)
- PT Fryers
- Health Improvement, Public Health England, Sheffield, UK
| | - S Barnard
- Life Course Centre, Telethon Kids Institute, Perth, Australia
- Health Improvement, Public Health England, Sheffield, UK
| | - PR Burton
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
- Health Improvement, Public Health England, Sheffield, UK
| | - S Fox
- Health Improvement, Public Health England, Sheffield, UK
| | - Z Waller
- Health Improvement, Public Health England, Sheffield, UK
| | - J Fitzpatrick
- Health Improvement, Public Health England, Sheffield, UK
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Rizvi I, Abroaf A, Veeratterapillay R, Rogers A, Shaw M, Fitzpatrick J. Management of acute ureteric colic in a large tertiary centre during the initial COVID-19 pandemic - How did our practice change? Eur Urol 2021. [PMCID: PMC8263123 DOI: 10.1016/s0302-2838(21)00636-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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8
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Smith M, Orchard JJ, La Gerche A, Gallagher R, Fitzpatrick J. Fit, Female or Fifty - is cardiac rehabilitation fit for purpose? A systematic review and meta-analysis with meta-regression. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardiac rehabilitation (CR) is a multi-disciplinary, evidence-based intervention, aimed to address modifiable risk factors for coronary artery disease. It is recommended worldwide for patients following myocardial infarction (MI), Percutaneous Coronary Intervention (PCI) and cardiac surgery. A growing body of evidence points towards a lack of uptake in CR in females and younger people.
Purpose
To examine the effectiveness of contemporary CR programs and assess whether they cater for all patients regardless of age, gender and prior level of fitness, via systematic review, meta-analysis and meta-regression.
Methods
MEDLINE was examined for studies involving exercise prescription or CR following MI, PCI and cardiac surgery from January 2010 to May 2020. RCTs and cohort studies of ≥10 patients were included for programs delivering phase II or III CR. Primary outcome measures were peakVO2max, 6-minute walk test (6MWT) and Metabolic Equivalent of Task (METs). Data were extracted using random effects meta-analysis. Epidemiological data were analysed for age, proportion of males to females and prior level of fitness. Baseline level of fitness was assessed by peakVO2max, 6MWT and METs values on entry into CR programs. Meta-regression was then used to determine change in fitness and the influence of age or gender.
Results
Thirty-three of the 713 studies (13 RCT, 20 cohort) were eligible and included in the review. Participants had a mean age of 60.0 years and 6/49 (12%) of study groups had a mean age <55 years. Male participants comprised 81.9% of those who completed CR and 41/58 (71%) participants were below average for cardiorespiratory fitness (CRF) when compared to normative values for those aged 60-69 years on entering CR.
CRF improved in all study groups by the end of CR programs (mean improvement in peakVO2 3.3mL/kg/min, 6MWT 90.8m and METs 1.7). Meta-regression analysis showed that males were more likely to have an increase in 6MWT distance compared to females (mean difference 3.16m (95% CI 0.44-5.89). However, gender and age did not independently affect peakVO2max or METs.
Conclusion
CR following MI, PCI or cardiac surgery improved mean CRF in all study groups. While males were more likely to show an improvement in 6MWT there was no appreciable difference in effect in other outcomes after controlling for age or gender differences.
Females, younger people and those of average or above CRF appear to be under-represented in data and attendance at cardiac rehabilitation. Given that CR outcomes are equal across gender and age, more effort should be made to encourage female and younger patients to attend. A ‘Precision Medicine’ model of exercise prescription may assist in this aim.
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Affiliation(s)
- M Smith
- Australasian College of Sports and Exercise Physicians, Melbourne, Australia
| | - JJ Orchard
- University of Sydney, Charles Perkins Centre, Sydney, Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - R Gallagher
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - J Fitzpatrick
- University of Melbourne, CHESM, Melbourne, Australia
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Kopecky B, Lin C, Frye C, Dun H, Bayguinov P, Fitzpatrick J, Kreisel D, Lavine K. Modulation of Donor Cardiac Macrophages is Sufficient to Suppress Rejection and Extend Allograft Survival. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Naughton C, Ezhova I, Hayes N, Fitzpatrick J. 77 Developing and Testing An Education-Career Pathway in Healthcare for Older People (ECHO) to Promote Retention in Early-Career Gerontological Nurses. Age Ageing 2020. [DOI: 10.1093/ageing/afz191.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The NHS Long Term Plan (2019) sets specific targets for multidisciplinary services for frail older people over the next ten years. Delivery and sustainability is crucially dependant on the capability and capacity of gerontological nursing. High cost cities such as London experience high staff vacancy rates in acute care older adult services.
Aim
The study took a regional approach, working with NHS Trusts to develop a multicomponent intervention to increase retention and competencies of early career nurses working in gerontological services. The study examined the acceptability and feasibility of the intervention and tested a quasi-experiential evaluation design. Ethical approval was obtained from the University Ethics committee.
Methods
A co-design approach with stakeholders, early career nurses, educationalists and nurse managers, produced a multicomponent intervention: education module (masters level), gerontological competency booklet, external clinical learning opportunities, career coaching and mentorship delivered over a six-month period. The evaluation involved a mix-methods pre-post survey and focus group interviews.
Results
Twenty-nine early career nurses were recruited from five Trusts. The multicomponent intervention was well received, but there were difficulties facilitating external learning opportunities and providing career mentors. The primary outcome was intention to remain in gerontological nursing (measured using a point Likert scale). Pre-post the intervention this remained high (mean score 6 IQR 5-7), p=0.78. There was a significant increase in gerontological knowledge: at baseline the median score was 87 (IQR 81-102) compared to 107 (IQR 98-112) post-intervention, p=0.006. In focus groups participants identified three main mechanism of action for ECHO: building gerontological knowledge and skills; professional identity as older adult nurse; and networking to broaden horizons.
Conclusions
The study has demonstrated the potential of Trusts to work collaboratively with education providers to deliver a model of career-education pathway that may help attract and retain early career nurses to work in gerontology.
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Fitzpatrick J, Fox E, Hoffman A, Dehlendorf C. Differences in social communication about contraception by age and race/ethnicity: baseline results from a randomized controlled trial. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
A kit for serum calcium determination (Calcium Rapid Stat Kit), based on a methyl thymol blue method, has been investigated and the results compared with those obtained from an AutoAnalyzer cresolphthalein complexone method. The kit technique is simple, requires a small amount of serum and has a better precision than the AutoAnalyzer method, with which it correlates well. The standards supplied should be checked before use.
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Affiliation(s)
- J. M. Cossar
- Area Laboratory, Ballochymyle Hospital, Mauchline, Ayrshire
| | - J. Fitzpatrick
- Area Laboratory, Ballochymyle Hospital, Mauchline, Ayrshire
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13
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Morris M, O'Neill A, Gillis A, Charania S, Fitzpatrick J, Redmond A, Rosli S, Ridgway P. Prepared for Practice? Interns' Experiences of Undergraduate Clinical Skills Training in Ireland. J Med Educ Curric Dev 2016; 3:10.4137_JMECD.S39381. [PMID: 29349313 PMCID: PMC5736273 DOI: 10.4137/jmecd.s39381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND Many previous studies on internship have reported a lack of preparedness for the role. More recently in Ireland, medical schools have introduced formal clinical skills training programmes. This study sought to evaluate the impact, if any, of formal skills training in the medical training on intern's preparedness for practice. METHODS The study utilized a survey approach followed by focus group discussions. The aim was to identify the skills that were taught and assessed in medical training and the skills that were actually required in their intern year. RESULTS Most interns had received skills training in designated skills laboratories. No intern had received training in all skills advised in the European guidelines. Skills taught to all interns were intravenous cannulation, basic life support, and basic suture. Skills required from all interns were intravenous cannulation, phlebotomy, and arterial blood sampling. Removal of peripherally inserted central line (PICC) lines, central lines, and chest drains were commonly requested but not taught. Senior staff underestimated skill abilities and expected failure. CONCLUSION These findings identify discordance between the skills taught and the skills required in the job. There is a need for standardization in the clinical skills training to ensure that all interns enter practice with equal competencies. Consideration should be given to experiential learning opportunities such as subintern programmes to consolidate learning and improve preparedness. Improvement in communications with senior clinicians is indicated to ensure that expectations are realistic and reflective of actual training.
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Affiliation(s)
- M. Morris
- Education Division, School of Medicine, Trinity College, Tallaght Campus, Tallaght, Dublin, Ireland
| | - A. O'Neill
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - A. Gillis
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - S. Charania
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - J. Fitzpatrick
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - A. Redmond
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - S. Rosli
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - P.F. Ridgway
- Education Division, School of Medicine, Trinity College, Tallaght Campus, Tallaght, Dublin, Ireland
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
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Kramar A, Negrier S, Sylvester R, Joniau S, Mulders P, Powles T, Bex A, Bonnetain F, Bossi A, Bracarda S, Bukowski R, Catto J, Choueiri T, Crabb S, Eisen T, El Demery M, Fitzpatrick J, Flamand V, Goebell P, Gravis G, Houédé N, Jacqmin D, Kaplan R, Malavaud B, Massard C, Melichar B, Mourey L, Nathan P, Pasquier D, Porta C, Pouessel D, Quinn D, Ravaud A, Rolland F, Schmidinger M, Tombal B, Tosi D, Vauleon E, Volpe A, Wolter P, Escudier B, Filleron T, Kramar A, Sylvester R, Filleron T, Negrier S, Joniau S, Mulders P, Powles T, Escudier B, Bex A, Bonnetain F, Bossi A, Braccarda S, Bukowski R, Catto J, Choueiri T, Crabb S, Eisen T, El Demery M, Fitzpatrick J, Flamand V, Goebell PJ, Gravis G, Houédé N, Jacqmin D, Kaplan R, Malavaud B, Massard C, Melichar B, Mourey L, Nathan P, Pasquier D, Porta C, Pouessel D, Quinn D, Ravaud A, Rolland F, Schmidinger M, Tombal B, Tosi D, Vauleon E, Volpe A, Wolter P. Guidelines for the definition of time-to-event end points in renal cell cancer clinical trials: results of the DATECAN project. Ann Oncol 2015; 26:2392-8. [DOI: 10.1093/annonc/mdv380] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/24/2015] [Indexed: 12/19/2022] Open
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Fitzpatrick J, Biju D, Amer T, Hutton R, Nair B. Timing of second resection in high-grade non-muscle-invasive bladder cancer: Does delay adversely affect outcome? Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.597] [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: 11/17/2022]
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16
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Fitzpatrick J, Nolke L, Redmond M, McGuinness J. Oxygen requirements on admission predict longer length of stay in paediatric empyema: Findings from a nine-year national referral centre retrospective study. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Fitzpatrick J, Anderson N, Kuppermann M, Steinauer J, Wittman A, Dehlendorf C. Pilot study of “My Birth Control,” a contraceptive counseling decision support tool. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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El-Mokadem I, Fitzpatrick J, Bondad J, Rauchhaus P, Cunningham J, Pratt N, Fleming S, Nabi G. Chromosome 9p deletion in clear cell renal cell carcinoma predicts recurrence and survival following surgery. Br J Cancer 2014; 111:1381-90. [PMID: 25137021 PMCID: PMC4183850 DOI: 10.1038/bjc.2014.420] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/25/2014] [Accepted: 07/01/2014] [Indexed: 11/23/2022] Open
Abstract
Background: Wider clinical applications of 9p status in clear cell renal cell carcinoma (ccRCC) are limited owing to the lack of validation and consensus for interphase fluorescent in situ hybridisation (I-FISH) scoring technique. The aim of this study was to analytically validate the applicability of I-FISH in assessing 9p deletion in ccRCC and to clinically assess its long-term prognostic impact following surgical excision of ccRCC. Methods: Tissue microarrays were constructed from 108 renal cell carcinoma (RCC) tumour paraffin blocks. Interphase fluorescent in situ hybridisation analysis was undertaken based on preset criteria by two independent observers to assess interobserver variability. 9p status in ccRCC tumours was determined and correlated to clinicopathological variables, recurrence-free survival and disease-specific survival. Results: There were 80 ccRCCs with valid 9p scoring and a median follow-up of 95 months. Kappa statistic for interobserver variability was 0.71 (good agreement). 9p deletion was detected in 44% of ccRCCs. 9p loss was associated with higher stage, larger tumours, necrosis, microvascular and renal vein invasion, and higher SSIGN (stage, size, grade and necrosis) score. Patients with 9p-deleted ccRCC were at a higher risk of recurrence (P=0.008) and RCC-specific mortality (P=0.001). On multivariate analysis, 9p deletion was an independent predictor of recurrence (hazard ratio 4.323; P=0.021) and RCC-specific mortality (hazard ratio 4.603; P=0.007). The predictive accuracy of SSIGN score improved from 87.7% to 93.1% by integrating 9p status to the model (P=0.001). Conclusions: Loss of 9p is associated with aggressive ccRCC and worse prognosis in patients following surgery. Our findings independently confirm the findings of previous reports relying on I-FISH to detect 9p (CDKN2A) deletion.
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Affiliation(s)
- I El-Mokadem
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - J Fitzpatrick
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - J Bondad
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - P Rauchhaus
- Division of Population Sciences, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - J Cunningham
- Department of Clinical Genetics, NHS Tayside Health Board, Dundee DD1 9SY, UK
| | - N Pratt
- Department of Clinical Genetics, NHS Tayside Health Board, Dundee DD1 9SY, UK
| | - S Fleming
- Department of Pathology, Medical Research Institute, School of Medicine, Dundee DD1 9SY, UK
| | - G Nabi
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
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Fitzpatrick J, Kricka W, James TC, Bond U. Expression of three Trichoderma reesei cellulase genes in Saccharomyces pastorianus for the development of a two-step process of hydrolysis and fermentation of cellulose. J Appl Microbiol 2014; 117:96-108. [PMID: 24666670 DOI: 10.1111/jam.12494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/26/2014] [Accepted: 03/04/2014] [Indexed: 11/26/2022]
Abstract
AIMS To compare the production of recombinant cellulase enzymes in two Saccharomyces species so as to ascertain the most suitable heterologous host for the degradation of cellulose-based biomass and its conversion into bioethanol. METHOD AND RESULTS cDNA copies of genes representing the three major classes of cellulases (Endoglucanases, Cellobiohydrolases and β-glucosidases) from Trichoderma reesei were expressed in Saccharomyces pastorianus and Saccharomyces cerevisiae. The recombinant enzymes were secreted by the yeast hosts into the medium and were shown to act in synergy to hydrolyse cellulose. The conditions required to achieve maximum release of glucose from cellulose by the recombinant enzymes were defined and the activity of the recombinant enzymes was compared to a commercial cocktail of T. reesei cellulases. CONCLUSIONS We demonstrate that significantly higher levels of cellulase activity were achieved by expression of the genes in S. pastorianus compared to S. cerevisiae. Hydrolysis of cellulose by the combined activity of the recombinant enzymes was significantly better at 50°C than at 30°C, the temperature used for mesophilic yeast fermentations, reflecting the known temperature profiles of the native enzymes. SIGNIFICANCE AND IMPACT OF THE STUDY The results demonstrate that host choice is important for the heterologous production of cellulases. On the basis of the low activity of the T. reesei recombinant enzymes at fermentation temperatures, we propose a two-step process for the hydrolysis of cellulose and its fermentation into alcohol using cellulases produced in situ.
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Affiliation(s)
- J Fitzpatrick
- School of Genetics and Microbiology, Moyne Institute, Trinity College Dublin, College Green, Dublin 2, Ireland
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Canning C, Martin Z, Colgan MP, Abdulrahim O, McCafferty M, Fitzpatrick J, Haider SN, Madhavan P, O'Neill S. Fenestrated endovascular repair of complex aortic aneurysms. Ir J Med Sci 2014; 184:249-55. [PMID: 24599499 DOI: 10.1007/s11845-014-1095-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 02/18/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Fenestrated endovascular aneurysm repair (FEVAR) provides an endovascular solution for patients with large abdominal aortic aneurysms and challenging neck anatomy in addition to repair of endoleaks and pseudoaneurysms. This article reports the midterm outcomes of FEVAR from a single-tertiary referral centre in Ireland. METHODS From 2006 to 2012, nine consecutive asymptomatic patients with neck anatomy unfavourable for standard EVAR underwent endovascular repair with a customised fenestrated Zenith stent graft. An additional three patients had fenestrated grafts for repair of pseudoaneurysms (n = 2) following open AAA repair and a type I endoleak (n = 1). All patients were prospectively enrolled in a computerised database. Outcomes including mortality, morbidity, renal function, target vessel patency, endoleak and reintervention were analysed. FINDINGS The mean age and aneurysm size in the primary repair group were 74 years (65-84 years) and 6 cm (5-8.3 cm), respectively, and in the secondary repair group, the mean age was 66 years (61-75 years). No procedures required open conversion, and no visceral arteries were lost. On completion angiography, two patients in group 1 had a type I endoleak and one had a type III endoleak. There were no endoleaks in the secondary repair group. Follow-up ranged from 30 days to 6 years. There was one death within 30 days (8 %) and two deaths at 3 years from non-aneurysm-related causes. Six patients required secondary interventions. Three patients had a transient post-operative creatinine rise of >30 %. CONCLUSION Our study supports FEVAR as a feasible and effective therapy in the management of patients with complex aortic aneurysms.
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Affiliation(s)
- C Canning
- St James's Hospital, Dublin, Ireland,
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21
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Yu NYC, Gdalevitch M, Murphy CM, Mikulec K, Peacock L, Fitzpatrick J, Cantrill LC, Ruys AJ, Cooper-White JJ, Little DG, Schindeler A, Schindeler A. Spatial control of bone formation using a porous polymer scaffold co-delivering anabolic rhBMP-2 and anti-resorptive agents. Eur Cell Mater 2014; 27:98-109; discussion 109-111. [PMID: 24488823 DOI: 10.22203/ecm.v027a08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/31/2023] Open
Abstract
Current clinical delivery of recombinant human bone morphogenetic proteins (rhBMPs) utilises freeze-dried collagen. Despite effective new bone generation, rhBMP via collagen can be limited by significant complications due to inflammation and uncontrolled bone formation. This study aimed to produce an alternative rhBMP local delivery system to permit more controllable and superior rhBMP-induced bone formation. Cylindrical porous poly(lactic-co-glycolic acid) (PLGA) scaffolds were manufactured by thermally-induced phase separation. Scaffolds were encapsulated with anabolic rhBMP-2 (20 µg) ± anti-resorptive agents: zoledronic acid (5 µg ZA), ZA pre-adsorbed onto hydroxyapatite microparticles, (5 µg ZA/2% HA) or IkappaB kinase (IKK) inhibitor (10 µg PS-1145). Scaffolds were inserted in a 6-mm critical-sized femoral defect in Wistar rats, and compared against rhBMP-2 via collagen. The regenerate region was examined at 6 weeks by 3D microCT and descriptive histology. MicroCT and histology revealed rhBMP-induced bone was more restricted in the PLGA scaffolds than collagen scaffolds (-92.3% TV, p < 0.01). The regenerate formed by PLGA + rhBMP-2/ZA/HA showed comparable bone volume to rhBMP-2 via collagen, and bone mineral density was +9.1% higher (p < 0.01). Local adjunct ZA/HA or PS-1145 significantly enhanced PLGA + rhBMP-induced bone formation by +78.2% and +52.0%, respectively (p ≤ 0.01). Mechanistically, MG-63 human osteoblast-like cells showed cellular invasion and proliferation within PLGA scaffolds. In conclusion, PLGA scaffolds enabled superior spatial control of rhBMP-induced bone formation over clinically-used collagen. The PLGA scaffold has the potential to avoid uncontrollable bone formation-related safety issues and to customise bone shape by scaffold design. Moreover, local treatment with anti-resorptive agents incorporated within the scaffold further augmented rhBMP-induced bone formation.
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Affiliation(s)
- N Y C Yu
- Orthopaedic Research & Biotechnology, Research Building, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145,
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Lim AKP, Patel N, Eckersley RJ, Fitzpatrick J, Crossey MME, Hamilton G, Goldin RD, Thomas HC, Vennart W, Cosgrove DO, Taylor-Robinson SD. A comparison of 31P magnetic resonance spectroscopy and microbubble-enhanced ultrasound for characterizing hepatitis c-related liver disease. J Viral Hepat 2011; 18:e530-4. [PMID: 21914073 DOI: 10.1111/j.1365-2893.2011.01455.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 01/06/2023]
Abstract
We compared in vivo hepatic (31) P magnetic resonance spectroscopy ((31) P MRS) and hepatic vein transit times (HVTT) using contrast-enhanced ultrasound with a microbubble agent to assess the severity of hepatitis C virus (HCV)-related liver disease. Forty-six patients with biopsy-proven HCV-related liver disease and nine healthy volunteers had (31) P MRS and HVTT performed on the same day. (31) P MR spectra were obtained at 1.5 T. Peak areas were calculated for metabolites, including phosphomonoesters (PME) and phosphodiesters (PDE). Patients also had the microbubble ultrasound contrast agent, Levovist (2 g), injected into an antecubital vein, and time-intensity Doppler ultrasound signals of the right and middle hepatic veins were measured. The HVTT was calculated as the time from injection to a sustained rise in Doppler signal 10% greater than baseline. The shortest times were used for analysis. Based on Ishak histological scoring, there were 15 patients with mild hepatitis, 20 with moderate/severe hepatitis and 11 with cirrhosis. With increasing severity of disease, the PME/PDE ratio was steadily elevated, while the HVTT showed a monotonic decrease. Both imaging modalities could separate patients with cirrhosis from the mild and moderate/severe hepatitis groups. No statistical difference was observed in the accuracy of each test to denote mild, moderate/severe hepatitis and cirrhosis (Fisher's exact test P =1.00). (31) P MRS and HVTT show much promise as noninvasive imaging tests for assessing the severity of chronic liver disease. Both are equally effective and highly sensitive in detecting cirrhosis.
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Affiliation(s)
- A K P Lim
- Imaging Sciences Department, Institute of Clinical Sciences Centre, Faculty of Medicine, London, UK.
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Schukken YH, Günther J, Fitzpatrick J, Fontaine MC, Goetze L, Holst O, Leigh J, Petzl W, Schuberth HJ, Sipka A, Smith DGE, Quesnell R, Watts J, Yancey R, Zerbe H, Gurjar A, Zadoks RN, Seyfert HM. Host-response patterns of intramammary infections in dairy cows. Vet Immunol Immunopathol 2011; 144:270-89. [PMID: 21955443 DOI: 10.1016/j.vetimm.2011.08.022] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 07/28/2011] [Accepted: 08/26/2011] [Indexed: 01/12/2023]
Abstract
Many different bacterial species have the ability to cause an infection of the bovine mammary gland and the host response to these infections is what we recognize as mastitis. In this review we evaluate the pathogen specific response to the three main bacterial species causing bovine mastitis: Escherichia coli, Streptococcus uberis and Staphylococcus aureus. In this paper we will review the bacterial growth patterns, host immune response and clinical response that results from the intramammary infections. Clear differences in bacterial growth pattern are shown between bacterial species. The dominant pattern in E. coli infections is a short duration high bacteria count infection, in S. aureus this is more commonly a persistent infection with relative low bacteria counts and in S. uberis a long duration high bacteria count infection is often observed. The host immune response differs significantly depending on the invading bacterial species. The underlying reasons for the differences and the resulting host response are described. Finally we discuss the clinical response pattern for each of the three bacterial species. The largest contrast is between E. coli and S. aureus where a larger proportion of E. coli infections cause potentially severe clinical symptoms, whereas the majority of S. aureus infections go clinically unnoticed. The relevance of fully understanding the bovine host response to intramammary infection is discussed, some major gaps in our knowledge are highlighted and directions for future research are indicated.
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Affiliation(s)
- Ynte H Schukken
- Quality Milk Production Services, Cornell University, 240 Farrier Road, Ithaca, NY 14853, USA.
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Pyörälä S, Hovinen M, Simojoki H, Fitzpatrick J, Eckersall PD, Orro T. Acute phase proteins in milk in naturally acquired bovine mastitis caused by different pathogens. Vet Rec 2011; 168:535. [DOI: 10.1136/vr.d1120] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S. Pyörälä
- Department of Production Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Paroninkuja 20 04920 Saarentaus Finland
| | - M. Hovinen
- Department of Production Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Paroninkuja 20 04920 Saarentaus Finland
| | - H. Simojoki
- Department of Production Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Paroninkuja 20 04920 Saarentaus Finland
| | - J. Fitzpatrick
- Moredun Research Institute; Pentlands Science Park, Bush Loan Penicuik Midlothian EH2 0PZ
| | - P. D. Eckersall
- Division of Animal Production and Public Health; Faculty of Veterinary Medicine; University of Glasgow; Bearsden Road Glasgow G61 1QH
| | - T. Orro
- Department of Animal Health and Environment; Institute of Veterinary Medicine and Animal Sciences; Estonian University of Life Sciences; Kreutzwaldi 62 51014 Tartu Estonia
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Fitzpatrick J, Aoki H, Koh S, deBarbadillo C, Midorikawa I, Miyazaki M, Omori A, Shimizu T. Phosphorus Recovery with New Ultra-Low Adsorption Process. ACTA ACUST UNITED AC 2011. [DOI: 10.2175/193864711802867270] [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: 11/09/2022]
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Fitzpatrick J, Weaver T, Boner M, Anderson M, O'Bryan C, Tarallo S. Wet-Weather Piloting Toward the Largest Compressible Media Filter on the Planet. ACTA ACUST UNITED AC 2011. [DOI: 10.2175/193864711802766218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mercer D, Morrell NT, Fitzpatrick J, Silva S, Child Z, Miller R, DeCoster TA. The course of the distal saphenous nerve: a cadaveric investigation and clinical implications. Iowa Orthop J 2011; 31:231-235. [PMID: 22096447 PMCID: PMC3215141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Injury to the saphenous nerve at the ankle has been described as a complication resulting from incision and dissection over the distal tibia and medial malleolus. However, the exact course and location of the distal saphenous nerve is not well described in the literature. The purpose of this study was to determine the distal limit of the saphenous nerve and its anatomic relationship to commonly identified orthopaedic landmarks and surgical incisions. METHODS Sixteen cadaveric ankles were examined at the level of the distal tibia medial malleolus. An incision was made along the medial aspect of the lower extremity from the knee to the hallux to follow the course and branches of the saphenous nerve under direct visualization. We recorded the shortest distance from the most distal visualized portion of the saphenous nerve to the tip of the medial malleolus, to the antero-medial arthroscopic portal site, and to the tibialis anterior tendon. RESULTS The saphenous nerve runs posterior to the greater saphenous vein in the leg and divides into an anterior and posterior branch approximately 3 cm proximal to the tip of the medial malleolus. These branches terminate in the integument proximal to the tip of the medial malleolus, while the vein continues into the foot. The anterior branch ends at the anterior aspect of the medial malleolus near the posterior edge of the greater saphenous vein. The posterior branch ends near the posterior aspect of the medial malleolus. The average distance from the distal-most visualized aspect of the saphenous nerve to the tip of the medial malleolus measured 8mm +/-; 5mm; from the nerve to the medial arthroscopic portal measured 14mm +/-2mm; and from the nerve to the tibialis anterior measured 16mm +/-3mm. In only one case (of 16) was there an identifiable branch of the saphenous nerve extending to the foot and in this specimen it extended to the first metatarsophalangeal joint. The first metatarsophalangeal joint was innervated by the superficial peroneal nerve in all cases. Small variations were also noted. DISCUSSION AND CONCLUSIONS This study highlights the proximity of the distal saphenous nerve to common landmarks in orthopaedic surgery. This has important clinical implications in ankle arthroscopy, tarsal tunnel syndrome, fixation of distal tibia medial malleolar fractures, and other procedures centered about the medial malleolus. While the distal course of the saphenous nerve is generally predictable, variations exist and thus the orthopaedic surgeon must operate cautiously to prevent iatrogenic injury. To avoid saphenous nerve injury, incisions should stay distal to the tip of the medial malleolus. The medial arthroscopic portal should be more than one centimeter from the anterior aspect of the medial malleolus which will also avoid the greater saphenous vein. Incision over the anterior tibialis tendon should stay within one centimeter of the medial edge of the tendon.
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Affiliation(s)
- D Mercer
- The University of New Mexico Albuquerque, NM 87131-0001, USA
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Alba R, Phillips A, Mackie S, Gillikin N, Maxwell C, Brune P, Ridley W, Fitzpatrick J, Levine M, Harris S. Improvements to the International Life Sciences Institute Crop Composition Database. J Food Compost Anal 2010. [DOI: 10.1016/j.jfca.2010.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cobbold JFL, Crossey MME, Colman P, Goldin RD, Murphy PS, Patel N, Fitzpatrick J, Vennart W, Thomas HC, Cox IJ, Taylor-Robinson SD. Optimal combinations of ultrasound-based and serum markers of disease severity in patients with chronic hepatitis C. J Viral Hepat 2010; 17:537-45. [PMID: 19804501 DOI: 10.1111/j.1365-2893.2009.01209.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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: 12/19/2022]
Abstract
Combinations of noninvasive markers may improve discrimination of chronic liver disease severity. The aims of this study were to compare four validated serum and ultrasound-based markers of hepatic disease severity head-to-head with liver biopsy and to assess optimal combinations with consideration of cost. A total of 67 patients with biopsy-proven chronic hepatitis C underwent all four techniques on the same visit [aspartate aminotransferase (AST) to platelet ratio index (APRI); Enhanced Liver Fibrosis (ELF) panel; transient elastography (TE) and ultrasound microbubble hepatic transit times (HTT)]. Markers were combined according to increasing financial cost and ordinal regression used to determine contributions. APRI, ELF, TE and HTT predicted cirrhosis with diagnostic accuracy of 86%, 91%, 90% and 83% respectively. ELF and TE were the most reliable tests with an intra-class correlation of 0.94 each. Either ELF or TE significantly enhanced the prediction of fibrosis stage when combined with APRI, but when combined together, did not improve the model further. Addition of third or fourth markers did not significantly improve prediction of fibrosis. Combination of APRI with either ELF or TE effectively predicts fibrosis stage, but combinations of three or more tests lead to redundancy of information and increased cost.
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Affiliation(s)
- J F L Cobbold
- Department of Hepatology and Gastroenterology, Division of Medicine, Imperial College London, London, UK
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Watson RA, Pride NB, Thomas EL, Fitzpatrick J, Durighel G, McCarthy J, Morin SX, Ind PW, Bell JD. Reduction of total lung capacity in obese men: comparison of total intrathoracic and gas volumes. J Appl Physiol (1985) 2010; 108:1605-12. [PMID: 20299612 PMCID: PMC2886677 DOI: 10.1152/japplphysiol.01267.2009] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 03/16/2010] [Indexed: 11/22/2022] Open
Abstract
Restriction of total lung capacity (TLC) is found in some obese subjects, but the mechanism is unclear. Two hypotheses are as follows: 1) increased abdominal volume prevents full descent of the diaphragm; and 2) increased intrathoracic fat reduces space for full lung expansion. We have measured total intrathoracic volume at full inflation using magnetic resonance imaging (MRI) in 14 asymptomatic obese men [mean age 52 yr, body mass index (BMI) 35-45 kg/m2] and 7 control men (mean age 50 yr, BMI 22-27 kg/m2). MRI volumes were compared with gas volumes at TLC. All measurements were made with subjects supine. Obese men had smaller functional residual capacity (FRC) and FRC-to-TLC ratio than control men. There was a 12% predicted difference in mean TLC between obese (84% predicted) and control men (96% predicted). In contrast, differences in total intrathoracic volume (MRI) at full inflation were only 4% predicted TLC (obese 116% predicted TLC, control 120% predicted TLC), because mediastinal volume was larger in obese than in control [heart and major vessels (obese 1.10 liter, control 0.87 liter, P=0.016) and intrathoracic fat (obese 0.68 liter, control 0.23 liter, P<0.0001)]. As a consequence of increased mediastinal volume, intrathoracic volume at FRC in obese men was considerably larger than indicated by the gas volume at FRC. The difference in gas volume at TLC between the six obese men with restriction, TLC<80% predicted (OR), and the eight obese men with TLC>80% predicted (ON) was 26% predicted TLC. Mediastinal volume was similar in OR (1.84 liter) and ON (1.73 liter), but total intrathoracic volume was 19% predicted TLC smaller in OR than in ON. We conclude that the major factor restricting TLC in some obese men was reduced thoracic expansion at full inflation.
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Affiliation(s)
- R. A. Watson
- Faculty of Medicine, National Heart and Lung Institute, and
| | - N. B. Pride
- Faculty of Medicine, National Heart and Lung Institute, and
| | - E. Louise Thomas
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
| | - J. Fitzpatrick
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
| | - G. Durighel
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
| | - J. McCarthy
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
| | - S. X. Morin
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
| | - P. W. Ind
- Faculty of Medicine, National Heart and Lung Institute, and
| | - J. D. Bell
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
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Wilkinson JR, Lam M, Fitzpatrick J. Public health observatories on the international stage. Public Health 2010; 124:269-73. [PMID: 20417533 DOI: 10.1016/j.puhe.2010.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 03/08/2010] [Indexed: 12/01/2022]
Abstract
This article reviews the involvement of public health observatories in the UK in international public health. It does not aim to be a comprehensive review, but to offer some examples of work in an international context.
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Affiliation(s)
- J R Wilkinson
- Wolfson Research Institute, Durham University, Stockton on Tees TS17 6BH, UK.
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Morin S, Cobbold J, Lim A, Eliahoo J, Thomas E, Mehta S, Durighel G, Fitzpatrick J, Bell J, Taylor-Robinson S. Incidental findings in healthy control research subjects using whole-body MRI. Eur J Radiol 2009; 72:529-33. [DOI: 10.1016/j.ejrad.2008.08.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 07/14/2008] [Accepted: 08/12/2008] [Indexed: 12/21/2022]
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Cooke R, Fitzpatrick J. Haemorrhage from femoral vein cannula: an additional potential source of haemorrhage among intravenous drug users. Emerg Med J 2009; 26:675. [PMID: 19700592 DOI: 10.1136/emj.2008.071175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R Cooke
- West Midlands Ambulance Service NHS Trust, Millenium Point, Waterfront Business Park, Waterfront Way, Brierley Hill, West Midlands DY5 1LX, UK.
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Fitzpatrick J, Aoki H, deBarbadillo C, Kubota A, Omori A, Midorikawa I, Shimizu T. Pilot Testing of a High Efficiency Adsorbent System for Phosphorus Removal and Recovery to Meet Ultra-Low Phosphorus Limits. ACTA ACUST UNITED AC 2009. [DOI: 10.2175/193864709793901149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
The production of viable sperm is essential for male reproductive success. However, because females in many species mate with several males during a single reproductive episode, leading to sperm competition, a male's reproductive success also depends critically on the ability of his sperm to compete efficiently with those from rival males for fertilizations. Therefore, males who regularly encounter sperm competition are expected to produce high quality ejaculates. Here, I will provide an overview of how sperm morphology and performance are influenced by sperm competition, both within and between species, using recent empirical examples. Having established the importance of producing high quality ejaculates in males experiencing sperm competition, I will then examine the reproductive consequences of producing sub-optimal sperm. Given the well known role that inbreeding plays in reducing genetic quality and reproductive success, I will focus in particular on how inbreeding acts to reduce sperm quality. Finally, I will examine the consequences of inbreeding for male reproductive success in species where sperm competition is rampant. Together, these results highlight the evolutionary importance of sperm competition and inbreeding in shaping ejaculate traits.
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Watson W, Gill C, O'Neill A, Dowling C, Fitzpatrick J. 307 POSTER Effects of triple knockdown of cIAP-1, c-IAP-2 and XIAP on prostate cancer cell susceptibility to apoptosis. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Dowling C, Cuffe S, Tacke M, Fitzpatrick J, Watson W. 493 POSTER Manipulating prostate cancer cell susceptibility to docetaxel and novel titanocene analogues induced apoptosis. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72427-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Boyle P, Anderson B, Andersson L, Ariyaratne Y, Auleley GR, Barbacid M, Bartelink H, Baselga J, Behbehani K, Belardelli F, Berns A, Bishop J, Brawley O, Burns H, Clanton M, Cox B, Currow D, Dangou JM, de Valeriola D, Dinshaw K, Eggermont A, Fitzpatrick J, Forstmane M, Garaci E, Gavin A, Kakizoe T, Kasler M, Keita N, Kerr D, Khayat D, Khleif S, Khuhaprema T, Knezevic T, Kubinova R, Mallath M, Martin-Moreno J, McCance D, McVie J, Merriman A, Ngoma T, Nowacki M, Orgelbrand J, Park JG, Pierotti M, Ashton L, Puska P, Escobar C, Rajan B, Rajkumar T, Ringborg U, Robertson C, Rodger A, Roovali L, Santini L, Sarhan M, Seffrin J, Semiglazov V, Shrestha B, Soo K, Stamenic V, Tamblyn C, Thomas R, Tuncer M, Tursz T, Vaitkiene R, Vallejos C, Veronesi U, Wojtyla A, Yach D, Yoo KY, Zatonski W, Zaridze D, Zeng YX, Zhao P, Zheng T. Need for global action for cancer control. Ann Oncol 2008; 19:1519-21. [DOI: 10.1093/annonc/mdn426] [Citation(s) in RCA: 25] [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] [Indexed: 11/12/2022] Open
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Domino M, Maxwell J, Cody M, Cheal K, Busch A, Stone WV, Cooley S, Zubtritsky C, Estes C, Shen Y, Lynch M, Grantham S, Wohlford P, Aoyama M, Fitzpatrick J, Zaman S, Dodson J, Levkoff S. The Influence of Integration on the Expenditures and Costs of Mental Health and Substance Use Care: Results from the randomized PRISM-E Study. Ageing Int 2008; 32:108-127. [PMID: 19777089 PMCID: PMC2748957 DOI: 10.1007/s12126-008-9010-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We compared the healthcare costs associated with an integrated care model to an enhanced referral model for the treatment of depression, anxiety, and at-risk drinking from the randomized Primary Care Research in Substance Abuse and Mental Health for the Elderly study. We examined total healthcare costs and cost components, separately for Veteran's Affairs and non-VA participants. No differences in total health expenditures were detected between study arms. No differences in behavioral health expenditures were detected for non-VA sites, but the VA integrated arm had slightly higher ($38; p<0.05) behavioral health costs. Differences in other types of services use were detected.
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Affiliation(s)
- Me Domino
- The University of North Carolina School of Public Health
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Murphy D, Cafferkey M, Falkiner F, Gillespie W, Fitzpatrick J. Antimikrobielle Wirkstoffe in der transurethralen Chirurgie: Bedeutung von Urinschnellkultur und direkter Resistenzbestimmung. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1062644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Webb D, Fitzpatrick J, O'Flynn J. Nachbeobachtung von 406 konsekutiven Rückenmarksverletzungen über 15 Jahre. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1062572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fichtner J, Fisch M, Voges G, Fitzpatrick J, Hohenfellner R. Kontinente Vesikostomie mittels submukös versenktem Boari-Rohr: Tierexperimentelle Studie im Schweinemodell. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1057877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schmitz SA, O'Regan DP, Fitzpatrick J, Neuwirth C, Potter E, Tosi I, Hajnal JV, Naoumova RP. White matter brain lesions in midlife familial hypercholesterolemic patients at 3-Tesla magnetic resonance imaging. Acta Radiol 2008; 49:184-9. [PMID: 18300144 DOI: 10.1080/02841850701736263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with hypercholesterolemia of 60 years and older have an increased risk for white matter brain lesions and dementia. PURPOSE To investigate whether patients with familial hypercholesterolemia (FH) develop white matter lesions at 3-Tesla (T) MRI as early as in midlife. MATERIAL AND METHODS Non-diabetic, nonsmoking, and non-hypertensive heterozygous FH patients on treatment with maximally tolerated dose of a statin for more than 5 years (n = 14) and matched controls (n = 22) aged 25 to 60 years of age were studied. Imaging was performed at 3T with a fluid-attenuated T2-weighted MR pulse sequence and a T1-weighted spin-echo pulse sequence following 10 ml of i.v. gadopentetate dimeglumine. Images were evaluated by two independent readers. Fasting blood samples were taken. Student's t test was employed at P<0.05. RESULTS Three volunteers and one FH patient had white matter lesions (P<0.53). No other evidence of past ischemic stroke was observed. Mean total serum cholesterol and low-density lipoprotein (LDL) cholesterol were significantly higher in the FH group (6.0+/-1.1 vs. 5.1+/-0.9 mmol/l, P<0.02 and 4.1+/-0.9 vs. 3.1+/-0.8 mmol/l, P<0.004, respectively). CONCLUSION Heterozygous FH patients on statin treatment in the age range of 25 to 60 years are not at increased risk of white matter lesions at 3T MRI.
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Affiliation(s)
- S. A. Schmitz
- Imaging Sciences Department and Clinical Research Facility, MRC Clinical Sciences Centre, London, UK;, Lipid Clinic, Hammersmith Hospital, London, UK
| | - D. P. O'Regan
- Imaging Sciences Department and Clinical Research Facility, MRC Clinical Sciences Centre, London, UK;, Lipid Clinic, Hammersmith Hospital, London, UK
| | - J. Fitzpatrick
- Imaging Sciences Department and Clinical Research Facility, MRC Clinical Sciences Centre, London, UK;, Lipid Clinic, Hammersmith Hospital, London, UK
| | - C. Neuwirth
- Imaging Sciences Department and Clinical Research Facility, MRC Clinical Sciences Centre, London, UK;, Lipid Clinic, Hammersmith Hospital, London, UK
| | - E. Potter
- Imaging Sciences Department and Clinical Research Facility, MRC Clinical Sciences Centre, London, UK;, Lipid Clinic, Hammersmith Hospital, London, UK
| | - I. Tosi
- Imaging Sciences Department and Clinical Research Facility, MRC Clinical Sciences Centre, London, UK;, Lipid Clinic, Hammersmith Hospital, London, UK
| | - J. V. Hajnal
- Imaging Sciences Department and Clinical Research Facility, MRC Clinical Sciences Centre, London, UK;, Lipid Clinic, Hammersmith Hospital, London, UK
| | - R. P. Naoumova
- Imaging Sciences Department and Clinical Research Facility, MRC Clinical Sciences Centre, London, UK;, Lipid Clinic, Hammersmith Hospital, London, UK
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Droz J, Balducci L, Bolla M, Emberton M, Fitzpatrick J, Joniau S, Kattan M, Monfardini S, Moul J, Naeim A, van Poppel H, Saad F, Sternberg C. VIA.1 SIOG (International Society of Geriatric Oncology) prostate cancer guidelines proposals in senior adult men. Crit Rev Oncol Hematol 2007. [DOI: 10.1016/s1040-8428(13)70139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Droz J, Balducci L, Bolla M, Emberton M, Fitzpatrick J, Joniau S, Kattan M, Monfardini S, Saad F, Sternberg C. 1305 POSTER SIOG (International Society of Geriatric Oncology) prostate cancer guidelines proposals in senior adult men. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Droz J, Balducci L, Bolla M, Emberton M, Fitzpatrick J, Joniau S, Kattan M, Monfardini S, Moul J, Naeim A, van Poppel H, Saad F, Sternberg C. POS-03.126: SIOG (International Society of Geriatric Oncology) prostate cancer guidelines proposals in senior adult men. Urology 2007. [DOI: 10.1016/j.urology.2007.06.675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mindell J, Klodawski E, Fitzpatrick J, Malhotra N, McKee M, Sanderson C. The impact of private-sector provision on equitable utilisation of coronary revascularisation in London. Heart 2007; 94:1008-11. [PMID: 17693460 DOI: 10.1136/hrt.2007.119875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the impact of including private-sector data on assessments of equity of coronary revascularisation provision using NHS data only. DESIGN Analyses of hospital episodes statistics and private-sector data by age, sex and primary care trust (PCT) of residence. For each PCT, the share of London's total population and revascularisations (all admissions, NHS-funded, and privately-funded admissions) were calculated. Gini coefficients were derived to provide an index of inequality across subpopulations, with parametric bootstrapping to estimate confidence intervals. SETTING London. PARTICIPANTS London residents undergoing coronary revascularisation April 2001-December 2003. INTERVENTION Coronary artery bypass graft or angioplasty. MAIN OUTCOME MEASURES Directly standardised revascularisation rates, Gini coefficients. RESULTS NHS-funded age-standardised revascularisation rates varied from 95.2 to 193.9 per 100,000 and privately funded procedures from 7.6 to 57.6. Although the age distribution did not vary by funding, the proportion of revascularisations among women that were privately funded (11.0%) was lower than among men (17.0%). Privately funded rates were highest in PCTs with the lowest death rates (p = 0.053). NHS-funded admission rates were not related to deprivation nor age-standardised deaths rates from coronary heart disease. Privately funded admission rates were lower in more deprived PCTs. NHS provision was significantly more egalitarian (Gini coefficient 0.12) than the private sector (0.35). Including all procedures was significantly less equal (0.13) than NHS-funded care alone. CONCLUSION Private provision exacerbates geographical inequalities. Those responsible for commissioning care for defined populations must have access to consistent data on provision of treatment wherever it takes place.
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Affiliation(s)
- J Mindell
- University College London, London, UK
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