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Don DM, Osterbauer B, Gowthaman D, Fisher L, Gillett ES. Polysomnographic Characteristics of Sleep Architecture in Children With Obstructive Sleep Apnea. Ann Otol Rhinol Laryngol 2024:34894241232477. [PMID: 38450648 DOI: 10.1177/00034894241232477] [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: 03/08/2024]
Abstract
BACKGROUND The conventional measure of sleep fragmentation is via polysomnographic evaluation of sleep architecture. Adults with OSA have disruption in their sleep cycles and spend less time in deep sleep stages. However, there is no available evidence to suggest that this is also true for children and published results have been inconclusive. OBJECTIVE To determine polysomnographic characteristics of sleep architecture in children with OSA and investigate effects relative to OSA severity. METHODS Overnight polysomnograms (PSG) of children referred for suspected OSA were reviewed. Subjects were classified by apnea hypopnea index (AHI). PSG parameters of sleep architecture were recorded and analyzed according to OSA severity. RESULTS Two hundred and eleven children were studied (median age of 7.0 years, range 4-10 years) Stage N1 sleep was longer while stage N2 sleep and REM sleep was reduced in the OSA group when compared to those without OSA (6.10 vs 2.9, P < .001; 42.0 vs 49.7, P < .001; 14.0 vs 15.9, P = .05). The arousal index was also higher in the OSA group (12.9 vs 8.2, P < .001). There was a reduction in sleep efficiency and total sleep time and an increase in wake after sleep onset noted in the OSA group (83.90 vs 89.40, P = .003; 368.50 vs 387.25, P = .001; 40.1 ± 35.59 vs 28.66 ± 24.14, P = .007; 29.00 vs 20.50; P = .011). No significant difference was found in N3 sleep stage (33.60 vs 30.60, P = .14). CONCLUSION We found evidence that children with OSA have a disturbance in their sleep architecture. The changes indicate greater sleep fragmentation and more time spent in lighter stages of sleep. Future research is needed and should focus on more effective methods to measure alterations in sleep architecture.
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Affiliation(s)
- Debra M Don
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Beth Osterbauer
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Divya Gowthaman
- Montefiore Medical Center Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laurel Fisher
- Caruso Department of Otolaryngology, University of Southern California, Los Angeles, CA, USA
| | - Emily S Gillett
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
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McInerney CD, Kotzé A, Bacon S, Cutting JE, Fisher L, Goldacre B, Johnson OA, Kua J, McGuckin D, Mehrkar A, Moonesinghe SR. Postoperative mortality and complications in patients with and without pre-operative SARS-CoV-2 infection: a service evaluation of 24 million linked records using OpenSAFELY. Anaesthesia 2023; 78:692-700. [PMID: 36958018 DOI: 10.1111/anae.16001] [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] [Accepted: 02/20/2023] [Indexed: 03/25/2023]
Abstract
Surgical decision-making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time-sensitive. Contemporary surgical policy to delay surgery is informed by highly heterogeneous country-specific guidance. We evaluated surgical provision in England during the COVID-19 pandemic to assess real-world practice and whether deferral remains necessary. Using the OpenSAFELY platform, we adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English NHS from 17 March 2018 to 17 March 2022. We assessed whether hospitals adhered to guidance not to operate on patients within 7 weeks of an indication of SARS-CoV-2 infection. Additional outcomes were postoperative all-cause mortality (30 days, 6 months) and complications (pulmonary, cardiac, cerebrovascular). The exposure was the interval between the most recent indication of SARS-CoV-2 infection and subsequent surgery. In any 6-month window, < 3% of surgical procedures were conducted within 7 weeks of an indication of SARS-CoV-2 infection. Mortality for surgery conducted within 2 weeks of a positive test in the era since widespread SARS-CoV-2 vaccine availability was 1.1%, declining to 0.3% by 4 weeks. Compared with the COVIDSurg study cohort, outcomes for patients in the English NHS cohort were better during the COVIDSurg data collection period and the pandemic era before vaccines became available. Clinicians within the English NHS followed national guidance by operating on very few patients within 7 weeks of a positive indication of SARS-CoV-2 infection. In England, surgical patients' overall risk following an indication of SARS-CoV-2 infection is lower than previously thought.
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Affiliation(s)
- C D McInerney
- Academic Unit of Primary Medical Care, University of Sheffield, UK
- School of Computing, University of Leeds, UK
- National Institute for Health Research Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - A Kotzé
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, UK
| | - S Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - J E Cutting
- Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucester, UK
| | - L Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - B Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - O A Johnson
- School of Computing, University of Leeds, UK
- National Institute for Health Research Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - J Kua
- Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, University College London, UK
| | - D McGuckin
- Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, University College London, UK
| | - A Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - S R Moonesinghe
- Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, University College London, UK
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Swanson MS, Gantz O, Zhou S, Fisher L, Kezirian E, Tan MH, Zhang Y, Chambers TN, Sinha UK, Kokot N. Comparison of Free Flap Outcomes at a University Hospital versus County Hospital Setting for Head and Neck Reconstruction. Int Arch Otorhinolaryngol 2023; 27:e183-e190. [PMID: 37125366 PMCID: PMC10147463 DOI: 10.1055/s-0043-1768204] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 10/25/2020] [Indexed: 05/02/2023] Open
Abstract
Introduction Patients at public county hospitals often have poorer access to healthcare with advanced disease on presentation. These factors, along with limited resources at county hospitals, may have an impact on outcomes for patients requiring complex head and neck reconstruction. Objective To delineate differences in the frequency of complications in two different care settings, a public county hospital and a private university hospital. Methods Retrospective review of otolaryngology patients at a university hospital compared with a publicly-funded county hospital. The main outcome measure was major complications including total flap loss or unplanned reoperation in 30 days. Secondary outcome measures included medical complications, partial flap loss, and unplanned hospital readmission in 30 days. Results In the county hospital sample ( n = 58) free flap failure or reoperation occurred in 20.7% of the patients, and minor complications, in 36.2% of the patients. In the university hospital sample ( n = 65) flap failure or reoperation occurred in 9.2% of the patients, and minor complications, in 12.3% of the patients. Patients at the private hospital who had surgery in the oropharynx were least likely to have minor complications. Conclusion Patients at the county hospital had a higher but not statistically significant difference in flap failure and reoperation than those at a university hospital, although the county hospital experienced more minor postoperative complications. This is likely multifactorial, and may be related to poorer access to primary care preoperatively, malnutrition, poorly controlled or undiagnosed medical comorbidities, and differences in hospital resources.
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Affiliation(s)
- Mark S. Swanson
- Tina and Rick Caruso Department of Otolaryngology, Head and Neck Surgery, University of Southern California (USC), Los Angeles, California, United States
| | - Oliver Gantz
- Tina and Rick Caruso Department of Otolaryngology, Head and Neck Surgery, University of Southern California (USC), Los Angeles, California, United States
- Address for correspondence Oliver Gantz, MD USC Tina and Rick Caruso Department of Otolaryngology – Head and Neck Surgery1540 Alcazar Street, Suite 204Q, Los Angeles, CA 90033United States
| | - Sheng Zhou
- Keck School of Medicine, University of Southern California (USC), Los Angeles, California, United States
| | - Laurel Fisher
- Tina and Rick Caruso Department of Otolaryngology, Head and Neck Surgery, University of Southern California (USC), Los Angeles, California, United States
| | - Eric Kezirian
- Tina and Rick Caruso Department of Otolaryngology, Head and Neck Surgery, University of Southern California (USC), Los Angeles, California, United States
| | - Michael H. Tan
- Keck School of Medicine, University of Southern California (USC), Los Angeles, California, United States
| | - Yanchen Zhang
- Keck School of Medicine, University of Southern California (USC), Los Angeles, California, United States
| | - Tamara N. Chambers
- Tina and Rick Caruso Department of Otolaryngology, Head and Neck Surgery, University of Southern California (USC), Los Angeles, California, United States
| | - Uttam K. Sinha
- Tina and Rick Caruso Department of Otolaryngology, Head and Neck Surgery, University of Southern California (USC), Los Angeles, California, United States
| | - Niels Kokot
- Tina and Rick Caruso Department of Otolaryngology, Head and Neck Surgery, University of Southern California (USC), Los Angeles, California, United States
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Fisher L, Ahmed O, Chalchal H, Deobald R, El-Gayed A, Graham P, Groot G, Haider K, Iqbal N, Johnson K, Le D, Mahmood S, Manna M, Meiers P, Pauls M, Salim M, Sami A, Wright P, Younis M, Ahmed S. P058 Outcomes of Rural Men With Breast Cancer: A Multicenter Population Based Retrospective Cohort Study. Breast 2023. [DOI: 10.1016/s0960-9776(23)00177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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Fisher L, Mack JM. Reducing the time of antibiotic administration to febrile neutropenic patients in the emergency room. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00186-6] [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: 01/28/2023]
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Fisher L, Polonsky WH, Perez-Nieves M, Desai U, Strycker L, Hessler D. A new perspective on diabetes distress using the type 2 diabetes distress assessment system (T2-DDAS): Prevalence and change over time. J Diabetes Complications 2022; 36:108256. [PMID: 35810147 DOI: 10.1016/j.jdiacomp.2022.108256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
AIMS To establish cut-points and thresholds for elevated diabetes distress; document change over time; and define minimal clinically important differences (MCID) using the new Type 2 Diabetes Distress Assessment System (T2-DDAS). METHODS A national sample of adults with type 2 diabetes completed the T2-DDAS CORE distress scale and the 7 T2-DDAS SOURCE distress scales at baseline and 6-months. Scores were computed separately for insulin- and non-insulin users. Spline regression models defined CORE cut-points and SEM formulas defined MCID. A rational "threshold" approach defined elevated SOURCE scores. RESULTS 471 participants (205 insulin, 266 non-insulin) completed both assessments. Analyses yielded ≥2.0 as the cut-point for both elevated CORE and elevated SOURCE. Prevalence of elevated CORE was 61.8 % (69.9 % over 6 months). Elevated SOURCE scores varied from 30.6 % (Stigma/Shame) to 76.4 % (Management); 87.5 % indicated at least 1 elevated SOURCE score. Most (77.1 %) reported multiple elevated SOURCES. 81.8 % with elevated CORE distress at baseline remained elevated at 6 months. MCID analyses yielded +/- 0.25 as significant change. Few differences between insulin- and non-insulin users occurred. CONCLUSIONS Elevated CORE distress is highly prevalent and persistent over time; most participants reported multiple SOURCES of distress. Findings highlight the need for comprehensive assessment of diabetes distress.
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Affiliation(s)
- L Fisher
- University of California, San Francisco, CA, USA.
| | - W H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA
| | | | - U Desai
- Analysis Group, Boston, MA, USA
| | - L Strycker
- Oregon Research Institute, Eugene, OR, USA
| | - D Hessler
- University of California, San Francisco, CA, USA
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Obando D, Hill J, Sharp H, Pickles A, Fisher L, Wright N. Synergy between callous-unemotional traits and aggression in preschool children: Cross-informant and cross-cultural replication in the UK Wirral Child Health and Development Study, and the Colombian La Sabana Parent-Child Study. Dev Psychopathol 2022; 34:1079-1087. [PMID: 33752771 DOI: 10.1017/s0954579420002114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Incremental prediction of aggression from callous-unemotional (CU) traits is well established, but cross-cultural replication and studies of young children are needed. Little is understood about the contribution of CU traits in children who are already aggressive. We addressed these issues in prospective studies in the United Kingdom and Colombia. In a UK epidemiological cohort, CU traits and aggression were assessed at age 3.5 years, and aggression at 5.0 years by mothers (N = 687) and partners (N = 397). In a Colombian general population sample, CU traits were assessed at age 3.5 years and aggression at 3.5 and 5.0 years by mother report (N = 220). Analyses consistently showed prediction of age-5.0 aggression by age-3.5 CU traits controlling for age-3.5 aggression. Associations between age-3.5 CU traits and age-5.0 aggression were moderated by aggression at 3.5 years, with UK interaction terms, same informant, β = .07 p = .014 cross-informant, β = .14 p = .002, and in Colombia, β = .09 p = .128. The interactions arose from stronger associations between CU traits and later aggression in those already aggressive. Our findings with preschoolers replicated across culturally diverse settings imply a major role for CU traits in the maintenance and amplification of already established aggression, and cast doubt on their contribution to its origins.
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Affiliation(s)
- D Obando
- Department of Psychology, Universidad de La Sabana, Chia, Colombia
| | - J Hill
- Department of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - H Sharp
- School of Psychology, Institute of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - A Pickles
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - L Fisher
- School of Psychology, Institute of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - N Wright
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
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Polonsky WH, Fortmann AL, Price D, Fisher L. "Hyperglycemia aversiveness": Investigating an overlooked problem among adults with type 1 diabetes. J Diabetes Complications 2021; 35:107925. [PMID: 33836966 DOI: 10.1016/j.jdiacomp.2021.107925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the problem of adults with type 1 diabetes (T1D) who purposefully keep their glucose levels low, and to explore contributors to, and possible impact of, this potentially dangerous phenomenon. METHODS We developed three self-report items as a means to identify individuals who endorse a consistent preference for hypoglycemia over hyperglycemia ("Hyperglycemia Aversives"). In a large T1D survey (n = 219), validated measures of well-being, emotional distress and hypoglycemic awareness, and glycemic metrics derived from the past 14-day period, were used to examine whether Hyperglycemia Aversives could be characterized as a distinct group. RESULTS Hyperglycemia Aversives comprised 16.4% of the sample. This unique group demonstrated significantly higher mean %TIR (71.6% vs. 63.6%) and %TBR (5.1% vs. 2.2%), lower mean %TAR > 250 mg/dL (6.0% vs. 10.1%), and higher rates of impaired hypoglycemic awareness and recurrent severe hypoglycemia episodes than the remaining study sample ("Non-Aversives") (all ps < 0.01). The two groups did not demonstrate significant differences on psychosocial outcomes. CONCLUSIONS We identified a group of T1D adults reporting a consistent preference for hypoglycemia over hyperglycemia. These individuals achieve significantly greater %TIR and less %TAR, but at the cost of greater %TBR and more frequent severe hypoglycemia episodes.
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Affiliation(s)
- W H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, United States of America; Department of Medicine, University of California, San Diego, CA, United States of America.
| | - A L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, CA, United States of America
| | - D Price
- Dexcom, Inc., San Diego, CA, United States of America
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States of America
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Polonsky WH, Fisher L, Hessler D, Liu J, Fan L, McAuliffe-Fogarty AH. Worries and concerns about hypoglycemia in adults with type 1 diabetes: An examination of the reliability and validity of the Hypoglycemic Attitudes and Behavior Scale (HABS). J Diabetes Complications 2020; 34:107606. [PMID: 32354623 DOI: 10.1016/j.jdiacomp.2020.107606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 11/26/2022]
Abstract
AIMS To examine the factor structure, validity and reliability of the Hypoglycemic Attitudes and Behavior Scale (HABS) in T1D adults (previously examined only in T2D adults), and to determine if it has unique value, after controlling for hypoglycemic fear. METHODS The original 14 HABS items were submitted to a confirmatory factor analysis (CFA) with T1D participants. Construct validity criteria included diabetes distress, generalized anxiety, well-being, hypoglycemic fear, hypoglycemia history and self-reported glycemic control. RESULTS A CFA yielded a similar 3-factor solution, with all items loading on the same factors as in the analyses with T2D adults: Hypoglycemia Anxiety, Avoidance and Confidence. Higher levels of Anxiety and Avoidance were significantly associated with poorer well-being and higher levels of generalized anxiety, diabetes distress and hypoglycemic fear, with correlations in the reverse direction for Confidence. After controls (including hypoglycemic fear), the HABS subscales were significantly linked to several criterion variables. CONCLUSIONS Though originally developed and validated with T2D adults, the HABS demonstrates sufficient validity and reliability for use with a T1D population; and it captures unique critical elements of hypoglycemic concerns. Thus, it may contribute to a greater understanding of hypoglycemia management and more targeted clinical interventions in a T1D population.
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Affiliation(s)
- W H Polonsky
- Department of Medicine, University of California, San Diego, United States of America; Behavioral Diabetes Institute, San Diego, CA, United States of America.
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States of America
| | - D Hessler
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States of America
| | - J Liu
- T1D Exchange, Boston, MA, United States of America
| | - L Fan
- Eli Lilly and Company, Lilly Diabetes, Indianapolis, IN, United States of America
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Reder L, Bertelsen C, Angajala V, O'Dell K, Fisher L. Hospitalized Patients With New-Onset Vocal Fold Immobility Warrant Inpatient Injection Laryngoplasty. Laryngoscope 2020; 131:115-120. [PMID: 32176334 DOI: 10.1002/lary.28606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/04/2020] [Accepted: 02/13/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate the impact of early inpatient bedside injection laryngoplasty (IL) in hospitalized patients with iatrogenic unilateral vocal fold immobility (UVFI). STUDY DESIGN Retrospective cohort study. METHODS A retrospective review of hospitalized patients with iatrogenic UVFI undergoing IL between September 2013 and June 2017 was performed. Patients had a swallow evaluation by a speech-language pathologist and bedside IL. Evaluated outcomes included swallow scores, return to diet, secondary events/procedures, and hospital length of stay. Outcomes related to etiology of UVFI were also examined. RESULTS The cohort consisted of 90 patients (61% male, 52% after cardiac/cardiothoracic surgery). Seventy-seven percent of all patients who could improve had increased swallow scores after IL. The lowest number (40%) from the subgroup of patients with high vagal injuries as the cause of UVFI obtained improvement in swallow scores, whereas 87% of those in the cardiac surgery group improved. There were more bronchoscopies and reintubations in patients before IL than after IL. CONCLUSION Hospitalized patients with UVFI are at increased risk of morbidity and mortality due to dysphagia. We advocate for early swallow evaluation and intervention with IL if there is dysphagia and risk of aspiration. Coordination of care between interdisciplinary teams is paramount to a successful inpatient IL program. LEVEL OF EVIDENCE 2b Laryngoscope, 131:115-120, 2021.
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Affiliation(s)
- Lindsay Reder
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Caitlin Bertelsen
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Varun Angajala
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Laurel Fisher
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
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Hessler D, Fisher L, Polonsky W, Strycker L, Parra J, Bowyer V, Dedhia M, Masharani U. There is value in treating elevated levels of diabetes distress: the clinical impact of targeted interventions in adults with Type 1 diabetes. Diabet Med 2020; 37:71-74. [PMID: 31314907 DOI: 10.1111/dme.14082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Accepted: 07/16/2019] [Indexed: 11/28/2022]
Abstract
AIM To compare the effect of targeted interventions to reduce high diabetes distress among adults with Type 1 diabetes with a comparison sample of similar but untreated individuals, and to document the stability of untreated diabetes distress over time. METHODS A total of 51 adults with Type 1 diabetes with elevated baseline diabetes distress (distress score ≥ 2.0) and HbA1c levels (≥ 58 mmol/mol) were identified from a longitudinal, non-intervention study, and compared with a similar sample of 51 participants in an intervention study. Both groups completed the T1-DDS diabetes distress questionnaire at baseline and 9 months. RESULTS Large and significant reductions in diabetes distress scores were recorded in the intervention group (mean ± sd change = -0.6 ± 0.6), while minimal change was found in the non-intervention group (-0.2 ± 0.6, group effect P = 0.002; effect size d = 0.67). Additional analyses using the established minimal clinically important difference for the T1-DDS showed that diabetes distress increased significantly (minimal clinically important difference ≥ 1) or persisted at high levels for 51% of participants in the non-intervention group, compared with 23.5% in the intervention group. CONCLUSION Our results showed that targeted interventions led to dramatic reductions in diabetes distress compared with a lack of treatment. We also conclude that elevated diabetes distress, when left unaddressed, does not resolve over time and often remains chronic. (Clinical Trials Registry no.: NCT02175732).
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Affiliation(s)
- D Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - W Polonsky
- Behavioural Diabetes Institute, Department of Psychiatry, University of California, San Diego, CA, USA
| | - L Strycker
- Oregon Research Institute, Eugene, OR, USA
| | - J Parra
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - V Bowyer
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - M Dedhia
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - U Masharani
- Department of Medicine, University of California, San Francisco, CA, USA
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Skinner T, Byrne M, Dickinson JK, Fisher L, Funnell M, Guzman S, Hendrieckx C, Hermanns N, Kanc K, Lloyd C, Mocan A, Nouwen A, Pouwer F, Saleh-Stattin N, Snoek F, Speight J, Sturt J, Vallis M, Wagner J, Willaing I, Young-Hyman D, Zoffmann V. Comment on the consensus report on the management of hyperglycaemia in Type 2 diabetes by the American Diabetes Association and the European Association for the Study of Diabetes. Diabet Med 2019; 36:911-912. [PMID: 30785642 DOI: 10.1111/dme.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T Skinner
- University of Copenhagen, Denmark
- Steno Diabetes Centre Copenhagen, Denmark
| | - M Byrne
- School of Psychology, National University of Ireland, Galway, Ireland
| | - J K Dickinson
- Diabetes Education and Management, Teachers College Columbia University, New York, NY, USA
| | - L Fisher
- Family and Community Medicine, University of California San Francisco, San Francisco, LA, USA
| | - M Funnell
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - S Guzman
- Behavioural Diabetes Institute, San Diego, CA, USA
| | - C Hendrieckx
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Deakin University, Australia
| | - N Hermanns
- Jazindiabetes, (Diabetes & Me), Slovenia
| | - K Kanc
- Forschungsinstitut Diabetes-Akademie, Bad Mergentheim, Germany
| | - C Lloyd
- Open University, Milton Keynes, UK
| | - A Mocan
- Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - A Nouwen
- Middlesex University, London, UK
| | - F Pouwer
- University of Southern Denmark, Odense, Denmark
| | | | - F Snoek
- Amsterdam UMC, Amsterdam, Netherlands
| | - J Speight
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Deakin University, Australia
| | - J Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, UK
| | - M Vallis
- Dalhousie University, Halifax, Canada
| | - J Wagner
- Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USA
| | - I Willaing
- Steno Diabetes Centre Copenhagen, Denmark
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Abstract
Addressing the emotional side of diabetes and its management has received considerable attention in recent years. At the centre of most of these efforts is the concept of 'diabetes distress', a generic term that captures the primary sources and intensity of emotional distress associated with diabetes and its management over time. As interest in diabetes distress has grown, however, it has been difficult to integrate and translate the various strands of clinical research in a manner that can guide diabetes distress intervention efforts in the real world of clinical care. The aim of this paper is to fill this gap by outlining practical strategies for intervention in clinical settings and to assist diabetes healthcare professionals in thinking through how diabetes distress might be addressed practically in their clinics. To address these goals, this review is divided into five sections: a definition of diabetes distress, ways diabetes distress can be assessed and monitored, information about diabetes distress for use in intervention planning, topics to be considered for inclusion in diabetes distress interventions, and alternatives for where in the care process a diabetes distress intervention might be considered. We focus on diabetes distress experienced by adults with both Type 1 and Type 2 diabetes.
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Affiliation(s)
- L Fisher
- Department of Family & Community Medicine, University of California, San Francisco, Ca, USA
| | - W H Polonsky
- University of California, San Diego, Behavioral Diabetes Institute, San Diego, Ca, USA
| | - D Hessler
- Department of Family & Community Medicine, University of California, San Francisco, Ca, USA
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14
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Joensen L, Fisher L, Skinner T, Doherty Y, Willaing I. Integrating psychosocial support into routine diabetes care: perspectives from participants at the Self-Management Alliance meeting 2016. Diabet Med 2019; 36:847-853. [PMID: 30315608 DOI: 10.1111/dme.13836] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Accepted: 10/11/2018] [Indexed: 01/09/2023]
Abstract
AIMS To identify challenges and solutions to integrating psychosocial support into routine diabetes care from the perspective of stakeholders with expertise in diabetes self-management education and support. METHODS Ninety-four people attended the annual international Diabetes Self-Management Alliance meeting in 2016, which included plenary sessions and workshops on self-management education, support and prevention. One workshop focused on how to integrate psychosocial support into routine diabetes care; this was run four times consecutively, allowing all conference participants to attend the workshops in groups of 20-25 people. RESULTS Challenges and solutions associated with integrating psychosocial support into routine diabetes care concern the patient-provider relationship, the healthcare system and the community. Challenges identified were: lack of time, skills and resources to deal with psychological well-being; a culture of patient blame and care expectations; the complexity of person-centred assessment of psychological issues; and the substantial healthcare system focus on productivity and biomedical indicators. Lack of involvement of local communities and of inclusion of social determinants of health were also highlighted as challenging. Solutions identified were more patient-provider dialogue; more training and better skills among care providers; system incentives for psychosocial outcomes; and targeting social determinants of health and involvement of family and peers. CONCLUSIONS From the perspective of international stakeholders with an expertise in diabetes self-management and support attending the conference in Denmark, substantial new incentives and systematic cultural changes are needed in healthcare systems to integrate psychosocial support into routine diabetes care, as recommended in international guidelines.
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Affiliation(s)
- L Joensen
- Department of Health Promotion, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - T Skinner
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Denmark
| | - Y Doherty
- Department of Psychological Medicine, York Teaching Hospitals NHS Foundation Trust, York, UK
| | - I Willaing
- Department of Health Promotion, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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15
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Kochhar A, Zhang Y, Fisher L, Byrne P, Smith SS, Ference EH. Analysis of the operative utilization of concurrent rhinoplasty and endoscopic sinus surgery. Laryngoscope 2019; 130:E311-E319. [PMID: 31077393 DOI: 10.1002/lary.28031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/25/2019] [Accepted: 04/05/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To quantify and analyze the concurrent performance of rhinoplasty (RP) (with or without septoplasty) and functional endoscopic sinus surgery (FESS). STUDY DESIGN Cross-sectional analysis. METHODS Current Procedural Terminology codes were used to extract cases of RP (n = 22,360), FESS (n = 99,173), and concurrent RP with FESS (RP + FESS) (n = 1,321) within the State Ambulatory Surgery Databases of California, Florida, Maryland, and New York from 2009 to 2011. Patient demographics, surgeon volume, charge, concurrent nasal procedures, and operating room (OR) time were compared. RESULTS Among the 1,321 RP + FESS combination cases, a majority involved primary rhinoplasty (n = 697, 52.8%), followed by nasal valve repair (n = 563, 42.6%) and revision rhinoplasty (n = 61, 4.6%). High-volume (n > 30), medium-volume (n = 10-30), and low-volume rhinoplasty surgeons (n ≤ 9) were observed to perform a similar number of FESS + RP combination surgeries (153, 152, and 155, respectively). A majority of RP + FESS involved two or fewer sinuses (65%). Mean OR time for RP + FESS was 189.4 ± 4.2 minutes, approximately 50 minutes shorter than the sum of standalone RP performed individually (138.8 ± 1.0 minutes) and standalone FESS (102.9 ± 0.4 minutes). CONCLUSIONS RP + FESS more frequently involved fewer sinuses (compared with FESS alone) and was also less likely to involve revision rhinoplasty (compared with rhinoplasty alone); therefore, these cases may be selected for lower sinus disease burden and less complex rhinoplasty compared to standalone procedures. Procedures combining rhinoplasty and sinus surgery had a reduction in OR time compared to the hypothetical sum of two standalone procedures. LEVEL OF EVIDENCE NA Laryngoscope, 130:E311-E319, 2020.
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Affiliation(s)
- Amit Kochhar
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Los Angeles, California
| | - Yanchen Zhang
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Laurel Fisher
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Los Angeles, California
| | - Patrick Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology -Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Stephanie Shintani Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Elisabeth H Ference
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Los Angeles, California
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16
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Trief PM, Fisher L, Sandberg J, Hessler DM, Cibula DA, Weinstock RS. Two for one? Effects of a couples intervention on partners of persons with Type 2 diabetes: a randomized controlled trial. Diabet Med 2019; 36:473-481. [PMID: 30485516 PMCID: PMC6408270 DOI: 10.1111/dme.13871] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Abstract
AIMS To compare the outcomes of partners who participated in a telephone couples behavioural intervention to improve glycaemic control in persons with Type 2 diabetes with those of untreated partners of participants in an individual intervention or education; to explore 'ripple effects', i.e. positive behaviour changes seen in untreated partners. METHODS The Diabetes Support Project was a three-arm randomized telephone intervention trial comparing outcomes of couples calls (CC), individual calls (IC) and diabetes education calls (DE). Couples included one partner with Type 2 diabetes and HbA1c ≥ 58 mmol/mol (7.5%). All arms received self-management education (two calls). CC and IC arms participated in 10 additional behaviour change calls. CC included partners, emphasizing partner communication, collaboration and support. Blinded assessments were performed at 4, 8 and 12 months. Partner outcomes were psychosocial (diabetes distress, relationship satisfaction, depressive symptoms), medical (BMI, blood pressure) and behavioural (fat intake, activity). RESULTS Partners' (N = 268) mean age was 55.8 years, 64.6% were female and 29.9% were from minority ethnic groups. CC (vs. IC and DE) partners had greater reductions in diabetes distress, greater increases in marital satisfaction (4 and 8 months), and some improvements in diastolic BP. There were no consistent differences among arms in other outcomes. There was no evidence of a dietary or activity behaviour ripple effect on untreated partners, i.e. comparing partners in the IC and DE arms. CONCLUSIONS A collaborative couples intervention resulted in significant improvements in partner diabetes distress and relationship satisfaction. There were no consistent effects on behavioural or medical partner outcomes, and no evidence of diet or activity behaviour ripple effects, suggesting that partners should be targeted directly to achieve these changes. (Clinical Trial Registry No: NCT01017523).
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Affiliation(s)
- P M Trief
- Department of Psychiatry & Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - L Fisher
- Department of Family Medicine, University of California, San Francisco, CA, USA
| | - J Sandberg
- School of Family Life, Brigham Young University, Provo, UT, USA
| | - D M Hessler
- Department of Family Medicine, University of California, San Francisco, CA, USA
| | - D A Cibula
- Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - R S Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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17
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Khan AJ, Pedrelli P, Shapero BG, Fisher L, Nyer M, Farabaugh AI, MacPherson L. The Association between Distress Tolerance and Alcohol Related Problems: The Pathway of Drinking to Cope. Subst Use Misuse 2018; 53:2199-2209. [PMID: 29708456 DOI: 10.1080/10826084.2018.1464027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 10/17/2022]
Abstract
Binge drinking (BD) and alcohol related problems (ARP) are highly prevalent among college students. However, current models examining ARP suggest drinking quantity only accounts for a portion of the variance, suggesting other variables contribute to ARP. Distress tolerance (DT), or the ability to withstand negative affect, is associated with alcohol misuse and may be an important mechanism related to ARP. However, studies have reported inconsistent findings on this association, which may be due to the use of only global scores to measure DT rather than specific DT components. Furthermore, the mechanisms underlying this association remain unknown. Drinking to cope with negative affect has been associated with both DT and ARP, suggesting it may be a mechanism explaining the relationship between DT and ARP. The current study examined the association between specific proposed DT components (i.e., tolerance, absorption, appraisal, and regulation) and drinking to cope and ARP in 147 college students who BD. A hierarchical linear regression was performed in order to examine which DT component best predicted ARP. Four follow-up mediation models were then tested to examine whether drinking to cope mediated the relationship between each DT component and ARP. Appraisal of DT was the only DT component that significantly predicted ARP, in the model controlling for drinking quantity and sex differences. Drinking to cope mediated the relationship between ARP and tolerance, absorption, and regulation, but not appraisal of DT. Implications for furthering our understanding of DT and treatment of BD as it relates to DT are explored.
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Affiliation(s)
- A J Khan
- a Emotion and Learning Lab, Department of Psychology , Suffolk University , Boston , Massachusetts , USA
| | - P Pedrelli
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - B G Shapero
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - L Fisher
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - M Nyer
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - A I Farabaugh
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - L MacPherson
- d Greenebaum Comprehensive Cancer Center, University of Maryland , Baltimore , Maryland , USA
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18
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Hessler DM, Fisher L, Polonsky WH, Bowyer V, Potter M. Motivation and attitudes toward changing health (MATCH): A new patient-reported measure to inform clinical conversations. J Diabetes Complications 2018; 32:665-669. [PMID: 29887299 PMCID: PMC6867057 DOI: 10.1016/j.jdiacomp.2018.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify and assess patient motivation to initiate or maintain behavior changes. METHODS Attitudinal statements were developed from structured patient interviews and translated into 18 survey items. Items were analyzed with exploratory factor analysis (EFA). RESULTS An EFA with 340 type 2 diabetes patients identified three areas of patient attitudes toward changing health behaviors: (1) willingness to make changes (3 items; α = 0.69), (2) perceived ability to make or maintain changes (3 items; α = 0.74), and (3) and feeling changes are worthwhile (3 items; α = 0.61). Greater perceived ability and feelings of worthwhileness were associated with positive psychosocial and behavioral management indicators. All three areas were associated with confidence and attitudes toward making a specific behavioral change (e.g., improve diet). CONCLUSIONS MATCH is an internally consistent and valid 9-item scale that provides a profile of factors influencing motivation that can be used in clinical and research settings.
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Affiliation(s)
- Danielle M Hessler
- Department of Family & Community Medicine, University of California-, San Francisco, United States.
| | - L Fisher
- Department of Family & Community Medicine, University of California-, San Francisco, United States
| | | | - V Bowyer
- Department of Family & Community Medicine, University of California-, San Francisco, United States
| | - M Potter
- Department of Family & Community Medicine, University of California-, San Francisco, United States
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19
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Polonsky WH, Fisher L, Hessler D. The impact of non-severe hypoglycemia on quality of life in patients with type 2 diabetes. J Diabetes Complications 2018; 32:373-378. [PMID: 29496364 DOI: 10.1016/j.jdiacomp.2018.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/26/2018] [Accepted: 01/28/2018] [Indexed: 01/08/2023]
Abstract
AIMS To determine the impact of frequency of non-severe hypoglycemic events (NSHE) and the perceived burden of NSHE on quality of life (QOL) over time. METHODS T2D adults (n = 424) were re-contacted two years after initial QOL assessment. Responding subjects (n = 290) reported the frequency and burden of NSHE over time and completed six generic and diabetes-specific QOL measures. RESULTS Most subjects (86%) reported ≥ one NSHE over time. Higher frequency of NSHE was significantly associated with decrements in QOL. Greater perceived burden of NSHE was significantly linked to decreases in QOL over time for all six QOL measures. Interaction terms indicated that participants with a higher frequency of NSHE and higher perceived burden reported the greatest decrease in QOL; participants who experienced frequent NSHE but did not perceive these events as burdensome evidenced little worsening in QOL over time. CONCLUSIONS NSHE have a negative impact on QOL over time in T2D adults. However, it is not just the occurrence of NSHE that affects QOL; it is the individual's felt burden of these events that is critical. The greatest reductions in QOL are seen among those subjects reporting a higher frequency of NSHE and indicating that such events are burdensome.
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Affiliation(s)
- W H Polonsky
- Department of Psychiatry, University of California, San Diego, USA; Behavioral Diabetes Institute, San Diego, USA.
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco
| | - D Hessler
- Department of Family and Community Medicine, University of California, San Francisco
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20
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Dennis S, Fisher L, Ware C, Giraldo C. Preliminary study of the effect of gamma irradiation on the vase life of Iridaceae Hollandica. Radiat Phys Chem Oxf Engl 1993 2018. [DOI: 10.1016/j.radphyschem.2017.12.003] [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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21
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Abstract
A wide range of diabetes-directed interventions - including novel medications, devices and comprehensive education programmes - have been shown to be effective in clinical trials. But in the real world of diabetes care their efficacy is often dependent upon on how well a clinician is able to support personal engagement and motivation of the person with diabetes to use these new tools and knowledge consistently, and as directed. Although many person-centred motivational and behavioural strategies have been developed, for example, action planning, motivational interviewing and empowerment-based communication, the sheer number and apparent lack of clear differences among them have led to considerable confusion. The primary goal of this review, therefore, is to provide a practical framework that organizes and structures these programmes to enhance their more systematic use in clinical care. Its purpose is to enhance clinician efforts to respectfully encourage and support engagement and motivation for behaviour change in people with diabetes. The three-step framework for organizing and describing the specific clinical processes involved is based on self-determination theory and includes: clinician preparation for a different type of clinical encounter, clinician/person with diabetes relationship building, and clinician utilization of specific behavioural tools. We conclude with practical considerations for application of this framework to the real world of clinical care.
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Affiliation(s)
- L Fisher
- Department of Family & Community Medicine, University of California, San Francisco
| | - W H Polonsky
- Behavioral Diabetes Institute, University of California, San Diego, USA
| | - D Hessler
- Department of Family & Community Medicine, University of California, San Francisco
| | - M B Potter
- Department of Family & Community Medicine, University of California, San Francisco
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22
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Hessler DM, Fisher L, Polonsky WH, Masharani U, Strycker LA, Peters AL, Blumer I, Bowyer V. Diabetes distress is linked with worsening diabetes management over time in adults with Type 1 diabetes. Diabet Med 2017; 34:1228-1234. [PMID: 28498610 PMCID: PMC5561505 DOI: 10.1111/dme.13381] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 12/20/2022]
Abstract
AIM To determine the cross-sectional and longitudinal associations between diabetes distress and diabetes management. METHODS In a non-interventional study, 224 adults with Type 1 diabetes were assessed for diabetes distress, missed insulin boluses, hypoglycaemic episodes, and HbA1c at baseline and 9 months. RESULTS At baseline, greater distress was associated with higher HbA1c and a greater percentage of missed insulin boluses. Longitudinally, elevated baseline distress was related to increased missed insulin boluses, and decreases in distress were associated with decreases in HbA1c . In supplementary analyses, neither depression symptoms nor a diagnosis of major depressive disorder was associated with missed insulin boluses, HbA1c or hypoglycaemic episodes in cross-sectional or longitudinal analyses. CONCLUSIONS Significant cross-sectional and longitudinal associations were found between diabetes distress and management; in contrast, no parallel associations were found for major depressive disorder or depression symptoms. Findings suggest that elevated distress may lead to more missed insulin boluses over time, suggesting a potential intervention target. The covarying association between distress and HbA1c points to the complex and likely interactive associations between these constructs. Findings highlight the need to address distress as an integral part of diabetes management in routine care.
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Affiliation(s)
- D M Hessler
- Department of Family & Community Medicine, San Francisco, USA
| | - L Fisher
- Department of Family & Community Medicine, San Francisco, USA
| | - W H Polonsky
- Behavioral Diabetes Institute, San Francisco, USA
| | - U Masharani
- Department of Medicine, University of California-San Francisco, San Francisco, USA
| | | | - A L Peters
- University of Southern California, Los Angeles, USA
| | - I Blumer
- Charles H. Best Diabetes Centre, Ontario, Canada
| | - V Bowyer
- Department of Family & Community Medicine, San Francisco, USA
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Khan S, Evans P, Fisher L. Gastrointestinal: Biliary tubulovillous adenoma. J Gastroenterol Hepatol 2017; 32:1423. [PMID: 28752689 DOI: 10.1111/jgh.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/23/2016] [Accepted: 11/17/2016] [Indexed: 12/09/2022]
Affiliation(s)
- S Khan
- Department of Gastroenterology and Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.,Department of Gastroenterology, Peninsula Health, Melbourne, Victoria, Australia
| | - P Evans
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
| | - L Fisher
- Department of Gastroenterology, Peninsula Health, Melbourne, Victoria, Australia
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Dempster N, Gajarski R, Fisher L, Missler H, Cole T, Nandi D. Psychosocial Determinants of Health in Young Heart Transplant Recipients: Thinking Outside the Box. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.272] [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: 10/19/2022] Open
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25
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Eisert C, Tai T, Fisher L, Giannotta S, Friedman R. High Volume Multidisciplinary Surgical Team Experience: Reduced Operative Times and Better Patient Outcomes. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Christian Eisert
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck USC, Los Angeles, California, United States
| | - Tymon Tai
- Keck USC School of Medicine, Los Angeles, California, United States
| | - Laurel Fisher
- Keck USC School of Medicine, Los Angeles, California, United States
| | - Steven Giannotta
- Department of Neurosurgery, Keck USC, Los Angeles, California, United States
| | - Rick Friedman
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck USC, Los Angeles, California, United States
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Silveira MSVM, Bovi TG, Oliveira PF, Pavin EJ, Fisher L. Translation and cultural adaptation into Brazilian culture of type 1 diabetes distress scale. Diabetol Metab Syndr 2017; 9:61. [PMID: 28794803 PMCID: PMC5545833 DOI: 10.1186/s13098-017-0260-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/02/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes related distress is common in type 1 diabetes patients (T1D). High levels of diabetes distress are related to poor metabolic control. An instrument to evaluate diabetes distress in T1D patients is "type 1 diabetes scale-T1DDS". The aim of this study was to translate and culturally adapt the T1DDS into Brazilian culture. METHODS T1DDS scale was translated into Portuguese. Back translation was performed and evaluated by a specialists committee. Pre-test was performed with 40 T1D outpatients at State University of Campinas hospital. Internal consistency, external consistency and re-test were performed. RESULTS 72% women, mean age: 32, 1 ± 9, 7 years, mean diabetes duration: 15, 8 ± 9, 1 years, mean scholarity: 11, 5 ± 3, 6, glycosylated hemoglobin mean: 9 ± 2%. Internal consistency: Cronbach alpha of T1DDS Brazilian version was 0.93. External consistency: Spearman's coefficient between T1DDS and PAID, Brazilian version, was 0.7781; (p < 0.0001). CONCLUSIONS The T1DDS Brazilian version is a reliable tool to evaluate diabetes distress in T1D patients in the Brazilian Population. This tool can be useful in clinical care and to identify patiens at risk and in need for psychosocial intervention.
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Affiliation(s)
- M. S. V. M. Silveira
- Internal Medicine Postgraduate Program, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences-Unicamp, Rua Vital Brasil, 251, Barão Geraldo, Campinas, São Paulo CEP: 13083970 Brazil
| | - T. G. Bovi
- Internal Medicine Postgraduate Program, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
| | - P. F. Oliveira
- Statistical Research Center, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
| | - E. J. Pavin
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences-Unicamp, Rua Vital Brasil, 251, Barão Geraldo, Campinas, São Paulo CEP: 13083970 Brazil
| | - L. Fisher
- Department of Family and Community Medicine, University of California San Francisco-UCSF, San Francisco, USA
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Affiliation(s)
- G W Judge
- Senior Scientific Officer, Department of Health and Social Security, 14 Russell Square, London WC1
| | - L Fisher
- Design Engineer, Biomechanical Research and Development Unit, Roehampton, London SW15
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28
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Fisher L, Hessler DM, Polonsky WH, Masharani U, Peters AL, Blumer I, Strycker LA. Prevalence of depression in Type 1 diabetes and the problem of over-diagnosis. Diabet Med 2016; 33:1590-1597. [PMID: 26433004 DOI: 10.1111/dme.12973] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [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] [Accepted: 09/28/2015] [Indexed: 12/19/2022]
Abstract
AIMS To determine the prevalence of depression and diabetes distress in adults with Type 1 diabetes and the rate of false-positives when compared with rates of major depressive disorder. METHODS The sample consisted of 368 individuals with Type 1 diabetes, aged > 19 years. Individuals completed: the eight-item Patient Health Questionnaire depression scale (PHQ8), which was coded using four scoring criteria (scores > 10, >12 and >15, and Diagnostic and Statistical Manual of Mental Disorders 5 (DSM) algorithm scores); the Type 1 Diabetes Distress Scale; and the Structured Clinical Interview for DSM Disorders (SCID) to assess major depressive disorder. RESULTS The prevalence rates of depression according to the eight-item Patient Health Questionnaire were: score >10, 11.4%; score >12, 7.1%; score >15, 3.8%; and positive algorithm result, 4.6%. The prevalence of major depressive disorder was 3.5%; and the prevalence of at least moderate diabetes distress was 42.1%. Depending on the criterion used, the false-positive rate when using the Patient Health Questionnaire compared with the results when using the SCID varied from 52 to 71%. Of those classified as depressed on the PHQ-8 or Structured Clinical Interview for DSM Disorders, between 92.3 and 96.2% also reported elevated diabetes distress. No significant association was found between any group classed as having depression according to the PHQ8 or the SCID and HbA1c concentration. Depression was significantly associated with more other life stress, more complications and a lower level of education. CONCLUSIONS We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false-positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology.
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Affiliation(s)
- L Fisher
- Department of Family and Community Medicine, UCSF, San Francisco, USA.
| | - D M Hessler
- Department of Family and Community Medicine, UCSF, San Francisco, USA
| | | | - U Masharani
- Department of Medicine, UCSF, San Francisco, USA
| | - A L Peters
- University of Southern California, Los Angeles, CA, USA
| | - I Blumer
- Charles H. Best Diabetes Centre, Ontario, Canada
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May PW, Clegg M, Silva TA, Zanin H, Fatibello-Filho O, Celorrio V, Fermin DJ, Welch CC, Hazell G, Fisher L, Nobbs A, Su B. Diamond-coated 'black silicon' as a promising material for high-surface-area electrochemical electrodes and antibacterial surfaces. J Mater Chem B 2016; 4:5737-5746. [PMID: 32263865 DOI: 10.1039/c6tb01774f] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This report describes a method to fabricate high-surface-area boron-doped diamond (BDD) electrodes using so-called 'black silicon' (bSi) as a substrate. This is a synthetic nanostructured material that contains high-aspect-ratio nano-protrusions, such as spikes or needles, on the Si surface produced via plasma etching. We now show that coating a bSi surface composed of 15 μm-high needles conformably with BDD produces a robust electrochemical electrode with high sensitivity and high electroactive area. A clinically relevant demonstration of the efficacy of these electrodes is shown by measuring their sensitivity for detection of dopamine (DA) in the presence of an excess of uric acid (UA). Finally, the nanostructured surface of bSi has recently been found to generate a mechanical bactericidal effect, killing both Gram-negative and Gram-positive bacteria at high rates. We will show that BDD-coated bSi also acts as an effective antibacterial surface, with the added advantage that being diamond-coated it is far more robust and less likely to become damaged than Si.
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Affiliation(s)
- P W May
- School of Chemistry, University of Bristol, Bristol BS8 1TS, UK.
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Khan S, Fisher L. Gastrointestinal: A rare case of polysplenia syndrome presenting with biliary obstruction in adulthood. J Gastroenterol Hepatol 2016; 31:1071. [PMID: 26699089 DOI: 10.1111/jgh.13276] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 12/09/2022]
Affiliation(s)
- S Khan
- Department of Gastroenterology, Peninsula Health, Frankston, Victoria, Australia
| | - L Fisher
- Department of Gastroenterology, Peninsula Health, Frankston, Victoria, Australia
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Fisher L, Lapointe AK, Gilliet M, Di Lucca-Chrisment J. Efficacité du lenalidomide (Revlimid®) dans un cas d’infiltrat lymphocytaire cutané de Jessner-Kanof réfractaire. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.285] [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]
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Polonsky WH, Fisher L, Hessler D, Edelman SV. Identifying the worries and concerns about hypoglycemia in adults with type 2 diabetes. J Diabetes Complications 2015; 29:1171-6. [PMID: 26338296 DOI: 10.1016/j.jdiacomp.2015.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/01/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
AIMS To identify the hypoglycemic concerns of adults with type 2 diabetes (T2D) and examine how these concerns are associated with key patient characteristics. METHODS Qualitative interviews with 16 T2D adults and 11 diabetes care providers were conducted. Survey items were then developed and submitted to exploratory factor analyses (EFAs). Construct validity was assessed by correlations with diabetes distress, anxiety and depressive symptoms, well-being, hypoglycemic fear, hypoglycemia history and glycemic control (A1C). RESULTS An EFA with 226 insulin users and 198 non-insulin users yielded 3 factors (14 items): Hypoglycemia Anxiety, Avoidance and Confidence. For both T2D groups, higher Anxiety and Avoidance were significantly associated with more hypoglycemia, lower well-being, and greater diabetes distress, depressive symptoms and hypoglycemic fear. Similar associations, in the converse direction, were found for Confidence. Among insulin users only, Anxiety was independently associated with greater emotional distress and more hypoglycemia, while Confidence was independently linked to less emotional distress and lower A1C. Avoidance was independently associated with greater emotional distress in both groups. CONCLUSIONS Using the new 14-item Hypoglycemic Attitudes and Behavior Scale (HABS), we found that hypoglycemic concerns are significant in T2D adults, are linked to emotional distress and A1C, and merit attention in clinical practice.
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Affiliation(s)
- W H Polonsky
- Department of Psychiatry, University of CA, San Diego, USA; Behavioral Diabetes Institute, San Diego, USA.
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco
| | - D Hessler
- Department of Family and Community Medicine, University of California, San Francisco
| | - S V Edelman
- Division of Endocrinology and Metabolism, University of California, San Diego, and Veterans Affairs Medical Center, San Diego
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Fisher L, Matthews D. PEDIATRICSB-104The Neuropathology of Disruptive Mood Dysregulation Disorder: Preliminary Hypothesis. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.199] [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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Affiliation(s)
- Laurel Fisher
- ResearchShaklee CorporationPleasantonCaliforniaUnited States
| | - Teodoro Ianiro
- ResearchShaklee CorporationPleasantonCaliforniaUnited States
| | - Francis Lau
- ResearchShaklee CorporationPleasantonCaliforniaUnited States
| | - Hong Wang
- ResearchShaklee CorporationPleasantonCaliforniaUnited States
| | - Bruce Daggy
- ResearchShaklee CorporationPleasantonCaliforniaUnited States
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Dong B, Belkhair S, Zaarour M, Fisher L, Verran J, Tosheva L, Retoux R, Gilson JP, Mintova S. Silver confined within zeolite EMT nanoparticles: preparation and antibacterial properties. Nanoscale 2014; 6:10859-10864. [PMID: 25117582 DOI: 10.1039/c4nr03169e] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The preparation of pure zeolite nanocrystals (EMT-type framework) and their silver ion-exchanged (Ag(+)-EMT) and reduced silver (Ag(0)-EMT) forms is reported. The template-free zeolite nanocrystals are stabilized in water suspensions and used directly for silver ion-exchange and subsequent chemical reduction under microwave irradiation. The high porosity, low Si/Al ratio, high concentration of sodium and ultrasmall crystal size of the EMT-type zeolite permitted the introduction of a high amount of silver using short ion-exchange times in the range of 2-6 h. The killing efficacy of pure EMT, Ag(+)-EMT and Ag(0)-EMT against Escherichia coli was studied semi-quantitatively. The antibacterial activity increased with increasing Ag content for both types of samples (Ag(+)-EMT and Ag(0)-EMT). The Ag(0)-EMT samples show slightly enhanced antimicrobial efficacy compared to that of Ag(+)-EMT, however, the differences are not substantial and the preparation of Ag nanoparticles is not viable considering the complexity of preparation steps.
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Affiliation(s)
- B Dong
- Laboratoire Catalyse & Spectrochimie, University of Caen, CNRS, 6, boulevard du Maréchal Juin, 14050 Caen Cedex, France.
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Fisher L, Ostovapour S, Kelly P, Whitehead KA, Cooke K, Storgårds E, Verran J. Molybdenum doped titanium dioxide photocatalytic coatings for use as hygienic surfaces: the effect of soiling on antimicrobial activity. Biofouling 2014; 30:911-919. [PMID: 25184432 DOI: 10.1080/08927014.2014.939959] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Titanium dioxide (TiO2) surfaces doped with molybdenum (Mo) were investigated to determine if their photocatalytic ability could enhance process hygiene in the brewery industry. Doping TiO2 with Mo showed a 5-log reduction in bacterial counts within 4 to 24 h and a 1-log reduction in yeast numbers within 72 h. The presence of a dilute brewery soil on the surface did not interfere with antimicrobial activity. The TiO2-Mo surface was also active in the dark, showing a 5-log reduction in bacteria within 4 to 24 h and a 1-log reduction in yeast numbers within 72 h, suggesting it could have a novel dual function, being antimicrobial and photocatalytic. The study suggests the TiO2-Mo coating could act as a secondary barrier in helping prevent the build-up of microbial contamination on surfaces within the brewery industry, in particular in between cleaning/disinfection regimes during long production runs.
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Affiliation(s)
- L Fisher
- a School of Healthcare Science , Manchester Metropolitan University , Manchester , UK
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Fisher L, Spencer F. Children’s Social Behaviour for Learning (SBL): reported and observed social behaviours in contexts of school and home. Soc Psychol Educ 2014. [DOI: 10.1007/s11218-014-9276-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Fisher L, Gonzalez JS, Polonsky WH. The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med 2014; 31:764-72. [PMID: 24606397 PMCID: PMC4065190 DOI: 10.1111/dme.12428] [Citation(s) in RCA: 274] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/20/2013] [Accepted: 03/04/2014] [Indexed: 01/05/2023]
Abstract
Studies have identified significant linkages between depression and diabetes, with depression associated with poor self-management behaviour, poor clinical outcomes and high rates of mortality. However, findings are not consistent across studies, yielding confusing and contradictory results about these relationships. We suggest that there has been a failure to define and measure 'depression' in a consistent manner. Because the diagnosis of depression is symptom-based only, without reference to source or content, the context of diabetes is not considered when addressing the emotional distress experienced by individuals struggling with diabetes. To reduce this confusion, we suggest that an underlying construct of 'emotional distress' be considered as a core construct to link diabetes-related distress, subclinical depression, elevated depression symptoms and major depressive disorder (MDD). We view emotional distress as a single, continuous dimension that has two primary characteristics: content and severity; that the primary content of emotional distress among these individuals include diabetes and its management, other life stresses and other contributors; and that both the content and severity of distress be addressed directly in clinical care. We suggest further that all patients, even those whose emotional distress rises to the level of MDD or anxiety disorders, can benefit from consideration of the content of distress to direct care effectively, and we suggest strategies for integrating the emotional side of diabetes into regular diabetes care. This approach can reduce confusion between depression and distress so that appropriate and targeted patient-centred interventions can occur.
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Affiliation(s)
- L Fisher
- University of California, San Francisco, San Francisco, CA
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Kong LM, Fok KC, Tsui A, Qian C, Fisher L. Peripheral T-cell lymphoma mimicking 5-aminosalicylate hypersensitivity in ulcerative colitis. Intern Med J 2014; 43:1137-40. [PMID: 24134170 DOI: 10.1111/imj.12240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 07/03/2013] [Indexed: 01/20/2023]
Abstract
5-aminosalicylates (5-ASA) remain an important strategy in the induction and maintenance of remission of inflammatory bowel diseases especially in ulcerative colitis. The prototypical drug of this class, sulfasalazine is generally well tolerated with severe hypersensitivity reactions and hepatotoxicity also described within the literature. When approaching a patient with an adverse reaction to 5-ASA, it can be difficult to differentiate clinically between a sulfa allergy versus a 5-ASA allergy versus a malignancy. We report on a case with initial signs and symptoms suggestive of a sulfa/5-ASA allergy that was subsequently found to be malignant in nature.
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Affiliation(s)
- L M Kong
- Department of Gastroenterology, Frankston Hospital, Frankston, Victoria, Australia
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Fisher L, Hessler D, Masharani U, Strycker L. Impact of baseline patient characteristics on interventions to reduce diabetes distress: the role of personal conscientiousness and diabetes self-efficacy. Diabet Med 2014; 31:739-46. [PMID: 24494593 PMCID: PMC4028368 DOI: 10.1111/dme.12403] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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] [Received: 08/27/2013] [Revised: 12/13/2013] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
Abstract
AIMS To improve patient-centred care by determining the impact of baseline levels of conscientiousness and diabetes self-efficacy on the outcomes of efficacious interventions to reduce diabetes distress and improve disease management. METHODS Adults with Type 2 diabetes with diabetes distress and self-care problems (N = 392) were randomized to one of three distress reduction interventions: computer-assisted self-management; computer-assisted self-management plus problem-solving therapy; and health education. The baseline assessment included conscientiousness and self-efficacy, demographics, diabetes status, regimen distress, emotional burden, medication adherence, diet and physical activity. Changes in regimen distress, emotional burden and self-care between baseline and 12 months were recorded and ancova models assessed how conscientiousness and self-efficacy qualified the significant improvements in distress and management outcomes. RESULTS Participants with high baseline conscientiousness displayed significantly larger improvements in medication adherence and emotional burden than participants with low baseline conscientiousness. Participants with high baseline self-efficacy showed greater improvements in diet, physical activity and regimen distress than participants with low baseline self-efficacy. The impact of conscientiousness and self-efficacy were independent of each other and occurred across all three intervention groups. A significant interaction indicated that those with both high self-efficacy and high conscientiousness at baseline had the biggest improvement in physical activity by 12 months. CONCLUSIONS Both broad personal traits and disease-specific expectations qualify the outcomes of efficacious interventions. These findings reinforce the need to change from a one-size-fits-all approach to diabetes interventions to an approach that crafts clinical interventions in ways that fit the personal traits and skills of individual people.
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Affiliation(s)
- L Fisher
- Departments of Family and Community Medicine, San Francisco, CA, USA
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Asif I, Price D, Fisher L, Zakrajsek R, Raabe J, Bejar M, Larsen L, Rao A, Harmon K, Drezner J. SCREENING FOR SUDDEN CARDIAC DEATH IN ATHLETES: THE PSYCHOLOGICAL IMPACT OF BEING DIAGNOSED WITH POTENTIALLY LETHAL DISEASE. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Matsumoto A, Angle J, Secic M, Carlson G, Fisher L, Fairman R. Secondary procedures after TEVAR in the first 3 years of the valor test and VALOR II trials. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.028] [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] Open
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Polonsky WH, Fisher L, Hessler D, Edelman SV. What is so tough about self-monitoring of blood glucose? Perceived obstacles among patients with Type 2 diabetes. Diabet Med 2014; 31:40-6. [PMID: 23819529 DOI: 10.1111/dme.12275] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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] [Accepted: 06/27/2013] [Indexed: 11/27/2022]
Abstract
AIMS To identify patient-reported obstacles to self-monitoring of blood glucose among those with Type 2, both insulin users and non-insulin users, and to investigate how obstacles are associated with frequency of self-monitoring and use of self-monitoring data. METHODS Patients with Type 2 diabetes (n = 886, 65% insulin users) who attended a 1-day diabetes education conference in cities across the USA completed a survey on current and recommended self-monitoring of blood glucose frequency, how they used self-monitoring results and perceived obstacles to self-monitoring use. Exploratory factor analysis examined 12 obstacle items to identify underlying factors. Regression analyses examined associations between self-monitoring of blood glucose use and the key obstacle factors identified in the exploratory factor analysis. RESULTS Three obstacle factors emerged: Avoidance, Pointlessness and Burden. Avoidance was the only significant independent predictor of self-monitoring frequency (β = -0.23, P < 0.001). Avoidance (β = -0.12, P < 0.01) and Pointlessness (β = -0.15, P < 0.001) independently predicted how often self-monitoring data were shared with healthcare professionals and whether or not data were used to make management adjustments (Avoidance: odds ratio = 0.74, P < 0.001; Pointlessness: odds ratio = 0.75, P < 0.01). Burden was not associated with any of the self-monitoring behavioural measures. Few differences between insulin users and non-insulin users were noted. CONCLUSIONS Obstacles to self-monitoring of blood glucose use, both practical and emotional, were common. Higher levels of Avoidance and Pointlessness, but not Burden, were associated with less frequent self-monitoring use. Addressing patients' self-monitoring-related emotional concerns (Avoidance and Pointlessness) may be more beneficial in enhancing interest and engagement with self-monitoring of blood glucose than focusing on day-to-day, behavioural issues (Burden).
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Affiliation(s)
- W H Polonsky
- Department of Psychiatry, University of California, San Diego, CA, USA; Behavioral Diabetes Institute, San Diego, CA, USA
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Choi EH, Mergener K, Semrad C, Fisher L, Cave DR, Dodig M, Burke C, Leighton JA, Kastenberg D, Simpson P, Sul J, Bhattacharya K, Charles R, Gerson L, Weber L, Eisen G, Reidel W, Vargo JJ, Wakim-Fleming J, Lo SK. A multicenter, prospective, randomized comparison of a novel signal transmission capsule endoscope to an existing capsule endoscope. Gastrointest Endosc 2013; 78:325-32. [PMID: 23664161 DOI: 10.1016/j.gie.2013.02.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 02/28/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND MiroCam, a capsule endoscope, uses a novel transmission technology, electric-field propagation, which uses the human body as a conduction medium for data transmission. OBJECTIVE To compare the ability of the MiroCam (MC) and PillCam (PC) to identify sources of obscure GI bleeding (OGIB). DESIGN Prospective, multicenter, comparative study. SETTING Six academic hospitals. PATIENTS A total of 105 patients with OGIB. INTERVENTION Patients ingested both the MC and PC capsules sequentially in a randomized fashion. MAIN OUTCOME MEASUREMENTS Concordance of rates in identifying a source of OGIB, operational times, and rates of complete small-bowel examination. RESULTS Data analysis resulted in 43 (48%) "abnormal" cases identifying a source of OGIB by either capsule. Twenty-four cases (55.8%) were positive by both capsules. There was negative agreement in 46 of 58 cases (79.3%). The κ index was 0.547 (χ(2) = 1.32; P = .36). In 12 cases, MC positively identified a source that was not seen on PC, whereas in 7 cases, PC positively identified a source that was not seen on MC. MC had a 5.6% higher rate of detecting small-bowel lesions (P = .54). MC captured images at 3 frames per second for 11.1 hours, and PC captured images at 2 frames per second for 7.8 hours (P < .0001). Complete small-bowel examination was achieved in 93.3% for MC and 84.3% for PC (P = .10). LIMITATIONS Readers were not blinded to the particular capsule they were reading. CONCLUSION A positive diagnostic finding for OGIB was identified by either capsule in 48% of cases. The concordance rate between the 2 capsules was comparable to that of prior studies in identifying sources of small-bowel bleeding. The longer operational time of the MC may result in higher rates of complete small-bowel examination, which may, in turn, translate into a higher rate of detecting small-bowel lesions. ( CLINICAL TRIAL REGISTRATION NUMBER NCT00878982.).
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Affiliation(s)
- Eric H Choi
- Division of Gastroenterology and Hepatology, Riverside Medical Clinic, Riverside, California, USA
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Ben-Menachem T, Decker GA, Early DS, Evans J, Fanelli RD, Fisher DA, Fisher L, Fukami N, Hwang JH, Ikenberry SO, Jain R, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Dominitz JA, Cash BD. Adverse events of upper GI endoscopy. Gastrointest Endosc 2012; 76:707-18. [PMID: 22985638 DOI: 10.1016/j.gie.2012.03.252] [Citation(s) in RCA: 209] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 03/20/2012] [Indexed: 12/13/2022]
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Abstract
BACKGROUND Using conscious subjects, measurement of the effects of low concentrations of anaesthetic agents can allow the dynamics of onset and offset of the agent to be measured and kinetic values estimated. However, the tests have to be rapid and preferably assess cerebral function. METHODS We used a short version of the digit symbol substitution test (DSST) that allowed frequent measurement of the impairment caused by nitrous oxide. We compared 10 min of onset and offset of breathing 5% and 30% nitrous oxide in 30% oxygen, compared with 30% oxygen only. End-tidal nitrous oxide concentrations were used to predict the concentration in a central compartment, according to a range of T(1/2) values chosen to be consistent with possible cerebral blood flow values. RESULTS We studied 19 volunteers and estimated a mean response. Only 30% nitrous oxide decreased the DSST. When DSST scores were related to the values in the predicted central compartment, the best dose-effect relationship was found when the T(1/2) was 37 s, consistent with a regional blood flow of about 120 ml 100 g(-1) min(-1). CONCLUSIONS The onset of nitrous oxide effect on DSST is rapid, consistent with the perfusion of metabolically active cerebral cortical tissues. The rate of onset is greater than previous measures based on a motor test which involved the function of subcortical structures in the central nervous system.
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Affiliation(s)
- G B Drummond
- Department of Anaesthesia and Pain Medicine, University of Edinburgh, Royal Infirmary, 51 Little France Crescent, Edinburgh, UK.
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Saifee TA, Kassavetis P, Pareés I, Kojovic M, Fisher L, Morton L, Foong J, Price G, Joyce EM, Edwards MJ. Inpatient treatment of functional motor symptoms: a long-term follow-up study. J Neurol 2012; 259:1958-63. [DOI: 10.1007/s00415-012-6530-6] [Citation(s) in RCA: 35] [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: 01/24/2012] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
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Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T, Cash BD, Decker GA, Early DS, Fanelli RD, Fisher DA, Fukami N, Hwang JH, Ikenberry SO, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Shergill AK, Dominitz JA. Complications of ERCP. Gastrointest Endosc 2012. [PMID: 22341094 DOI: 10.1016/j.gie.2011.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T, Cash BD, Decker GA, Early DS, Fanelli RD, Fisher DA, Fukami N, Hwang JH, Ikenberry SO, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Shergill AK, Dominitz JA. Complications of ERCP. Gastrointest Endosc 2012; 75:467-73. [PMID: 22341094 DOI: 10.1016/j.gie.2011.07.010] [Citation(s) in RCA: 279] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 07/11/2011] [Indexed: 12/11/2022]
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