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Senior A, Chan J, Brookes K, Jolly K, Darr A, Ameen R. Emergency management of neck stoma patients during the coronavirus pandemic: a national nurse survey. ACTA ACUST UNITED AC 2021; 30:742-746. [PMID: 34170732 DOI: 10.12968/bjon.2021.30.12.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Neck stoma patient care involves significant clinical complexity. Inadequate staff training, equipment provision and infrastructure have all been highlighted as causes for avoidable patient harm. AIMS To establish the perception of knowledge and confidence levels relating to the emergency management of neck stomas among UK nurses during the COVID-19 pandemic. METHOD A nationwide prospective electronic survey of both primary and secondary care nurses via the Royal College of Nursing and social media. FINDINGS 402 responses were collated: 81 primary care and 321 secondary care; the majority (n=130) were band 5. Forty-nine per cent could differentiate between a laryngectomy and a tracheostomy; ENT nurses scored highest (1.56; range 0-2) on knowledge. Fifty-seven per cent could oxygenate a tracheostomy stoma correctly and 54% could oxygenate a laryngectomy stoma correctly. Sixty-five per cent cited inadequate neck stoma training and 91% felt inclusion of neck stoma training was essential within the nursing curriculum. CONCLUSION Clinical deficiencies of management identified by nurses can be attributed to a lack of confidence secondary to reduced clinical exposure and education.
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Affiliation(s)
- Andrew Senior
- ENT Registrar, Birmingham Women's and Children's NHS Foundation Trust
| | | | - Kim Brookes
- Head and Neck Clinical Nurse Specialist, Royal Wolverhampton New Cross Hospital, Wolverhampton
| | - Karan Jolly
- ENT Registrar, Princess Royal Hospital, Telford
| | - Adnan Darr
- ENT Registrar, Princess Royal Hospital, Telford
| | - Rohan Ameen
- ENT Senior House Officer, Princess Royal Hospital, Telford
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2
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Estai M, Walsh J, Maddison K, Shepherd K, Hillman D, McArdle N, Baker V, King S, Al-Obaidi Z, Bamagoos A, Parry R, Langdon C, Trzaskowski R, Harris G, Brookes K, Blacker D, Eastwood PR. Sleep-disordered breathing in patients with stroke-induced dysphagia. J Sleep Res 2020; 30:e13179. [PMID: 32856372 DOI: 10.1111/jsr.13179] [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: 03/25/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
This study examined the nature and characteristics of sleep-disordered breathing, including obstructive sleep apnea and central sleep apnea, in patients with post-stroke dysphagia, to determine the demographic, anthropometric and clinical variables that were associated with sleep-disordered breathing. Thirty-nine patients diagnosed with acute stroke (28 males and 11 females with a mean age of 72.3 ± 10.0 years) underwent overnight polysomnography (within 3.9 ± 1.6 days after admission). Sleep-disordered breathing was described by the apnea-hypopnea index and its obstructive and central components by the obstructive apnea-hypopnea index and central apnea-hypopnea index, respectively. Severity of dysphagia was assessed using the Mann Assessment of Swallowing Ability score. Severity of stroke and functional dependence were assessed by the National Institute of Health Stroke Scale and the modified Barthel index, respectively. Most of the cohort (87%) had moderate-to-severe dysphagia (Mann Assessment of Swallowing Ability of 143.2 ± 19.9). Sleep-disordered breathing (apnea-hypopnea index ≥ 5 events/hr) was present in 38 participants (97%) with a mean apnea-hypopnea index of 37.5 ± 24.4 events/hr. Sleep-disordered breathing was predominantly obstructive in nature, with a mean obstructive apnea-hypopnea index and central apnea-hypopnea index of 19.6 ± 15.7 and 11.4 ± 17.6 events/hr, respectively. Multivariate linear regression analyses showed that the apnea-hypopnea index was associated with sex (p = .0001), body mass index (p = .029) and the modified Barthel index (p = .006); the obstructive apnea-hypopnea index was associated with the Mann Assessment of Swallowing Ability (p = .006), sex (p = .004) and body mass index (p = .015) and had a nonlinear relationship with the modified Barthel index (p = .019); and the central apnea-hypopnea index was associated with sex (p = .027) and the modified Barthel index (p = .019). The present study showed that dysphagia severity was associated with obstructive sleep apnea severity and this association was independent of sex, modified Barthel index and body mass index. However, stroke-induced dysphagia was not associated with central sleep apnea or overall sleep-disordered breathing.
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Affiliation(s)
- Mohamed Estai
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,The Australian e-Health Research Centre, CSIRO, Perth, WA, Australia
| | - Jennifer Walsh
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Kathleen Maddison
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Kelly Shepherd
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - David Hillman
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Nigel McArdle
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Vanessa Baker
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Stuart King
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Zeena Al-Obaidi
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Ahmad Bamagoos
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Physiology, Rabigh Medical School, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Reece Parry
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Claire Langdon
- Department of Health & Human Services, Melbourne, Vic., Australia.,Department of Speech Pathology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Robyn Trzaskowski
- Department of Speech Pathology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Geraldine Harris
- Department of Speech Pathology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Kim Brookes
- Department of Speech Pathology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - David Blacker
- Department of Neurology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA, Australia
| | - Peter R Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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3
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Overton K, Mennon V, Mothobi N, Neild B, Martinez E, Masters J, Grant P, Akhunji Z, Su WY, Torda A, Whyte CM, Lloyd A, Weatherall C, Hofmeyr A, Foo H, Brookes K, Marriott D, Sintchenko V, Clezy K, Konecny P, Post JJ. Cluster of invasive Mycobacteria chimaera infections following cardiac surgery demonstrating novel clinical features and risks of aortic valve replacement. Intern Med J 2019; 48:1514-1520. [PMID: 30517986 DOI: 10.1111/imj.14093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/06/2018] [Revised: 04/18/2018] [Accepted: 04/22/2018] [Indexed: 12/01/2022]
Abstract
There is a global outbreak of infections due to Mycobacterium chimaera associated with cardiac surgery. The most serious infections involve prosthetic material implantation, and all have followed surgical procedures involving cardiopulmonary bypass. We describe a cluster of four cases following cardiac surgery at a tertiary referral centre in Sydney, Australia. We report novel clinical findings, including haemolysis and kidney rupture possibly related to immune reconstitution inflammatory syndrome. The positive effect of corticosteroids on haemodynamic function in two cases and the failure of currently recommended antimicrobial therapy to sterilise prosthetic valve material in the absence of surgery despite months of treatment are also critically examined. Positron emission tomography was positive in two cases despite normal transoesophageal echocardiograms. The proportion of cases with M. chimaera infection after aortic valve replacement (4/890, 0.45%; 95% confidence interval 0.18-1.15%) was significantly higher than after all other cardiothoracic surgical procedures (0/2433, 0%; 95% confidence interval 0-0.16%).
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Affiliation(s)
- Kristen Overton
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Vidthyia Mennon
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Nomvuyo Mothobi
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Blake Neild
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Kogarah, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Elena Martinez
- Centre for Infectious Diseases and Microbiology, Public Health, Westmead Hospital, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia.,NSW Mycobacterium Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Jeffrey Masters
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Peter Grant
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Zakir Akhunji
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Wei-Yuen Su
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Adrienne Torda
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Claudia M Whyte
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Lloyd
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Chris Weatherall
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Kogarah, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Ann Hofmeyr
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Hong Foo
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Kim Brookes
- Clinical Governance Unit, South Eastern Sydney Local Health District, The Sutherland Hospital, Caringbah, New South Wales, Australia
| | - Debbie Marriott
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Vitali Sintchenko
- Centre for Infectious Diseases and Microbiology, Public Health, Westmead Hospital, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia.,NSW Mycobacterium Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Kate Clezy
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Pam Konecny
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Kogarah, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jeffrey J Post
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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4
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Brogan E, Langdon C, Brookes K, Budgeon C, Blacker D. Can't swallow, can't transfer, can't toilet: factors predicting infections in the first week post stroke. J Clin Neurosci 2014; 22:92-7. [PMID: 25174763 DOI: 10.1016/j.jocn.2014.05.035] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 05/15/2014] [Indexed: 11/18/2022]
Abstract
Post stroke infections are a significant clinical problem. Dysphagia occurs in approximately half of stroke patients and is associated with respiratory infections; however it is unclear what other factors contribute to an increased risk. This study aimed to determine which factors are most strongly predictive of infections in the first 7 days post stroke admission. A retrospective review of 536 stroke patients admitted to Australian hospitals in 2010 was conducted. Data were collected on 37 clinical and demographic parameters. Univariate and multivariate logistic regression analysis was performed. The overall incidence of infection was 21%. Full assistance with mobility and incontinence on admission were associated with increased odds of general infection. Nil by mouth and presence of a nasogastric tube were significantly associated with patients developing respiratory infections. Urinary incontinence was a significant predictor for a urinary tract infection. Incidence of infection was highest on day two post admission. This study found enteral feeding, requiring full assistance with mobility and incontinence were significantly associated with developing infections in acute stroke. It contributes valuable new data from a large cohort of stroke patients demonstrating a period of susceptibility to infection in the very acute post stroke period.
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Affiliation(s)
- Emily Brogan
- Speech Pathology Department, Sir Charles Gairdner Hospital, 3rd Floor A Block, Hospital Avenue, Nedlands, WA 6009, Australia.
| | - Claire Langdon
- Western Australian Department of Health, East Perth, WA, Australia
| | - Kim Brookes
- Speech Pathology Department, Sir Charles Gairdner Hospital, 3rd Floor A Block, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Charley Budgeon
- Centre for Applied Statistics, University of Western Australia, Crawley, WA, Australia; Department of Research, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - David Blacker
- Neurology Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; The School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
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5
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Brogan E, Langdon C, Brookes K, Budgeon C, Blacker D. Dysphagia and Factors Associated with Respiratory Infections in the First Week Post Stroke. Neuroepidemiology 2014; 43:140-4. [DOI: 10.1159/000366423] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/31/2014] [Indexed: 11/19/2022] Open
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6
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Brookes K, Limbert C, Deacy C, O'Reilly A, Scott S, Thirlaway K. Systematic review: Work-related stress and the HSE Management Standards. Occup Med (Lond) 2013; 63:463-72. [DOI: 10.1093/occmed/kqt078] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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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7
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Brookes K, Cummings J, Backen A, Greystoke A, Ward T, Jayson GC, Dive C. Issues on fit-for-purpose validation of a panel of ELISAs for application as biomarkers in clinical trials of anti-Angiogenic drugs. Br J Cancer 2010; 102:1524-32. [PMID: 20407440 PMCID: PMC2869162 DOI: 10.1038/sj.bjc.6605661] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Successful introduction of new anticancer agents into the clinic is often hampered by a lack of qualified biomarkers. Studies have been conducted of 17 ELISAs representing a potential panel of pharmacodynamic/predictive biomarkers for drugs targeted to tumour vasculature. Methods: The fit-for-purpose approach to method validation was used. Stability studies were performed using recombinant proteins in surrogate matrices, endogenous analytes in healthy volunteer and cancer patient plasma. The impact of platelet depletion was investigated. Results: Method validation focused on measuring precision and showed that 15 of the 17 assays were within acceptable limits. Stability at −80°C was shown for 3 months with all recombinant proteins in surrogate matrices, whereas under the same conditions instability was observed with KGF in platelet-rich and platelet-depleted plasma, and with PDGF-BB in platelet-depleted plasma from cancer patients. For measurement of extracellular circulating analytes, platelet depletion should be conducted before freezing of plasma to prevent release of PDGF-BB, FGFb and VEGF-A. A protocol was developed to remove >90% platelets from plasma requiring centrifugation at 2000 g for 25 min. Conclusions: These studies highlight the need for assay validation and crucial assessment of sample handling issues before commencement of biomarker analysis in clinical trials.
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Affiliation(s)
- K Brookes
- Clinical and Experimental Pharmacology Group, Paterson Institute for Cancer Research, University of Manchester, Manchester M20 4BX, UK
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8
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Xu X, Duman EA, Anney R, Brookes K, Franke B, Zhou K, Buschgens C, Chen W, Christiansen H, Eisenberg J, Gabriëls I, Manor I, Marco R, Müller U, Mulligan A, Rommelse N, Thompson M, Uebel H, Banaschewski T, Buitelaar J, Ebstein R, Gill M, Miranda A, Mulas F, Oades R, Roeyers H, Rothenberger A, Sergeant J, Sonuga-Barke E, Steinhausen HC, Taylor E, Faraone S, Asherson P. No association between two polymorphisms of the serotonin transporter gene and combined type attention deficit hyperactivity disorder. Am J Med Genet 2009. [DOI: 10.1002/ajmg.b.30921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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9
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Xu X, Duman E, Anney R, Brookes K, Franke B, Zhou K, Buschgens C, Chen W, Christiansen H, Eisenberg J, Gabriëls I, Manor I, Marco R, Müller U, Mulligan A, Rommelse N, Thompson M, Uebel H, Banaschewski T, Buitelaar J, Ebstein R, Gill M, Miranda A, Mulas F, Oades R, Roeyers H, Rothenberger A, Sergeant J, Sonuga-Barke E, Steinhausen HC, Taylor E, Faraone S, Asherson P. No association between two polymorphisms of the serotonin transporter gene and combined type attention deficit hyperactivity disorder. Am J Med Genet 2009. [DOI: 10.1002/ajmg.b.30892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Xu X, Duman EA, Anney R, Brookes K, Franke B, Zhou K, Buschgens C, Chen W, Christiansen H, Eisenberg J, Gabriëls I, Manor I, Marco R, Müller UC, Mulligan A, Rommelse N, Thompson M, Uebel H, Banaschewski T, Buitelaar J, Ebstein R, Gill M, Miranda A, Mulas F, Oades RD, Roeyers H, Rothenberger A, Sergeant J, Sonuga-Barke E, Steinhausen HC, Taylor E, Faraone SV, Asherson P, Asherson P. No association between two polymorphisms of the serotonin transporter gene and combined type attention deficit hyperactivity disorder. Am J Med Genet B Neuropsychiatr Genet 2008; 147B:1306-9. [PMID: 18452186 DOI: 10.1002/ajmg.b.30737] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 12/20/2022]
Abstract
Several independent studies have reported association between serotonin transporter gene (SLC6A4) polymorphisms and attention deficit hyperactivity disorder (ADHD). Five studies found evidence for association between the long-allele of a 44-bp insertion/deletion polymorphism (5-HTTLPR) and ADHD. Another two studies corroborated this finding while a further six studies did not find such an association. For a second polymorphism within the gene, a variable number tandem repeat (VNTR) within intron 2, one study demonstrated that the 12/12 genotype was significantly less frequent in ADHD cases compared to controls, while a second study found that the 12-allele was preferentially transmitted to offspring affected with ADHD. To provide further clarification of the reported associations, we investigated the association of these two markers with ADHD in a sample of 1,020 families with 1,166 combined type ADHD cases for the International Multi-Centre ADHD Genetics project, using the Transmission Disequilibrium Test. Given the large body of work supporting the association of the promoter polymorphism and mood disorders, we further analyzed the group of subjects with ADHD plus mood disorder separately. No association was found between either of the two markers and ADHD in our large multisite study or with depression within the sample of ADHD cases.
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Affiliation(s)
- X Xu
- MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry, London, UK
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11
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Asherson P, Zhou K, Anney RJL, Franke B, Buitelaar J, Ebstein R, Gill M, Altink M, Arnold R, Boer F, Brookes K, Buschgens C, Butler L, Cambell D, Chen W, Christiansen H, Feldman L, Fleischman K, Fliers E, Howe-Forbes R, Goldfarb A, Heise A, Gabriëls I, Johansson L, Lubetzki I, Marco R, Medad S, Minderaa R, Mulas F, Müller U, Mulligan A, Neale B, Rijsdijk F, Rabin K, Rommelse N, Sethna V, Sorohan J, Uebel H, Psychogiou L, Weeks A, Barrett R, Xu X, Banaschewski T, Sonuga-Barke E, Eisenberg J, Manor I, Miranda A, Oades RD, Roeyers H, Rothenberger A, Sergeant J, Steinhausen HC, Taylor E, Thompson M, Faraone SV. A high-density SNP linkage scan with 142 combined subtype ADHD sib pairs identifies linkage regions on chromosomes 9 and 16. Mol Psychiatry 2008; 13:514-21. [PMID: 18180756 DOI: 10.1038/sj.mp.4002140] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [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: 01/07/2023]
Abstract
As part of the International Multi-centre ADHD Genetics project we completed an affected sibling pair study of 142 narrowly defined Diagnostic and Statistical Manual of Mental Disorders, fourth edition combined type attention deficit hyperactivity disorder (ADHD) proband-sibling pairs. No linkage was observed on the most established ADHD-linked genomic regions of 5p and 17p. We found suggestive linkage signals on chromosomes 9 and 16, respectively, with the highest multipoint nonparametric linkage signal on chromosome 16q23 at 99 cM (log of the odds, LOD=3.1) overlapping data published from the previous UCLA (University of California, Los Angeles) (LOD>1, approximately 95 cM) and Dutch (LOD>1, approximately 100 cM) studies. The second highest peak in this study was on chromosome 9q22 at 90 cM (LOD=2.13); both the previous UCLA and German studies also found some evidence of linkage at almost the same location (UCLA LOD=1.45 at 93 cM; German LOD=0.68 at 100 cM). The overlap of these two main peaks with previous findings suggests that loci linked to ADHD may lie within these regions. Meta-analysis or reanalysis of the raw data of all the available ADHD linkage scan data may help to clarify whether these represent true linked loci.
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Affiliation(s)
- P Asherson
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.
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12
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Abstract
Nurses' perceptions of their role are influenced by societal attitudes, government policies and trends in professional issues. Dynamic factors in contemporary health environments challenge traditional nursing roles, in particular those of community nurses. Role theory is a conceptual framework that defines how individuals behave in social situations and how these behaviours are perceived by external observers. This paper reviews the role theory literature as a conceptual framework to explore community nurses' perceptions of their role. Three theoretical perspectives of role theory have emerged from the literature review: 1. social structuralism 2. symbolic interactionism and 3. the dramaturgical perspective. These philosophical perspectives provide a useful framework to investigate the role of community nurses in the contemporary health care system.
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Affiliation(s)
- Kim Brookes
- St George Hospital, Sydney South East Illawarra Area Health Service, Sydney NSW, Australia
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13
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Hussein D, Brookes K, Ward T, Estlin E, Dive C, Makin G. 262 POSTER Pre-clinical evaluation of the novel alkylating agent RH1 against paediatric tumour cell lines. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Brookes K, Xu X, Chen W, Zhou K, Neale B, Lowe N, Anney R, Aneey R, Franke B, Gill M, Ebstein R, Buitelaar J, Sham P, Campbell D, Knight J, Andreou P, Altink M, Arnold R, Boer F, Buschgens C, Butler L, Christiansen H, Feldman L, Fleischman K, Fliers E, Howe-Forbes R, Goldfarb A, Heise A, Gabriëls I, Korn-Lubetzki I, Johansson L, Marco R, Medad S, Minderaa R, Mulas F, Müller U, Mulligan A, Rabin K, Rommelse N, Sethna V, Sorohan J, Uebel H, Psychogiou L, Weeks A, Barrett R, Craig I, Banaschewski T, Sonuga-Barke E, Eisenberg J, Kuntsi J, Manor I, McGuffin P, Miranda A, Oades RD, Plomin R, Roeyers H, Rothenberger A, Sergeant J, Steinhausen HC, Taylor E, Thompson M, Faraone SV, Asherson P. The analysis of 51 genes in DSM-IV combined type attention deficit hyperactivity disorder: association signals in DRD4, DAT1 and 16 other genes. Mol Psychiatry 2006; 11:934-53. [PMID: 16894395 DOI: 10.1038/sj.mp.4001869] [Citation(s) in RCA: 431] [Impact Index Per Article: 23.9] [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: 01/02/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, starting in early childhood and persisting into adulthood in the majority of cases. Family and twin studies have demonstrated the importance of genetic factors and candidate gene association studies have identified several loci that exert small but significant effects on ADHD. To provide further clarification of reported associations and identify novel associated genes, we examined 1,038 single-nucleotide polymorphisms (SNPs) spanning 51 candidate genes involved in the regulation of neurotransmitter pathways, particularly dopamine, norepinephrine and serotonin pathways, in addition to circadian rhythm genes. Analysis used within family tests of association in a sample of 776 DSM-IV ADHD combined type cases ascertained for the International Multi-centre ADHD Gene project. We found nominal significance with one or more SNPs in 18 genes, including the two most replicated findings in the literature: DRD4 and DAT1. Gene-wide tests, adjusted for the number of SNPs analysed in each gene, identified associations with TPH2, ARRB2, SYP, DAT1, ADRB2, HES1, MAOA and PNMT. Further studies will be needed to confirm or refute the observed associations and their generalisability to other samples.
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Affiliation(s)
- K Brookes
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, London, UK
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Brookes K, Davidson P, Daly J, Hancock K. Community health nursing in Australia: a critical literature review and implications for professional development. Contemp Nurse 2004; 16:195-207. [PMID: 15125102 DOI: 10.5172/conu.16.3.195] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Increasing emphasis on community-based mandates an examination of the community health nurse (CHN). AIM A critical literature review of the CHN role internationally, with an emphasis on Australia, was undertaken in order to understand historical precedents and inform policy and strategic directions for the CHN. METHOD A search of the CINAHL, EMBASE, and COCHRANE electronic data-bases from 1982 to June 2002 using community' and 'nursing' as key words and hand searching of books and government reports was undertaken. FINDINGS This search strategy revealed a lack of literature compared with other areas of nursing. Key themes emerging from this review are: (1) an absence of clear role definitions and lack of clarity of roles; (2) variability in educational requirements for CHNs; (3) diminished CHN power in policy decision making; (3) conflicting role expectations between different facets of the health care system; (4) underutilisation and untapped potential of the role of the CHN in the contemporary health care system; (5) the emerging influence of specialist nurses in community based-care; (6) uptake of traditional nursing roles by non-nurses and (7) an absence of a cohesive model of professional development of CHN that is able to articulate with contemporary social, political and economic trends in health care delivery. CONCLUSIONS Community health nursing in Australia has a low professional profile when compared to other nursing specialties. An emerging issue, gleaned from the literature review is the tension and debate between specialist and generalist services. It is apparent from this review that CHN have to more actively participate in research and peer reviewed debate in order to have their voice heard and promote their unique and valuable contribution to the nursing profession and the health care system.
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Abstract
OBJECTIVE To investigate the benefits of a community services liaison pharmacist in addressing medication misuse in elderly patients, which occur on both admission and discharge. DESIGN Completion of a medication history for each patient on admission by the community liaison pharmacist. On discharge updated medication record sheets were faxed to the patient's GP and community pharmacy; a survey of GPs' and community pharmacists' opinions who were involved in the study was carried out. SUBJECTS AND SETTING 109 patients over the age of 60 on 4 or more medications admitted by the medical admissions unit of Antrim Area Hospital. MAIN OUTCOME MEASURES Medication related problems; GP and community pharmacist opinions of the service. RESULTS Of the 109 patients, 61% had an incomplete medication history on admission, 21% of patients who brought their own drugs were not dealt with appropriately in hospital and 33% of discharged patients had medication-related problems. The service was felt to be very useful by GPs (80%) and community pharmacists (100%). A reduction in readmission rate of 2.4% was seen in these patients compared to the average for this age group. CONCLUSION The community services liaison pharmacist produced benefits in terms of patient medication management, reduced readmission rates and wastage of patients' own drugs. A more detailed one-year study will now be carried out.
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Affiliation(s)
- K Brookes
- Antrim Hospital Academic Pharmacy Practice Unit, Antrim Area Hospital, UK
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Cowan M, Davies J, Brookes K, Billstrom M, McLeish P, Buchan A, Skinner GR. Inhibition of rate of tumour growth in rodent species by inoculation of herpesviruses and encephalomyocarditis virus. J Med Virol 1990; 30:211-5. [PMID: 2160515 DOI: 10.1002/jmv.1890300313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Inoculation of herpesviruses and encephalomyocarditis virus into subcutaneous tumours in hamsters and mice reduced the rate of tumour growth compared to untreated tumours or secondary tumours which had arisen following surgical excision of the primary tumour; in addition, survival times were increased in animals whose tumours were inoculated with virus. It is suggested that the role of virus in the modification of tumour growth merits further exploration.
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Affiliation(s)
- M Cowan
- Vaccine Research Foundation, Department of Medical Microbiology, The Medical School, University of Birmingham, England
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Skinner GR, Cowan M, Davies J, Brookes K, Billstrom M, Buchan A. Reduced tumorigenicity of rodent tumour cells and tumour explants following infection with wild type and mutant herpes simplex virus, bovine mammillitis virus and encephalomyocarditis virus. Br J Exp Pathol 1988; 69:495-504. [PMID: 2846027 PMCID: PMC2013228] [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: 01/02/2023]
Abstract
The tumorigenicity of neoplastic hamster and mouse cell lines and tumour explants was reduced by infection with herpes simplex virus (HSV-1), a thymidine-kinaseless mutant of herpes simplex virus, namely 'MDK', encephalomyocarditis virus (EMC) and bovine mammillitis virus (BMV). There was an approximate relationship between duration of virus infection in vitro and reduction in incidence and/or rate of tumour development. The rate of tumour development was also reduced by 'site inoculation' of virus (HSV-1) at various time intervals following inoculation of tumorigenic BHK 21 cells indicating that virus was capable of reducing the rate of tumour development in a situation where the neoplastic cells were already transplanted into the susceptible host species. It is suggested that the therapeutic role of wild type, mutant or recombinant viruses merits further exploration towards prevention and treatment of human cancer.
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Affiliation(s)
- G R Skinner
- Department of Medical Microbiology, Medical School, University of Birmingham, UK
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Skinner GR, Buchan A, Durham J, Cowan M, Davies J, Brookes K, Castrucci G. Role of bovine mammillitis virus towards preparation of an alternative vaccine against herpes simplex virus infections of human subjects. Vaccine 1987; 5:55-9. [PMID: 3033927 DOI: 10.1016/0264-410x(87)90010-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Bovine mammillitis virus (BMV) cross-reacted in neutralization and radioimmune assay with herpes simplex virus (HSV) and pre-immunization with BMV protected against challenge by type 2 HSV. There was no evidence to suggest a pathogenic role for BMV as adjudged by a literature search or field enquiry and BMV specific antibody was not detected in 21 human sera or in four sera from personnel engaged in research with BMV; in addition there was no replication or antigen synthesis by BMV in explants of human tissue or cell lines of human origin. It is proposed that BMV might provide an alternative vaccine against HSV infections of human subjects.
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