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Shields M, James D, McCormack L. Organisational challenges to wellbeing in nuclear medicine technologists: Professionalism, burnout and pragmatic growth. Radiography (Lond) 2024; 30:622-627. [PMID: 38330894 DOI: 10.1016/j.radi.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Occupational risk for burnout in nuclear medicine technologists globally, and particularly during disaster demands on the profession, is poorly researched. This idiographic study explored the lived experience of nuclear medicine technologists during COVID-19 in a regional city in Australia. METHODS Data was collected from five participants using semi-structured interviews and transcribed and analysed according to the protocols of Interpretative Phenomenological Analysis (IPA). RESULTS Four group experiential themes were identified: Systemic Contraindications, Professional Strengths and Limitations, Pragmatic Growth, and Covid Rollercoaster. For these participants a dichotomous health care system, impacted by COVID-19, risked career longevity and burnout. Through empathic connection with vulnerable patients, they redefined their priorities, re-engaged in supportive connections with colleagues, and sought new pathways. CONCLUSION Multiple workplace stressors compounded by COVID-19, risked mental wellbeing, in these participants. Nevertheless, these challenges provided opportunities for reflection around career trajectory and longevity precipitating personal growth, job satisfaction and work-life balance. IMPLICATIONS FOR PRACTICE This study provided a lens on the risk factors inherent for nuclear medicine technologists in Australia, exacerbated by the COVID-19 pandemic. Current, and disaster protective practices, to ensure wellbeing and prevent burnout risk are recommended for future research.
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Affiliation(s)
- M Shields
- The University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia.
| | - D James
- The University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia.
| | - L McCormack
- The University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia.
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Nguyen K, McCormack L, Deans R, Nesbitt-Hawes E, Knapman B, Li F, Lim C, Abbott JA. A Prospective Study of Bladder Function Following Endometriosis Surgery With Up to Eight years Follow-up. J Minim Invasive Gynecol 2024; 31:205-212.e4. [PMID: 38042477 DOI: 10.1016/j.jmig.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
STUDY OBJECTIVE To assess long-term urinary function for women having laparoscopic surgery for endometriosis. DESIGN Institutional Review Board-approved nested cohort study within a larger randomized controlled trial assessing urinary function following any benign laparoscopy for gynecological presentations. SETTING Two tertiary-level university-affiliated hospitals. PATIENTS Women with histologically confirmed endometriosis within the randomized controlled trial between April 2012 and November 2019, where baseline urinary function was determined. INTERVENTIONS Women with histologically confirmed endometriosis were contacted between February and October 2020, and urinary function was re-assessed. MEASUREMENTS AND MAIN RESULTS Urinary function was assessed using validated questionnaires across the domains of filling, voiding, incontinence, and quality of life determined distant from surgery. Higher scores correlated with a greater severity of symptoms. From 518/711 (72.9%) women with histologically confirmed endometriosis, 289/518 (55.8%) consented to the nested study. At a mean of 50 months (range 12-103 months) post-operatively, 35 participants (12.1%) had sought treatment for bladder symptoms, and 81 participants (28.0%) reported at least one urinary tract infection since their index surgery. There was a significant worsening of symptoms for filling, voiding, incontinence, and quality of life pre-operative to post-operatively (2.27 vs 3.32, 0.93 vs 2.02, 1.06 vs 2.32, 0.83 vs 2.13 respectively, p <.001). There was no statistically significant difference in urinary questionnaire scores in participants with and without uterovesical endometriosis. There was no statistically significant difference in any parameter when comparing any revised American Society of Reproductive Medicine (rASM) stage of endometriosis. Participants who had post-operative urinary retention reported a higher mean voiding score than those who did not (3.24 vs 1.94, p = .017), while participants with post-operative urinary tract infection reported a higher mean frequency score than those who did not (5.17 vs 3.24, p = .016). CONCLUSION This study suggests a decline in urinary function over time following laparoscopic surgery for endometriosis that is not dependent on the severity or location of the disease.
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Affiliation(s)
- Kimberly Nguyen
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)..
| | - Lalla McCormack
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Rebecca Deans
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Erin Nesbitt-Hawes
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Blake Knapman
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Fiona Li
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Claire Lim
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Jason A Abbott
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
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Li FG, Fuchs T, Deans R, McCormack L, Nesbitt-Hawes E, Abbott J, Farnsworth A. Vaginal epithelial histology before and after fractional CO 2 laser in postmenopausal women: a double-blind, sham-controlled randomized trial. Am J Obstet Gynecol 2023; 229:278.e1-278.e9. [PMID: 37192705 DOI: 10.1016/j.ajog.2023.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/22/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Postmenopausal vaginal symptoms affect over 60% of women and may substantially impact a woman's quality of life. Since 2012, fractional CO2 laser has been suggested as a treatment for this indication. Structural assessment of vaginal epithelium using microscopic biopsy examination has been used as a primary outcome measure and surrogate determinant of success of vaginal laser in previous clinical studies. OBJECTIVE This study aimed to report the effects of laser compared with sham treatment on human vaginal epithelium from postmenopausal women using microscopic examination of tissue biopsies. STUDY DESIGN This single-center double-blind, sham-controlled randomized controlled trial was performed in a tertiary hospital in Sydney, Australia. A total of 49 postmenopausal women who were symptomatic of at least 1 vaginal symptom (vaginal dryness, burning, itching; dyspareunia; or dryness) were randomized to either laser or sham treatment. For this nested histologic study, participants had a pre- and post-treatment vaginal wall biopsy collected. Biopsy samples were analyzed by 3 independent specialist gynecologic pathologists and categorized as Type 1 (well-estrogenized), 2 (poorly estrogenized), or 3 (combination) mucosae. Other outcomes assessed included symptom severity (visual analog scale for symptoms including most bothersome symptom, and Vulvovaginal Symptom Questionnaire) and Vaginal Health Index. Prespecified secondary analyses of data were performed. Categorical data were analyzed using the Pearson chi-square test (or Fisher exact test if <5 in any category) or related-samples McNemar test for paired nonparametric data. Nonparametric, continuous variables were assessed using Wilcoxon signed-rank test or Mann-Whitney U test, and parametric variables with t test or 1-way analysis of variance as appropriate. All analyses were performed using SPSS software version 26.0 (IBM Corp, Armonk, NY). RESULTS There was no significant difference in microscopic features of vaginal epithelium following laser or sham treatment (P=.20). Further subgroup analyses of age, menopause type, duration of reproductive life, time since menopause and BMI, still demonstrated no significant difference between laser and sham groups in histological category of vaginal epithelium. Microscopic features at pre-treatment vaginal biopsy were Type 1 in 27% (13/49). There was no significant difference in VAS score for overall vaginal symptom between those classified as Type 1 vs. Type 2/3 (VAS score overall: Type 1 vs. Type 2/3, (48.1 [95% CI 27.0, 69.2] vs. 61.5 [95% CI 49.8, 73.3]; P=.166). CONCLUSION Data from this double-blind, sham-controlled randomized controlled trial demonstrate that fractional CO2 laser and sham treatment have a comparable histologic effect on vaginal tissue that is not significantly different. Fractional CO2 laser is not significantly different from sham treatment and should not be recommended for clinical use for postmenopausal vaginal symptoms.
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Affiliation(s)
- Fiona G Li
- School of Clinical Medicine, University of New South Wales Sydney, New South Wales, Australia; Gynaecological Research and Clinical Evaluation Group, New South Wales, Australia.
| | - Talia Fuchs
- Douglas Hanly Moir Pathology, New South Wales, Australia
| | - Rebecca Deans
- School of Clinical Medicine, University of New South Wales Sydney, New South Wales, Australia; Gynaecological Research and Clinical Evaluation Group, New South Wales, Australia
| | - Lalla McCormack
- School of Clinical Medicine, University of New South Wales Sydney, New South Wales, Australia; Gynaecological Research and Clinical Evaluation Group, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Clinical Medicine, University of New South Wales Sydney, New South Wales, Australia; Gynaecological Research and Clinical Evaluation Group, New South Wales, Australia
| | - Jason Abbott
- School of Clinical Medicine, University of New South Wales Sydney, New South Wales, Australia; Gynaecological Research and Clinical Evaluation Group, New South Wales, Australia
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McCormack L, Song S, Budden A, Ma C, Nguyen K, Li FG, Lim CY, Maheux-Lacroix S, Arnold A, Deans R, Won HR, Knapman B, Nesbitt-Hawes E, Abbott JA. Immediate versus delayed urinary catheter removal following non-hysterectomy benign gynaecological laparoscopy: a randomised trial. BJOG 2023; 130:1112-1119. [PMID: 36852512 DOI: 10.1111/1471-0528.17442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To compare rates of urinary retention and postoperative urinary tract infection between women with immediate versus women with delayed removal of indwelling catheter following benign non-hysterectomy gynaecological laparoscopic surgery. DESIGN This randomised clinical trial was conducted between February 2012 and December 2019, with follow-up to 6 weeks. SETTING Two university-affiliated teaching hospitals in Sydney, Australia. POPULATION Study participants were 693 women aged 18 years or over, undergoing non-hysterectomy laparoscopy for benign gynaecological conditions, excluding pelvic floor or concomitant bowel surgery. METHODS Three hundred and fifty-five participants were randomised to immediate removal of urinary catheter and 338 participants were randomised to delayed removal of urinary catheter. MAIN OUTCOME MEASURES The co-primary outcomes were urinary retention and urinary tract infection. Secondary outcomes included hospital readmission, analgesia requirements, duration of hospitalisation and validated bladder function questionnaires. RESULTS Urinary retention was higher after immediate compared with delayed removal of the urinary catheter (8.2% vs 4.2%, RR 1.8, 95% CI 1.0-3.0, p = 0.04). Although urinary tract infection was 7.2% following delayed removal of the urinary catheter and 4.7% following immediate removal of the urinary catheter, the difference was not statistically significant (RR 0.7, 95% CI 0.3-1.2, p = 0.2). CONCLUSIONS There is an increased risk of urinary retention with the immediate compared with the delayed removal of the urinary catheter following benign non-hysterectomy gynaecological laparoscopic surgery. The difference in urinary tract infection was not significant. There is 1/12 risk of re-catheterisation after immediate urinary catheter removal. It is important to ensure that patients report normal voiding and emptying prior to discharge, to reduce the need for readmission for the management of urinary retention.
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Affiliation(s)
- Lalla McCormack
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Sophia Song
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Aaron Budden
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Christine Ma
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Kimberly Nguyen
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Fiona G Li
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Claire Y Lim
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Sarah Maheux-Lacroix
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Amy Arnold
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Rebecca Deans
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Ha Ryun Won
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Blake Knapman
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Jason A Abbott
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
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Lim CY, Alonso A, Koh YY, Roydhouse S, McCormack L, Deans R, Nesbitt-Hawes E, Rao A, Causer L, Abbott JA. A Double-Blinded, Randomised, Placebo-Controlled Trial of Antibiotic Prophylaxis in Elective Non-Hysterectomy Laparoscopic Surgery for Benign Gynaecological Conditions: A Pilot Study. J Minim Invasive Gynecol 2022; 29:992-997. [PMID: 35513301 DOI: 10.1016/j.jmig.2022.04.018] [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: 01/23/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To determine the feasibility of a double-blinded randomised, placebo-controlled study in determining the efficacy of antibiotic prophylaxis in preventing postoperative infections (POI) in elective non-hysterectomy laparoscopic procedures for benign gynaecological conditions. DESIGN Double-blinded, randomised, placebo-controlled trial. SETTING University-affiliated tertiary referral hospital in Sydney, Australia. PATIENTS Women over the age of 18 undergoing elective non-hysterectomy laparoscopic procedures for benign gynaecological conditions were eligible for the study and approached. INTERVENTIONS Prior to surgery, participants were randomised to receive either 2g cephazolin or placebo (10ml normal saline) administered by the anaesthetist. Participants and other research staff were blinded to group allocation. MEASUREMENTS AND MAIN RESULTS The primary outcome was study feasibility measured by recruitment rates, compliance rates of drug administration, compliance rates of delivery, maintenance of double blinding and follow-up rates. Secondary outcomes included rate of postoperative infections, length of hospitalisation, re-admission to hospital, unscheduled presentations to healthcare facilities and antibiotic-related reactions. Between February 2019 and March 2021, 170 patients were approached with 117 (68.8%) participants recruited and randomised. The study had a high compliance rate of trial drug delivery (95.7%) and a high follow-up rate (99.1%). CONCLUSION This pilot study has demonstrated feasibility of a large-scale study with a recruitment rate of 68% of patients approached and excellent trial drug delivery and follow-up rates. As anticipated, it is underpowered for identifying clinically significant findings for postoperative infection rates. A large-scale study is appropriate and essential to determine the health-related risks of antibiotic prophylaxis with an emphasis on antimicrobial stewardship. The sample size for a large-scale study is 1678 participants based on infection rates in this pilot study.
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Affiliation(s)
- Claire Yinn Lim
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Anaïs Alonso
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Yi Ying Koh
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Stephanie Roydhouse
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Lalla McCormack
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Archana Rao
- Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Louise Causer
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Jason A Abbott
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia.
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McCormack L, Nesbitt-Hawes E, Deans R, Alonso A, Lim C, Li F, Knapman B, Abbott JA. A review of gynaecological surgical practices for trainees and certified specialists in Australia by volume using MBS and AIHW databases. Aust N Z J Obstet Gynaecol 2022; 62:574-580. [PMID: 35474508 PMCID: PMC9542106 DOI: 10.1111/ajo.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a finite volume of surgery performed annually by trainees and certified specialists alike. The detailed assessment of this surgical substrate is important, since it guides true exposure in gynaecological surgical training and practice after fellowship. AIMS This study quantifies the volume and profile of major gynaecological surgical procedures performed in Australia within a specified five-year period and discusses the implications for training and practice. MATERIALS AND METHODS Australian Institute of Health and Welfare data were examined to quantify the total number of major gynaecological procedures performed between 2013 and 2018. Medicare data were analysed to quantify the number of billed procedures. These data were compared with published Australian RANZCOG trainees and operative gynaecologists, to estimate the potential annual average exposure for each procedure. RESULTS Major open, laparoscopic and vaginal surgeries constitute less than 27% of the 600 000 gynaecological procedures performed annually in Australia. Most major gynaecological surgeries are performed at rates lower than 12 cases per year for both trainees and specialists. Over the study period, laparotomies, vaginal hysterectomies and continence procedures decreased, and operative laparoscopies and laparoscopic hysterectomies increased. CONCLUSIONS The volume of available major gynaecological procedures in Australia may not allow sufficient exposure for optimal training and practice for all trainees and specialists in operative gynaecology. This shortfall may compromise the ability to obtain and maintain proficiency in some core gynaecological operative procedures.
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Affiliation(s)
- Lalla McCormack
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Rebecca Deans
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Anais Alonso
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Claire Lim
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Fiona Li
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Blake Knapman
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Jason A Abbott
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
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Rutstein A, Baldini M, Morris N, Atherton J, McCormack L, Wong Y, Dashwood A, Wee Y, McKenzie S, Wang W, Hill J, Denman R, Ng K, Haqqani H. Embedding Genetic Counselling Into Cardiology Clinics: Case Studies From a Queensland Cardiology Genomics Service. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Li FG, Maheux-Lacroix S, Deans R, Nesbitt-Hawes E, Budden A, Nguyen K, Lim CY, Song S, McCormack L, Lyons SD, Segelov E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: A Randomized Clinical Trial. JAMA 2021; 326:1381-1389. [PMID: 34636862 PMCID: PMC8511979 DOI: 10.1001/jama.2021.14892] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Postmenopausal vaginal symptoms are common and frequently detrimental to a woman's quality of life. Fractional carbon dioxide vaginal laser is increasingly offered as a treatment, but the efficacy remains unproven. OBJECTIVE To determine the efficacy of fractional carbon dioxide laser for treatment of vaginal symptoms associated with menopause. DESIGN, SETTING, AND PARTICIPANTS A double-blind, randomized, sham-controlled trial with 12-month follow-up was undertaken at a single tertiary referral hospital in Sydney, Australia. Enrollment commenced on September 19, 2016, with final follow-up on June 30, 2020. Participants were postmenopausal women with vaginal symptoms substantive enough to seek medical treatment. Of 232 participants approached, 85 were randomized. INTERVENTIONS Three treatments using a fractional microablative carbon dioxide laser system performed 4 to 8 weeks apart, with 43 women randomized to the laser group and 42 to the sham group. MAIN OUTCOMES AND MEASURES The co-primary outcomes were symptom severity assessed using a visual analog scale (VAS; range, 0-100; 0 indicates no symptoms and 100 indicates the most severe symptoms) and the Vulvovaginal Symptom Questionnaire (VSQ; range, 0-20; 0 indicates no symptoms and 20 indicates the most severe symptoms) at 12 months. The minimal clinically important difference was specified as a 50% decrease in both VAS and VSQ severity scores. There were 5 prespecified secondary outcomes, including quality of life (range, 0-100; higher scores indicate better quality of life), the Vaginal Health Index Score (range, 5-25; higher scores indicate better health), and vaginal histology (premenopausal or postmenopausal status). RESULTS Of 85 randomized participants (mean [SD] age, 57 [8] years), 78 (91.7%) completed the 12-month follow-up. From baseline to 12 months, there was no significant difference between the carbon dioxide laser group and the sham group in change in symptom severity (VAS score for overall vaginal symptoms: -17.2 vs -26.6; difference, 9.4 [95% CI, -28.6 to 47.5]; VAS score for the most severe symptom: -24.5 vs -20.4; difference -4.1 [95% CI, -32.5 to 24.3]; VSQ score: -3.1 vs -1.6; difference, -1.5 [95% CI, -5.9 to 3.0]). There were no significant differences between the laser and sham group in the mean quality of life score (6.3 vs 1.4; difference, 4.8 [95% CI, -3.9 to 13.5]) and Vaginal Health Index Score (0.9 vs 1.3; difference, -0.4 [95% CI, -4.3 to 3.6]) or in histological comparisons between laser and sham treatment groups. There were 16 adverse events in the laser group and 17 in the sham group, including vaginal pain/discomfort (44% vs 68%), spotting, discharge, and lower urinary tract symptoms. No severe adverse events were reported in either group. CONCLUSIONS AND RELEVANCE Among women with postmenopausal vaginal symptoms, treatment with fractional carbon dioxide laser vs sham treatment did not significantly improve vaginal symptoms after 12 months. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12616001403426.
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Affiliation(s)
- Fiona G. Li
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Sarah Maheux-Lacroix
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Rebecca Deans
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Aaron Budden
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Kimberly Nguyen
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Claire Y. Lim
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Sophia Song
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Lalla McCormack
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Stephen D. Lyons
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Eva Segelov
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jason A. Abbott
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
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9
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Campbell LE, Swaab L, Freeman EE, McCormack L, Simon TJ, Angkustsiri K, McCabe KL. The Importance of Understanding Individual Differences of Emotion Regulation Abilities in 22q11.2 Deletion Syndrome. J Autism Dev Disord 2021; 52:3076-3087. [PMID: 34251567 DOI: 10.1007/s10803-021-05172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
Chromosome 22q11.2 deletion syndrome (22q11DS) is characterised by a complex behavioural phenotype including anxiety, attention-deficit/hyperactivity disorder and psychosis. In the current study, we aimed at improving our understanding of the heterogeneity of behavioural characteristics in a group of 129 young people (aged 4-22) with a confirmed 22q11.2 microdeletion and 116 age and gender matched typically developing controls. Half the participants with 22q11DS had behaviour characterised by emotion dysregulation. A cluster analyses, of the participants with 22q11DS, revealed four groups characterised by intact emotion regulation; predominantly internalizing problems; both internalizing and externalizing problems; and predominantly externalizing difficulties. Importantly, it was found that young people with 22q11DS whose emotion dysregulation was characterised by externalizing problems had the poorest levels of functioning. As our understanding of 22q11DS improves, it is becoming increasingly clear that we need a better understanding of how individual differences and psychosocial factors contribute to, and interact with one another, to result in the observable individual differences in the 22q11DS behavioural phenotype.
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Affiliation(s)
- L E Campbell
- School of Psychological Science, University of Newcastle, Newcastle, Australia. .,Priority Research Centre GrowUpWell, University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2320, Australia.
| | - L Swaab
- School of Psychological Science, University of Newcastle, Newcastle, Australia
| | - E E Freeman
- School of Psychological Science, University of Newcastle, Newcastle, Australia.,Priority Research Centre Brain and Mental Health Research, University of Newcastle, Newcastle, Australia
| | - L McCormack
- School of Psychological Science, University of Newcastle, Newcastle, Australia
| | - T J Simon
- Department of Psychiatry and Behavioural Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.,M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - K Angkustsiri
- M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.,Department of Pediatrics, Section of Developmental &, Behavioral Pediatrics University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - K L McCabe
- Department of Psychiatry and Behavioural Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.,M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
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10
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Alonso A, Deans R, Nesbitt-Hawes E, Yazdani A, McCormack L, Koh YY, Abbott J. Gynaecological and IVF procedures billed through the Medicare Benefits Schedule (MBS) during the COVID-19 pandemic. Aust N Z J Obstet Gynaecol 2021; 61:585-590. [PMID: 33890300 PMCID: PMC8251179 DOI: 10.1111/ajo.13355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
Background In response to the COVID‐19 pandemic in Australia, restrictions to elective surgeries were implemented nationwide. Aims To investigate the response to these restrictions in elective gynaecological and In vitro fertilisation (IVF) procedures during the first wave of the COVID‐19 pandemic. Materials and Methods We analysed the Medicare Item Reports for the number of elective gynaecological (labioplasty, vulvoplasty; prolapse and continence; operative hysteroscopy; hysterectomy; fertility) and IVF procedures claimed in Australia between January–June 2020 and compared these to January–June 2019. Results The number of included gynaecological and IVF procedures performed in January–June 2020 decreased by −13.71% and −12.56%, respectively, compared to January–June 2019. The greatest reductions were in May 2020 (gynaecology −43.71%; IVF −51.63% compared to May 2019), while April 2020 reported decreases of −37.69% and −31.42% in gynaecological and IVF procedures, respectively. In April 2020, 1963 IVF cycle initiations (−45.20% compared to April 2019), 2453 oocyte retrievals (−26.99%) and 3136 embryo transfers (−22.95%) were billed. The procedures with greatest paired monthly decrease were prolapse and continence surgeries in April (676 procedures; −51.85%) and May 2020 (704 procedures; −60.05%), and oocyte retrievals in May 2020 (1637 procedures; −56.70%). Conclusions While we observed a decrease in procedural volumes, elective gynaecological and IVF procedures continued in considerable numbers during the restricted timeframes. In the event of future overwhelming biological threat, careful consideration must be given to more effective measures of limiting access for non‐emergency procedures to conserve essential resources and reduce risk to both the public and healthcare staff.
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Affiliation(s)
- Anais Alonso
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Anusch Yazdani
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lalla McCormack
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Yi Ying Koh
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Jason Abbott
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
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11
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Li F, Deans R, Nesbitt-Hawes E, Budden A, McCormack L, Maheux-Lacroix S, Segelov E, Lyons S, Abbott J. Fractionated Laser for Vaginal Atrophy Symptoms: A Randomized, Double-Blind Placebo Controlled Study. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.590] [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: 11/30/2022]
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12
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Thompson LL, Chang MS, McCormack L, Polyakov N, Yoon J, Song H, Huang JT, Chen ST. Patterns of cutaneous immune-related adverse events in adults and children with advanced sarcoma: a retrospective cohort study. Br J Dermatol 2020; 184:363-365. [PMID: 32894776 DOI: 10.1111/bjd.19540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022]
Affiliation(s)
- L L Thompson
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - M S Chang
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - L McCormack
- Department of Dermatology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | - N Polyakov
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - J Yoon
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - H Song
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Department of Dermatology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Harvard Combined Dermatology Residency Program, Harvard Medical School, Boston, MA, USA
| | - J T Huang
- Department of Dermatology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - S T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Department of Dermatology, Harvard Medical School, Boston, MA, USA
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13
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McCormack L, Milburn T, Ashover S, Berndt S, Foran L, Cullen L. 438 Accelerating the Care of Patients Presenting to Queensland Health EDs with Suspected ACS. Timely Translation of Advances in Care. – The Statewide ACRE II Project. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Squiers L, Lynch M, Dolina S, Ray S, Kelly B, Herrington J, Turner M, Chawla D, Becker-Dreps S, Stamm L, McCormack L. Zika and travel in the news: a content analysis of US news stories during the outbreak in 2016-2017. Public Health 2019; 168:164-167. [PMID: 30772009 DOI: 10.1016/j.puhe.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/08/2018] [Accepted: 12/02/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to understand what information the US media communicated about Zika virus (ZIKV) and travel in 2016 and 2017. STUDY DESIGN We conducted a content analysis of news coverage about ZIKV and travel from April 5, 2016 to March 31, 2017. METHODS We obtained a stratified, random sample of English language, US print newspaper and television news coverage about ZIKV and travel. We developed a coding scheme to assess key messages in the news, including how ZIKV is transmitted, the symptoms and outcomes of ZIKV infection, and recommended prevention behaviors. RESULTS Almost all news stories mentioned mosquito-borne transmission (96.8%) and just over half mentioned sexual transmission (55.3%). News stories were more likely to talk about ZIKV outcomes (78.8%) than ZIKV symptoms (40.6%). However, outcomes affecting babies were mentioned more frequently than outcomes affecting adults. Recommendations included a wide array of protective behaviors, such as delaying or avoiding travel (77.6%) and using mosquito repellent (41.0%). However, few studies (10.9%) mentioned barriers to practicing ZIKV prevention behaviors. CONCLUSIONS Public health organizations and professionals can use these findings to help improve communication about future outbreaks of mosquito-borne illnesses. We also recommend conducting real-time monitoring of news media and frequent content analysis of news stories to ensure coverage provides the information the public needs.
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Affiliation(s)
- L Squiers
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
| | - M Lynch
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
| | - S Dolina
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
| | - S Ray
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
| | - B Kelly
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
| | - J Herrington
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC, USA.
| | - M Turner
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC, USA.
| | - D Chawla
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC, USA.
| | - S Becker-Dreps
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC, USA; University of North Carolina School of Medicine, University of North Carolina, 321 S Columbia St., Chapel Hill, NC, USA.
| | - L Stamm
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC, USA.
| | - L McCormack
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
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15
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Stluka S, Wells K, McCormack L. Power Chef Challenge: A Middle School Youth Cooking Curriculum. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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McCormack L, Cullen L, Graves N, Parsonage W, Starmer G, Stone R, Bonnin R, Starmer K, Drahm-Butler T, Davis T, Mowatt E, Proctor K, Campbell V, Greenslade J, Ashover S, Milburn T, Foran L. Validation of an Accelerated Diagnostic Protocol for Aboriginal and Torres Strait Islander Patients with Suspected Acute Coronary Syndrome. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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McCormack L, Ashover S, Milburn T, Foran L, Cullen L. Translating Chest Pain Research into Practice Through the Queensland Health ACRE Project - The Impact of Improved Assessment of Chest Pain Trial. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Shand AW, Harpham ME, Lainchbury A, McCormack L, Leung S, Nassar N. Knowledge, advice and attitudes toward women driving a car after caesarean section or hysterectomy: A survey of obstetrician/gynaecologists and midwives. Aust N Z J Obstet Gynaecol 2016; 56:460-465. [DOI: 10.1111/ajo.12496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/26/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Antonia W. Shand
- Clinical and Population Perinatal Health Research; Kolling Institute; Northern Sydney Local Health District; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; Sydney New South Wales Australia
- Department of Obstetrics; Royal Hospital for Women; Randwick New South Wales Australia
| | - Margie E. Harpham
- Clinical and Population Perinatal Health Research; Kolling Institute; Northern Sydney Local Health District; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; Sydney New South Wales Australia
- Department of Obstetrics; Royal Hospital for Women; Randwick New South Wales Australia
| | - Anne Lainchbury
- Department of Obstetrics; Royal Hospital for Women; Randwick New South Wales Australia
| | - Lalla McCormack
- Department of Obstetrics; Royal Hospital for Women; Randwick New South Wales Australia
| | - Stefanie Leung
- Discipline of Addiction Medicine; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Drug and Alcohol Services; South Eastern Sydney Local Health District; Sydney New South Wales Australia
| | - Natasha Nassar
- Clinical and Population Perinatal Health Research; Kolling Institute; Northern Sydney Local Health District; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; Sydney New South Wales Australia
- Menzies Centre for Health Policy; University of Sydney; Sydney New South Wales Australia
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19
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Threader J, McCormack L. Cancer-related trauma, stigma and growth: the 'lived' experience of head and neck cancer. Eur J Cancer Care (Engl) 2015; 25:157-69. [PMID: 25899673 DOI: 10.1111/ecc.12320] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 11/29/2022]
Abstract
Head and neck cancer is associated with multiple layers of distress including stigma. Stigma attraction or devalued social identity is twofold: (1) it is a cancer associated with lifestyle risk factors and (2) treatment often results in confronting facial disfigurement. Subjective interpretations from nine head and neck cancer patients were analysed using Interpretative Phenomenological Analysis. An overarching superordinate theme--Distress, Stigma and Psychological Growth--encompassed four subordinate themes. Two themes captured the expressed trauma and terror as a result of diagnosis and treatment, and two the redefining of self despite stigma through meaning making. Distress was interpreted as a catalyst for awakening new life interpretations and combined with social support to facilitate two distinct pathways of growth: (1) psychological growth without support; (2) psychological and relational growth with support. Previously unfelt empathetic understanding and altruism for others with cancer emerged from the impact of stigma on 'self'. Acceptance allowed a new sense of identity that recognised cancer-related traumatic distress as integral to growth for these participants. The present study offers a unique insight into cancer-related trauma and stigma and the potential to redefine a more accepting, empathic and altruistic 'self' for psychological growth. Implications are discussed.
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Affiliation(s)
- J Threader
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
| | - L McCormack
- Faculty of Science and IT, School of Psychology, University of Newcastle, Callaghan, NSW, Australia
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20
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Ingles J, Medi C, Burns C, McCormack L, Yeates L, Hunt L, McGaughran J, McGeechan K, Atherton J, Driscoll T, Semsarian C. Confounder bias in sudden death risk stratification for hypertrophic cardiomyopathy. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Haun J, Sorensen K, Valerio M, McCormack L. Taking stock of health literacy measurement tools: choosing the right tool for the right purpose. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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McCormack L, Younger J, Lo A, Hunt L, McGaughran J, Atherton J. Incremental Utility of Cardiac Magnetic Resonance Imaging in Assessing Adult Hypertrophic Cardiomyopathy Mutation Carriers. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Lo A, Dahiya A, McCormack L, Hunt L, Ng A, McGaughan J, Atherton J. Insight into the Myocardial Mechanics of Genotype Positive Phenotype ‘Negative’ Patients with Suspected Preclinical Hypertrophic Cardiomyopathy. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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McCormack L, Quiñónez E, Goldaracena N, Anders M, Rodríguez V, Orozco Ganem F, Mastai RC. Liver transplantation using Chagas-infected donors in uninfected recipients: a single-center experience without prophylactic therapy. Am J Transplant 2012; 12:2832-7. [PMID: 22813351 DOI: 10.1111/j.1600-6143.2012.04160.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Organ shortage is the first cause of death on liver transplant waiting lists. As a consequence, we recently decided to expand liver acceptance to those organs that could potentially transmit infectious diseases to their recipients. On January 2010, we initiated a prospective protocol using livers from Chagas-infected donors for transplanting uninfected recipients without using prophylactic therapy. During a 13-month period, 9 of 37 (24%) liver transplants were performed within this protocol. After transplant, each recipient was sequentially and strictly monitored for infection transmission using the Strout method and promptly treated with benznidazole if this occurs. During follow-up, two patients died without Chagas infection and only two (donor-derived T. cruzi transmission rate: 2/9; 22%) patients developed donor-derived Chagas transmission without clinical symptoms. The median follow-up time of the seven live patients was 15 months (range: 13-20). At present, all are symptoms-free with excellent allograft function and without evidence of Chagas disease. In conclusion, we consider that Chagas-infected donors are a promising source of liver grafts that could reduce the growing mortality on liver waiting lists in America. Relevant data from larger prospective studies are required to confirm these preliminary excellent results.
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Affiliation(s)
- L McCormack
- Liver Surgery and Transplantation Unit, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
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25
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Goldaracena N, Quiñonez E, Méndez P, Anders M, Orozco Ganem F, Mastai R, McCormack L. Extremely Marginal Liver Grafts From Deceased Donors Have Outcome Similar to Ideal Grafts. Transplant Proc 2012; 44:2219-22. [DOI: 10.1016/j.transproceed.2012.07.113] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Brüning-Richardson A, Bond J, Alsiary R, Richardson J, Cairns DA, McCormack L, Hutson R, Burns P, Wilkinson N, Hall GD, Morrison EE, Bell SM. ASPM and microcephalin expression in epithelial ovarian cancer correlates with tumour grade and survival. Br J Cancer 2011; 104:1602-10. [PMID: 21505456 PMCID: PMC3101901 DOI: 10.1038/bjc.2011.117] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 03/09/2011] [Accepted: 03/13/2011] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The clinico-pathological and molecular heterogeneity of epithelial ovarian cancer (EOC) complicates its early diagnosis and successful treatment. Highly aneuploid tumours and the presence of ascitic fluids are hallmarks of EOC. Two microcephaly-associated proteins, abnormal spindle-like microcephaly-associated protein (ASPM) and microcephalin, are involved in mitosis and DNA damage repair. Their expression is deregulated at the RNA level in EOC. Here, ASPM and microcephalin protein expression in primary cultures established from the ascites of patients with EOC was determined and correlated with clinical data to assess their suitability as biomarkers. METHODS Five established ovarian cancer cell lines, cells derived from two benign ovarian ascites samples and 40 primary cultures of EOC derived from ovarian ascites samples were analysed by protein slot blotting and/or immunofluorescence to determine ASPM and microcephalin protein levels and their cellular localisation. Results were correlated with clinico-pathological data. RESULTS A statistically significant correlation was identified for ASPM localisation and tumour grade, with high levels of cytoplasmic ASPM correlating with grade 1 tumours. Conversely, cytoplasmic microcephalin was only identified in high-grade tumours. Furthermore, low levels of nuclear microcephalin correlated with reduced patient survival. CONCLUSION Our results suggest that ASPM and microcephalin have the potential to be biomarkers in ovarian cancer.
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Affiliation(s)
- A Brüning-Richardson
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - J Bond
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - R Alsiary
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - J Richardson
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - D A Cairns
- Section of Oncology and Clinical Research, Leeds Institute of Molecular Medicine, St James's University Hospital, Leeds LS9 7TF, UK
| | - L McCormack
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - R Hutson
- St James's Institute of Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - P Burns
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - N Wilkinson
- St James's Institute of Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - G D Hall
- St James's Institute of Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - E E Morrison
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - S M Bell
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
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27
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McCormack L, Gadano A, Lendoire J, Imventarza O, Andriani O, Gil O, Toselli L, Bisigniano L, de Santibañes E. Model for end-stage liver disease-based allocation system for liver transplantation in Argentina: does it work outside the United States? HPB (Oxford) 2010; 12:456-64. [PMID: 20815854 PMCID: PMC3030754 DOI: 10.1111/j.1477-2574.2010.00199.x] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In July 2005, Argentina was the first country after the United States to adopt the MELD system. The purpose of the present study was to analyse the impact of this new system on the adult liver waiting list (WL). METHODS Between 2005 and 2009, 1773 adult patients were listed for liver transplantation: 150 emergencies and 1623 electives. Elective patients were categorized using the MELD system. A prospective database was used to analyse mortality and probability to be transplanted (PTBT) on the WL. RESULTS The waiting time increased inversely with the MELD score and PTBT positively correlated with MELD score. With scores >/= 18 the PTBT remained over 50%. However, the largest MELD subgroup with <10 points (n = 433) had the lower PTBT (3%). In contrast, patients with T(2) hepatocellular carcinoma benefited excessively with the highest PTBT (84.2%) and the lowest mortality rate (5.4%). The WL mortality increased after MELD adoption (10% vs. 14.8% vs. P < 0.01). Patients with <10 MELD points had >fourfold probability of dying on the WL than PTBT (14.3% vs. 3%; P < 0.0001). CONCLUSIONS After MELD implementation, WL mortality increased and most patients who died had a low MELD score. A comprehensive revision of the MELD system must be performed to include cultural and socio-economical variables that could affect each country individually.
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Affiliation(s)
- L McCormack
- Liver Transplant Unit, Hospital Alemán of Buenos AiresBuenos Aires
| | - A Gadano
- Liver Transplant Unit, Hospital Italiano of Buenos AiresBuenos Aires
| | - J Lendoire
- Liver Transplant Unit, Sanatorio Trinidad MitreBuenos Aires
| | - O Imventarza
- Liver Transplant Unit, Hospital ArgerichBuenos Aires
| | - O Andriani
- Liver Transplant Unit, Hospital Austral UniversityPilar
| | - O Gil
- Liver Transplant Unit, Sanatorio Allende of CórdobaCórdoba
| | - L Toselli
- Liver Transplant Unit, CRAI NorteINCUCAI, Buenos Aires, Argentina
| | - L Bisigniano
- Scientific and Technical SectionINCUCAI, Buenos Aires, Argentina
| | - E de Santibañes
- Liver Transplant Unit, Hospital Italiano of Buenos AiresBuenos Aires
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Perez D, McCormack L, Petrowsky H, Jochum W, Mullhaupt B, Clavien PA. Successful outcome of severe adenovirus hepatitis of the allograft following liver transplantation. Transpl Infect Dis 2007; 9:318-22. [PMID: 17605750 DOI: 10.1111/j.1399-3062.2007.00205.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/26/2022]
Abstract
Here we report the first adult patient who survived severe adenoviral hepatitis of a liver graft, in contrast to 4 previously reported cases in adults, all of which had a fatal outcome. Early diagnosis was based on the immunohistological detection of adenoviral protein in the context of biopsy-proven hepatitis. Dramatic reduction of immunosuppression along with supportive care were the treatment strategies in this case. Adenoviral infection of the allograft should always be considered as a differential diagnosis when clinical signs of severe hepatitis are present after liver transplantation. Accurate diagnosis with immunohistochemical detection of viral proteins in the liver graft is of paramount importance for the early diagnosis and management of this uncommon, severe, and probably underdiagnosed entity.
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MESH Headings
- Adenovirus Infections, Human/diagnosis
- Adenovirus Infections, Human/drug therapy
- Adenovirus Infections, Human/virology
- Adult
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/drug therapy
- Hepatitis, Viral, Human/virology
- Humans
- Immunocompromised Host
- Liver/virology
- Liver Transplantation/adverse effects
- Male
- Prednisone/administration & dosage
- Transplantation, Homologous
- Transplants/virology
- Treatment Outcome
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Affiliation(s)
- D Perez
- Department of Visceral & Transplantation Surgery, Zürich University Hospital, Zürich, Switzerland
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McCormack L, Hany TI, Hübner M, Petrowsky H, Mullhaupt B, Knuth A, Stenner F, Clavien PA. How useful is PET/CT imaging in the management of post-transplant lymphoproliferative disease after liver transplantation? Am J Transplant 2006; 6:1731-6. [PMID: 16827878 DOI: 10.1111/j.1600-6143.2006.01358.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Post-transplant lymphoproliferative disease (PTLD) is a serious and potentially life-threatening complication after solid organ transplantation. Here, we report our first experience with the use of PET/CT (positron emission tomography combined with computed tomogram) for the management of patients with PTLD after liver transplantation. Four patients with histologically proven PTLD were analyzed. Conventional work-up included physical examination and head-to-pelvis CT. PET/CT was used in one patient for initial staging and in all patients for follow-up. PET/CT positive findings underwent biopsy. Information provided by PET/CT resulted in a change of medical management in three of the four patients. Conventional work-up missed residual disease after surgery in one and failed to detect a tumor relapse in another patient. However, one patient disclosed a false positive PET/CT finding in the lungs. In conclusion, PET/CT may be a useful tool for staging and therapy monitoring of PTLD after liver transplantation.
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Affiliation(s)
- L McCormack
- Swiss Hepato-Pancreato Biliary Center, Department of Visceral and Transplant Surgery, University Hospital of Zurich, Switzerland
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Abstract
A few years ago surgical resection was the only treatment modality for primary and metastatic liver tumors. However, most of the liver tumors are diagnosed at advanced stage and are unresectable. Criteria for unresectability are: uncontrolled extrahepatic disease, extensive intrahepatic tumor growth, insufficient remnant liver volume and severe co-morbid disease. Several therapeutic strategies have been developed to deal with primarily unresectable tumors. A downstaging ("downsizing") of hepatocellular carcinoma (HCC) can be reached by transarterial chemoembolisation (TACE) or local tumor ablation using ethanol injection, cryosurgery and radiofrequency. Preoperative unilateral portal vein embolization resulting in hypertrophy of the remnant liver volume permits to resect some patients with former unresectable liver tumors. Furthermore, liver transplantation is an option for patients with early stage HCC and liver cirrhosis. Preoperative downstaging of colorectal metastases can be achieved with neoadjuvant chemotherapy, whereas TACE, ethanol injection and liver transplantation are no established options for these patients. So far, there are no standardized guidelines for the treatment of patients with unresectable primary or metastatic liver tumors. In this review we aim to describe the different approaches suggested in the literature and to present our algorithms for the management of patients with liver tumors.
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Affiliation(s)
- M Hübner
- Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich
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31
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Abstract
BACKGROUND Diagnostic and therapeutic options for hepatocellular carcinoma (HCC) have improved substantially in recent years. A number of new palliative and potentially curative treatment strategies are now available. However, evaluation of the therapeutic modalities and assessment of the prognosis of HCC remain difficult owing to the lack of consensus on a single staging system and the availability of a number of new staging systems, each claiming to be the most appropriate. METHODS The most frequently used staging systems for HCC are presented here. Their ability to stratify patients into different treatment groups and to define prognosis are discussed. In addition, the advantages and disadvantages of each system are analysed. RESULTS AND CONCLUSION None of the currently used staging systems fulfils all the requirements for stratification of patients with HCC into groups of different prognosis and therapeutic recommendations. An international agreement on a single staging system is urgently needed in order to permit comparable randomized clinical trials. Only in this way will the outcome for those with HCC be improved.
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Affiliation(s)
- S Wildi
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, 8091 Zurich, Switzerland
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McCormack L. Global Snapshots: Brazil - a rich country full of poor people. Assoc Med J 2003. [DOI: 10.1136/sbmj.0305160a] [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: 11/03/2022]
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de Santibañes E, Pekolj J, McCormack L, Nefa J, Mattera J, Sívori J, Bonofiglio C, Gadano A, Ciardullo M. Liver transplantation for the sequelae of intra-operative bile duct injury. HPB (Oxford) 2002; 4:111-5. [PMID: 18332936 PMCID: PMC2020545 DOI: 10.1080/136518202760387993] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intra-operative bile duct injuries (IBDI) are potentially severe complications of the treatment of benign conditions, with unpredictable long-term results. Multiple procedures are frequently needed to correct these complications. In spite of the application of these procedures, patients with severe injuries can develop irreversible liver disease. Liver transplantation (LT) is currently the only treatment available for such patients, but little information has been published concerning the results of LT. METHODS Eight patients with LT for end-stage liver disease for IBDI were studied retrospectively. They had failure of multiple previous treatments and experienced recurrent episodes of cholangitis, oesophageal variceal bleeding, severe pruritus, refractory ascites and spontaneous peritonitis. RESULTS Mean recipient hepatectomy time was of 243 minutes (range 140-295 min), the complete procedure averages 545 minutes (260-720) and intraoperative red-blood-cells consumption was 6.5 units (1-7). One patient required reoperation due to perforation of a Roux-en-Y loop, and three developed minor complications (2 wound infections, I inguinal lymphocele). One patient died due to nosocomial pneumonia (mortality rate 12.5%). One patient required retransplantation due to delayed hepatic artery thrombosis. At follow-up 75% of patients are alive with normal graft function and an excellent quality of life. CONCLUSIONS LT represents a safe curative treatment for end-stage liver disease after IBDI, albeit a major undertaking in the context of a surgical complication in the treatment of benign disease. The complications of the surgical procedure and the long-standing immunosuppression impart a high cost for resolutions of these sequelae but LT represents the only long-term effective treatment for these selected patients.
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Affiliation(s)
- E de Santibañes
- Hepato Bilio Pancreatic Surgery and Liver Transplant Unit, General Surgery Service, Hospital ItalianoBuenos AiresArgentina
| | - J Pekolj
- Hepato Bilio Pancreatic Surgery and Liver Transplant Unit, General Surgery Service, Hospital ItalianoBuenos AiresArgentina
| | - L McCormack
- Hepato Bilio Pancreatic Surgery and Liver Transplant Unit, General Surgery Service, Hospital ItalianoBuenos AiresArgentina
| | - J Nefa
- Hepato Bilio Pancreatic Surgery and Liver Transplant Unit, General Surgery Service, Hospital ItalianoBuenos AiresArgentina
| | - J Mattera
- Hepato Bilio Pancreatic Surgery and Liver Transplant Unit, General Surgery Service, Hospital ItalianoBuenos AiresArgentina
| | - J Sívori
- Hepato Bilio Pancreatic Surgery and Liver Transplant Unit, General Surgery Service, Hospital ItalianoBuenos AiresArgentina
| | - C Bonofiglio
- Hepato Bilio Pancreatic Surgery and Liver Transplant Unit, General Surgery Service, Hospital ItalianoBuenos AiresArgentina
| | - A Gadano
- Hepato Bilio Pancreatic Surgery and Liver Transplant Unit, General Surgery Service, Hospital ItalianoBuenos AiresArgentina
| | - M Ciardullo
- Hepato Bilio Pancreatic Surgery and Liver Transplant Unit, General Surgery Service, Hospital ItalianoBuenos AiresArgentina
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Albornoz L, Motta A, Alvarez D, Estevez A, Bandi JC, McCormack L, Matera J, Bonofiglio C, Ciardullo M, De Santibañes E, Gimeno M, Gadan A. Nitric oxide synthase activity in the splanchnic vasculature of patients with cirrhosis: relationship with hemodynamic disturbances. J Hepatol 2001; 35:452-6. [PMID: 11682028 DOI: 10.1016/s0168-8278(01)00168-4] [Citation(s) in RCA: 25] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND/AIMS It has been demonstrated that an overproduction of nitric oxide plays an important role in the pathogenesis of the hyperdynamic circulation exhibited by cirrhotic patients. Nevertheless, evidence is supported by studies performed in experimental models or by indirect measurements in humans. The purpose of this study has been to evaluate nitric oxide production in splanchnic vasculature of patients with cirrhosis and to investigate its possible relationship with systemic and splanchnic hemodynamics. METHODS Nitric oxide synthase (NOS) activity was measured in hepatic artery and portal vein tissues of nine cirrhotic patients. Samples were obtained during liver transplantation. Control samples were obtained simultaneously from the corresponding tissues of the liver donors. Hemodynamic parameters were determined with Doppler ultrasonography. RESULTS NOS activity was significantly higher in hepatic artery of cirrhotic patients than in controls (8.17 +/- 1.30 vs 4.57 +/- 0.61 pmoles/g of tissue/min, P < 0.05). Patients with ascites showed a higher hepatic artery NOS activity than patients without ascites. Highly significant correlation was observed between cardiac output and hepatic artery NOS activity as well as between portal blood flow and hepatic artery NOS activity. CONCLUSIONS The present study demonstrates an enhanced production of nitric oxide in the splanchnic vasculature of patients with cirrhosis.
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Affiliation(s)
- L Albornoz
- Sección de Hígado, Servicio de Clínic a Medica, Hospital Italiano, Buenos Aires, Argentina
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Abstract
A shortage of liver donors for low-weight transplant recipients has prompted the development of procedures for liver-reduction, split-liver, and living related donor transplantations. For pediatric recipients weighing less than 10 kg, the left lateral segment is often still too large. We describe the procedure of monosegmental transplantation using segment II after segment III was resected in situ from a living related donor. Successful monosegmental transplantation is technically feasible and is a valid alternative to be considered for cases of size discrepancy between the recipient's volume and the donor's left lateral segment.
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Kohler HP, Boothby M, McCormack L, Knowler WC, Grant PJ. Incidence of Arg506 --> Gln mutation (factor V Leiden) in Pima Indians. Thromb Haemost 1997; 78:961-2. [PMID: 9268205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Gough S, McCormack L, Rice P, Grant P. The fibrinolytic response to exercise at diagnosis and after 12 months in patients with type 2 diabetes mellitus. ACTA ACUST UNITED AC 1994. [DOI: 10.1016/0268-9499(94)90006-x] [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: 01/17/2023]
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Gough SC, Rice PJ, McCormack L, Chapman C, Grant PJ. The relationship between plasminogen activator inhibitor-1 and insulin resistance in newly diagnosed type 2 diabetes mellitus. Diabet Med 1993; 10:638-42. [PMID: 8403825 DOI: 10.1111/j.1464-5491.1993.tb00137.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
It is not clear whether elevated levels of the fibrinolytic inhibitor, plasminogen activator inhibitor-1 (PAl-1) in Type 2 diabetes mellitus are the result of obesity or coexistent atherosclerosis. Therefore the relationship between PAl-1 and insulin resistance, determined by the homeostasis model assessment (HOMA) was investigated in a group of 26 insulin-resistant, normotensive newly diagnosed Type 2 diabetic patients with a low probability of atherosclerosis. Compared with a normal control group, closely matched for body mass index (BMI), fibrinolytic activity was depressed in the diabetic patients due to elevated levels of the inhibitor PAl-1, 17.6 (11.1-28) vs 8.4 (4.9-14.1) IU ml-1, p < 0.001. PAl-1 was related to BMI, r = 0.59, p < 0.001 plasma insulin, r = 0.66, p < 0.001; insulin resistance, r = 0.54, p < 0.005 and urinary albumin excretion, r = 0.48, p < 0.01, but not HbA1c or fasting glucose. PAl-1 was not related to blood pressure or plasma triglyceride levels. This study suggests that at the time of diagnosis of Type 2 diabetes mellitus, elevated PAl-1 levels are already linked to other risk factors for vascular disease including hyperinsulinaemia, insulin resistance, and urinary albumin excretion, and this is not the result of obesity or coexistent atherosclerosis.
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Affiliation(s)
- S C Gough
- Academic Unit of Medicine, The General Infirmary, Leeds, UK
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McCormack L, Stickland M, Grant P. Plasminogen activator inhibitor-1 antigen concentrations during insulin and oral glucose tolerance tests in obese man. ACTA ACUST UNITED AC 1993. [DOI: 10.1016/0268-9499(93)90129-j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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